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Intensity Modulated Radiotherapy

Biochemical Control and Toxicity after Intensity-Modulated Radiation Therapy for Prostate Cancer (201-206)

Intensity modulated radiation therapy (IMRT) has achieved widespread use for prostate cancer; however, in relation to this use, outcomes studies are still relatively sparse. We report a single-institutional experience in outcomes analysis with the use of IMRT for the primary management of prostate cancer. One hundred thirty consecutive patients with adenocarcinoma of the prostate were treated at a single institution using IMRT with curative intent. Thirty-six (28%) patients were classified as low-risk, 69 (53%) as intermediate-risk, and 25 (19%) as high-risk. The median dose prescription was 76 Gy to the planning target volume. Sixty-five (50%) patients received androgen deprivation therapy (ADT) for a median 4 months, starting 2 months prior to IMRT. Biochemical failure was defined as PSA > post-treatment nadir+2. Gastrointestinal (GI) and Genitourinary (GU) toxicity were defined by RTOG criteria. Median follow-up was 53 months. By NCCN risk category, 4-year biochemical control was 97%, 94%, and 87% for low, intermediate, and high-risk patients, respectively. Among disease factors, multivariable analysis demonstrated the strongest association between biochemical control and Gleason score ≤6 (p=0.0371). Therapy was well tolerated with no Grade 4 toxicity and limited grade 3 GI or GU toxicity. Acute Grade 3+ GI and GU toxicity rates were 0% and 2%, and maximal late Grade 3+ GI and GU toxicity rates were 5% and 6%, respectively. Late rectal toxicity was associated with higher volumes of RT to the rectum. By last follow-up late Grade 3+ toxicity was 2% for both GI and GU systems. In conclusion, patients treated with IMRT for prostate cancer have excellent rates of biochemical control and low rates of severe toxicity of treatment.

Key words: Prostate cancer; Radiation therapy (RT); Intensity modulated RT (IMRT); Outcomes.

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TCRT June 2009

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Volume 8
No. 3 (p 177-248)
June 2009
ISSN 1533-0338

Stanley L. Liauw, MD1,*
Ralph R. Weichselbaum, MD1
Carla Rash, CMD1
David Correa, BS1
Hania A. Al-Hallaq, PhD1
Charles A. Pelizzari, PhD1
Ashesh B. Jani, MD, MSEE2

1Dept of Radiation and Cellular Oncology
University of Chicago
5758 S. Maryland Ave, MC 9006
Chicago, IL 60637, USA
2Dept of Radiation Oncology
Emory University
1365 Clifton Road, NE, Suite A1300
Atlanta, GA 30322, USA