Dosimetry and acute toxicity in prostate cancer patients treated with image-guided intensity modulated radiotherapy: Preliminary results in the first 100 men

Abstract

OBJECTIVES We aimed to analyze the dosimetric criteria and preliminary acute toxicity in the first 100 men treated with image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer. METHODS For image guidance, three fiducial gold markers were implanted in each patient under transurethral ultrasound guidance. According to the risk group classification, prostate and/or seminal vesicles and/or pelvic lymph nodes were defined as the clinical target volume. A median of 76 Gy (range, 74-78 Gy) was delivered to the planning target volume. The patients were evaluated once a week during the treatment and one month after the completion of the treatment. Acute toxicity was scored according to the RTOG scoring system. RESULTS Acute grade 2 gastrointestinal (GI) toxicity was observed in 9% of the patients, acute grade 2 genitourinary (GU) toxicity in 65%, and grade 3 GU toxicity in 1% of the patients. No breaks were given except for the patient with grade 3 GU toxicity. Logistic linear regression analysis revealed maximum rectal dose as a predisposing factor for the acute GI toxicity and previous history of transurethral resection (TUR) for the acute grade 2 and greater GU toxicity. CONCLUSION IG-IMRT is a safe method for dose escalation in localized prostate cancer, and is tolerated well by the patients.

Keywords

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Görüntü rehberliğinde yoğunluk ayarlı radyoterapi uygulanan prostat kanserli olgularda dozimetri ve akut toksisite: İlk 100 olguda erken sonuçlar

Öz

AMAÇ Lokalize prostat kanseri olgularında uygulanan görüntü rehberliğinde yoğunluk ayarlı radyoterapinin (YART) dozimetrik ölçütlerini ve erken dönem akut yan etkilerini araştırmak amacıyla ilk 100 olgunun dosyaları retrospektif olarak incelendi. GEREÇ VE YÖNTEM Görüntü rehberliği amacıyla her olguda prostat içersine transüretral ultrason eşliğinde üç adet altın marker yerleştirildi, her tedavi öncesi bu markerların lokalizasyonu verifiye edildikten sonra radyoterapi uygulandı. Olguların risk gruplarına göre prostat +/- seminal veziküller +/- pelvik lenf nodları klinik hedef volüme dahil edildi. Hedef volüme ortanca 76 Gy (aralık, 74-78 Gy) radyoterapi uygulandı. Tedavi sonrası en az üç ay takip edilen olgular tedavi sırasında her hafta, tedavi sonrasında da 1. ayda akut toksisite açısından değerlendirildi ve akut yan etkiler RTOG skorlamasına göre derecelendirildi. BULGULAR Olguların %9'unda grad 2 gastrointestinal (Gİ), %65'inde grad 2 genitoüriner (GÜ), %1'inde de grad 3 GÜ akut yan etki görüldü. Grad 3 yan etki gelişen olgu dışında hiçbir olgunun tedavisine ara verilmedi. Yapılan lojistik regresyon analizinde rektumun aldığı maksimum dozun akut Gİ yan etki gelişmesinde, TUR uygulamasının da akut grad 2 ve üzeri GÜ yan etki gelişiminde predispozan faktör olduğu gözlendi. SONUÇ Görüntü rehberliğinde yapılan YART doz yükseltilmesi için güvenilir bir yöntemdir ve erken dönemde olgular tarafından çok iyi tolere edilmektedir.

Anahtar Kelimeler

• Prostat kanseri, görüntü rehberliği, yoğunluk ayarlı radyoterapi, toksisite

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