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Toxicity and outcome of pelvic IMRT for node-positive prostate cancer

Nebenwirkungen und Ergebnisse einer Becken-IMRT nodal-positiver Prostatakarzinome

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Abstract

Background and purpose

This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).

Patients and methods

Pelvic IMRT to 45–50.4 Gy was applied in 39 cases either after previous surgery of involved lymph nodes (n = 18) or with a radiation boost to suspicious nodes (n = 21) with doses of 60–70 Gy, usually combined with androgen deprivation (n = 37). The prostate and seminal vesicles received 70–74 Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66–70 Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.

Results

Acute radiation-related toxicity higher than  grade 2 occurred in 2 patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1–2) after a median follow-up of 70 months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over  5 years.

Conclusion

Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.

Zusammenfassung

Hintergrund

Diese Studie beschreibt Behandlungstechniken, Nebenwirkungen und Ergebnisse einer intensitätsmodulierten Bestrahlung (IMRT) des Beckens bei lymphonodal-positiven Prostatakarzinomen (LNPPC, T1–4, c/pN1 cM0).

Material und Methoden

Eine Becken-IMRT bis 45–50,4 Gy wurde bei 39 Patienten entweder nach chirurgischer Entfernung histologisch befallener Lymphknoten (n = 18) oder mit einem IMRT-Boost auf klinisch befallene Lymphknoten (n = 21) bis 60–70 Gy durchgeführt und mit einer antihormonellen Langzeittherapie (n = 37) kombiniert. Prostata und Samenblasen erhielten 70–74 Gy, nach radikaler Prostatektomie wurde die Prostataloge ggf. mit residuellen Samenblasenanteilen bis 66–70 Gy bestrahlt. Akute und späte Nebenwirkungen wurden nach den Kriterien der Radiation Therapy Oncology Group (RTOG) erfasst.

Ergebnisse

Akutnebenwirkungen ≥ Grad 2 traten bei 2 Patienten auf (Blasenkatheteranlage, Subileus aufgrund von postoperativen Adhäsionen). Die Spätnebenwirkungen nach einer medianen Nachsorgedauer von 70 Monaten waren mild (Grad 1–2). Über die Hälfte der Patienten berichtete über keine postradiogenen Spätnebenwirkungen (Grad 0). Die biochemische Kontrolle und das krebsspezifische Überleben erreichten Werte von 67% und 97% nach > 5 Jahren.

Schlussfolgerung

Die Becken-IMRT nach Entfernung befallener Lymphknoten oder mit Boost klinisch befallener Lymphknoten war mit akzeptablen Spätnebenwirkungen (kein Grad 3 oder 4) verbunden, sodass eine Evaluation dieses Vorgehens in einem größeren Kollektiv gerechtfertigt ist.

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Acknowledgements

The authors acknowledge the assistance of Silke Theden in the data management, and the assistance of Bettina Frey in generating treatment plans.

Conflict of interest

On behalf of all authors, the corresponding author states that are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiooncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    A.-C. Müller, J. Lütjens, F. Eckert & M. Bamberg

  2. Department of Medical Physics, Eberhard Karls University, Tübingen, Germany

    M. Alber

  3. Department of Urology, Eberhard Karls University, Tübingen, Germany

    D. Schilling

  4. Department of Radiation Oncology, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany

    C. Belka & U. Ganswindt

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  1. A.-C. Müller
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  3. M. Alber
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Correspondence to A.-C. Müller.

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Müller, AC., Lütjens, J., Alber, M. et al. Toxicity and outcome of pelvic IMRT for node-positive prostate cancer. Strahlenther Onkol 188, 982–989 (2012). https://doi.org/10.1007/s00066-012-0169-1

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  • DOI: https://doi.org/10.1007/s00066-012-0169-1

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