PURPOSE: The goal of this project was to see if using IMRT to deliver elective pelvic nodal irradiation (EPNI) for prostate cancer reduced acute treatment toxicity.
METHODS: Two hundred and thirty patients were enrolled into prospective trials delivering EPNI with a concomitant hypofractionated IMRT boost to the prostate. During accrual, the method of EPNI delivery changed as new literature emerged. Three methods were used (1) 4FB, (2) IMRT with 2cm CTV margins around the pelvic vessels as suggested by Shih et al. (2005) [7] (IMRT-Shih), and (3) IMRT with nodal volumes suggested by the RTOG (IMRT-RTOG). Initially patients were treated with an empty bladder, with the remainder treated with bladder full.
RESULTS: Patients in the 4FB group had higher rates of grade 2 acute GI toxicities compared to the IMRT-Shih and IMRT-RTOG groups (31.9% vs 20.8% vs 7.2%, p=0.0009). Patients in the 4FB group had higher rates of grade 3 urinary frequency compared to the two IMRT groups (8.5% vs 0% vs 0%, p=0.027). However, multivariate analysis suggested the factor that most influenced toxicity was bladder filling followed by IMRT.
CONCLUSIONS: Bladder filling appeared to be the dominant factor which predicted for acute toxicity, followed by the use of IMRT.
Written by:
Jain S, Loblaw DA, Morton GC, Danjoux C, Szumacher E, Chu W, Chung HT, Vesprini D, Sahgal A, Zhang L, Deabreu A, Cheung PC. Are you the author?
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Reference: Radiother Oncol. 2012 Nov;105(2):193-7.
doi: 10.1016/j.radonc.2012.09.020
PubMed Abstract
PMID: 23182057
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