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Target Localization and Toxicity in Dose-Escalated Prostate Radiotherapy with Image-Guided Approach using Daily Planar Kilovoltage Imaging (31-37)

Dose escalation with intensity-modulated radiation therapy (IMRT) for carcinoma of the prostate has augmented the need for accurate prostate localization prior to dose delivery. Daily planar kilovoltage (kV) imaging is a low-dose image-guidance technique that is prevalent among radiation oncologists. However, clinical outcomes evaluating the benefit of daily kV imaging are lacking. The purpose of this study was to report our clinical experience, including prostate motion and gastrointestinal (GI) and genitourinary (GU) toxicities, using this modality. A retrospective analysis of 100 patients treated consecutively between December 2005 and March 2008 with definitive external beam IMRT for T1c-T4 disease were included in this analysis. Prescription doses ranged from 74-78 Gy (median, 76) in 2 Gy fractions and were delivered following daily prostate localization using on-board kV imaging (OBI) to localize gold seed fiducial markers within the prostate. Acute and late toxicities were graded as per the NCI CTCAEv3.0. The median follow-up was 22 months. The magnitude and direction of prostate displacement and daily shifts in three axes are reported. Of note, 9.1% and 12.9% of prostate displacements were ≥ 5 mm in the anterior-posterior and superior-inferior directions, respectively. Acute grade 2 GI and GU events occurred in 11% and 39% of patients, respectively, however no grade 3 or higher acute GI or GU events were observed. Regarding late toxicity, 2% and 17% of patients developed grade 2 toxicities, and similarly no grade 3 or higher events had occurred by last follow-up. Thus, kV imaging detected a substantial amount of inter-fractional displacement and may help reduce toxicity profiles, especially high grade events, by improving the accuracy of dose delivery.

Key words: Acute toxicity; Image guided radiotherapy; Late toxicity; On-board imaging; Prostate cancer.

This article can be cited as: Nath, S. K., Sandhu, A. P., Sethi, R. A., Jensen, L. G., Rosario, M. D., Kane, C.J., Parsons, J. K., Millard, F. E., Jiang, S. B., Rice, R. K., Pawlicki, T., Mundt, A. J., Target Localization and Toxicity in Dose-Escalated Prostate Radiotherapy with Image-Guided Approach using Daily Planar Kilovoltage Imaging. Technol Cancer Res Treat. 10, 31-37 (2011). DOI: 10.7785/tcrt.2012.500177

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Received: April 20, 2010; Revised: August 12, 2010; Accepted: August 20, 2010

TCRT February 2011

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Volume 10
No. 1 (1-100)
February 2011
ISSN 1533-0338

DOI: 10.7785/tcrt.2012.500177

S. K. Nath, M.D., MAS1,4
A. P. Sandhu, M.D., DMRT1*
R. A. Sethi, M.D.1
L. G. Jensen, BA1,4
M. D. Rosario, M.D.1
C. J. Kane, M.D.2
J. K. Parsons, M.D.2
F. E. Millard, M.D.3
S. B. Jiang, Ph.D.1,4
R. K. Rice, Ph.D.1
T. Pawlicki, Ph.D.1
A. J. Mundt, M.D.1,4

1Departments of Radiation Oncology 2Surgery, Division of Urologic Oncology
3Medicine, Division of Hematology and Oncology Moores Comprehensive Cancer Center
4Center for Advanced Radiotherapy Technologies University of California San Diego 3855 Health Sciences Drive, #0843 La Jolla, CA 92093-0843, USA

Presented in part at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), Boston, MA, September 2008.