High-dose intensity-modulated radiation therapy as primary treatment of prostate cancer: genitourinary/gastrointestinal toxicity and outcomes, a single-institution experience
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Prostatectomy, radiotherapy and watchful waiting are the main therapeutic options available for local stage of prostate cancer (PCa). We report our experience on 394 patients affected by prostate cancer primarily treated with high-dose, image-guided, IMRT, focusing on gastrointestinal, genitourinary toxicities and biochemical control.
From July 2003 to August 2014, 394 patients were treated with radical high-dose radiotherapy (HDRT) for prostate cancer; the mean total radiation dose was 79 Gy in standard fractions. Hormonal therapy (HT) was administered to 7.6% of low-risk patients, to 20.3% of intermediate-risk patients and to 72% of high-risk patients. Patients were evaluated for biochemical failure, local recurrence (LR) and metastases.
Ninety-seven patients (26.65%) developed acute GU toxicity at the medium dose of 25.4 Gy, grade 1 (G1) or grade 2 (G2) in 94 cases. Only 16 patients (4.06%) reported chronic GU toxicity (G1 or G2), and one case developed G3 cystitis. No G3 GI acute and late toxicity were detected. Fifty-six (14.2%) patients experienced LR, 26 (6.6%) developed metastases and 70 patients (17.8%) were deceased. Gleason sum score > 7 was predictive for worse overall survival (GS = 7 was borderline) and for metastasis. No factors resulted predictive for local relapse. HT pre-RT had been demonstrated as a negative predictor for OS and DFS-DM.
Data confirm the safety of HDRT for PCa. Treatment was efficient with low toxicity profile. Moreover, continued technologic advancements, as image-guided radiotherapy, could lead to further reduction in toxicity, thus increasing the therapeutic index.
KeywordsProstate cancer Intensity-modulated radiation therapy (IMRT) Genitourinary toxicity Gastrointestinal toxicity
Compliance with ethical standards
Conflict of interest
We declare that the absence of conflict of interest and financial relationships relevant to the content of this article have been disclosed by all authors. Our original article and our experience were not funded by an agency with a proprietary or financial interest. We had full access to all data in this study, and we take complete responsibility for the integrity of the data and the accuracy of the data analysis.
Research involving human participants
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and its later amendments or comparable ethical standards. For our retrospective study, formal consent is not required.
All authors declare that informed consent was obtained from all individual participants included in the study and to have used adequate strategies for protecting anonymity. Therefore, all patients gave the permission for manuscript to be published and their personal identifiers have been removed so as not to be identified; all patients cannot be identified through the details of the story.
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