Hypofractionated Prostate Radiotherapy with or without Conventionally Fractionated Nodal Irradiation: Clinical Toxicity Observations and Retrospective Daily Dosimetry

McDonald, Andrew M.; Bishop, Justin M.; Jacob, Rojymon; Dobelbower, Michael C.; Kim, Robert Y.; Yang, Eddy S.; Smith, Heather; Xingen Wu; Fiveash, John B.
January 2012
Prostate Cancer (20903111);2012, p1
Academic Journal
Purpose. To evaluate toxicity associated with the addition of elective nodal irradiation (ENI) to a hypofractionated regimen for the treatment of prostate cancer. Methods and Materials. Fifty-seven patients received pelvic image-guided IMRT to 50.4Gy in 28 fractions with a hypofractionated simultaneous boost to the prostate to 70Gy. Thirty-one patients received prostate-only treatment to 70Gy in 28 fractions. Results. Median followup was 41.1 months. Early grade =2 urinary toxicity rates were 49% (28 of 57) for patients receiving ENI and 58% (18 of 31) for those not (P = 0.61). Early grade =2 rectal toxicity rates were 40% (23 of 57) and 23% (7 of 31), respectively (P = 0.09). The addition of ENI resulted in a 21% actuarial rate of late grade =2 rectal toxicity at 4 years, compared to 0% for patients treated to the prostate only (P = 0.02). Retrospective daily dosimetry of patients experiencing late rectal toxicity revealed an average increase of 2.67% of the rectal volume receiving 70Gy compared to the original plan. Conclusions. The addition of ENI resulted in an increased risk of late rectal toxicity. Grade =2 late rectal toxicity was associated with worse daily rectal dosimetry compared to the treatment plan.


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