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Dose escalation using ultra-high dose IMRT in intermediate risk prostate cancer without androgen deprivation therapy: preliminary results of toxicity and biochemical control

Maria Grazia Petrongari1*, Valeria Landoni2, Biancamaria Saracino1, Sara Gomellini1, Stefano Arcangeli1, Giuseppe Iaccarino2, Paola Pinnarò1, Giorgio Arcangeli1 and Lidia Strigari2

Author Affiliations

1 Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy

2 Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy

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Journal of Experimental & Clinical Cancer Research 2013, 32:103  doi:10.1186/1756-9966-32-103

Published: 13 December 2013

Abstract

Background

To investigate the feasibility of dose escalation (86 Gy at 2 Gy/fraction) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer without androgen deprivation therapy.

Methods

Patients with histologically proven adenocarcinoma of the prostate, intermediate prognostic category, were enrolled in this study. Early and late toxicity were scored according to the Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. Treatment outcome was stated in terms of biochemical failure, biopsy result and clinical failure.

Results

39 patients with a median follow-up of 71 months were analyzed. No patient experienced G3 or G4 acute gastrointestinal (GI) or genitourinary (GU) toxicity. G2 acute GI and GU toxicity were observed in 17 (44%) and 20 (51%) patients, respectively. Fourteen patients (36%) did not experience acute GI toxicity and 4 patients (10%) did not experience acute GU toxicity. G2 late GI bleeding occurred in 7 of 39 patients (18%). Both G3 and G4 late GI toxicity were seen only in one patient (2.5%). Two patients (5%) experienced G2 late GU toxicity, while G3 late GU toxicity occurred in 3 patients (8%). The 5-year actuarial freedom from biochemical failure (FFBF) was 87%. Thirty-four patients (87%) did not show biochemical relapse. Seventeen patients (44%) underwent biopsy two year after radiotherapy; of these only two were non-negative and both did not show evidence of biochemical disease.

Conclusions

IMRT treatment of patients with localized intermediate-risk prostate cancer at high dose levels without using androgen deprivation therapy (ADT) seems to give good disease control. Nevertheless, future trials should aim at further decreasing toxicity by exploiting image guidance techniques and by reducing the dose delivered at the interface between organs at risk and prostate.

Keywords:
Prostate cancer; Intermediate risk; Dose escalation; Absence of ADT; Toxicity; Outcome