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Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

Adkison, Jarrod B., M.D ; McHaffie, Derek R., M.D ; Bentzen, Søren M., Ph.D ; Patel, Rakesh R., M.D ; Khuntia, Deepak, M.D ; Petereit, Daniel G., M.D ; Hong, Theodore S., M.D ; Tomé, Wolfgang, Ph.D ; Ritter, Mark A., M.D., Ph.D

International journal of radiation oncology, biology, physics, 2012-01, Vol.82 (1), p.184-190 [Peer Reviewed Journal]

New York, NY: Elsevier Inc

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Title:
Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer
Author: Adkison, Jarrod B., M.D ; McHaffie, Derek R., M.D ; Bentzen, Søren M., Ph.D ; Patel, Rakesh R., M.D ; Khuntia, Deepak, M.D ; Petereit, Daniel G., M.D ; Hong, Theodore S., M.D ; Tomé, Wolfgang, Ph.D ; Ritter, Mark A., M.D., Ph.D
Subjects: Adenocarcinoma - drug therapy ; Adenocarcinoma - radiotherapy ; Adenocarcinoma - secondary ; Aged ; Aged, 80 and over ; Androgen Antagonists - therapeutic use ; ANDROGENS ; BALLOONS ; Biological and medical sciences ; Bowel displacement board ; Dose Fractionation ; FAILURES ; Follow-Up Studies ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Tract - radiation effects ; Gonadotropin-Releasing Hormone - agonists ; Gynecology. Andrology. Obstetrics ; HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; Hypofractionated radiation therapy ; Image-guided prostate intensity-modulated radiation therapy ; LYMPH NODES ; Lymphatic Irradiation - adverse effects ; Lymphatic Irradiation - methods ; Lymphatic Metastasis ; Male ; Male genital diseases ; Medical sciences ; Middle Aged ; NEOPLASMS ; Nephrology. Urinary tract diseases ; PATIENTS ; Pelvic lymph node dose escalation ; Pelvis ; Prospective Studies ; PROSTATE ; Prostatic Neoplasms - drug therapy ; Prostatic Neoplasms - radiotherapy ; RADIATION DOSES ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy, Image-Guided - adverse effects ; Radiotherapy, Image-Guided - methods ; Radiotherapy, Intensity-Modulated - methods ; Rectal balloon ; RECTUM ; Rectum - radiation effects ; TOXICITY ; Tumors ; Tumors of the urinary system ; Urinary tract. Prostate gland ; Urogenital System - radiation effects
Is Part Of: International journal of radiation oncology, biology, physics, 2012-01, Vol.82 (1), p.184-190
Description: Purpose Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5½ weeks. Methods and Materials Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results The median follow-up time was 25.4 months (range, 4.2–57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose–volume descriptors correlated with GU toxicity, and only the volume of bowel receiving ≥30 Gy correlated with early GI toxicity ( p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 ± 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose escalation may be an option in any future exploration of potential benefits of pelvic radiation therapy in high-risk prostate cancer patients.
Publisher: New York, NY: Elsevier Inc
Language: English

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Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

Adkison, Jarrod B., M.D ; McHaffie, Derek R., M.D ; Bentzen, Søren M., Ph.D ; Patel, Rakesh R., M.D ; Khuntia, Deepak, M.D ; Petereit, Daniel G., M.D ; Hong, Theodore S., M.D ; Tomé, Wolfgang, Ph.D ; Ritter, Mark A., M.D., Ph.D

New York, NY: Elsevier Inc

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