Phase i trial of pelvic nodal dose escalation with hypofractionated IMRT for high-risk prostate cancer

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

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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 5 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.

Original languageEnglish (US)
Pages (from-to)184-190
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number1
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

toxicity
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
dosage
grade
Prostate
Cautery
Radiation Oncology
deprivation
bleeding
terminology
Terminology
Androgens
schedules
Prescriptions
Appointments and Schedules
resources
Hemorrhage

Keywords

  • Bowel displacement board
  • Hypofractionated radiation therapy
  • Image-guided prostate intensity-modulated radiation therapy
  • Pelvic lymph node dose escalation
  • Rectal balloon

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Adkison, J. B., McHaffie, D. R., Bentzen, S. M., Patel, R. R., Khuntia, D., Petereit, D. G., ... Ritter, M. A. (2012). Phase i trial of pelvic nodal dose escalation with hypofractionated IMRT for high-risk prostate cancer. International Journal of Radiation Oncology Biology Physics, 82(1), 184-190. https://doi.org/10.1016/j.ijrobp.2010.09.018

Phase i trial of pelvic nodal dose escalation with hypofractionated IMRT for high-risk prostate cancer. / Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Søren M.; Patel, Rakesh R.; Khuntia, Deepak; Petereit, Daniel G.; Hong, Theodore S.; Tome, Wolfgang A.; Ritter, Mark A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 1, 01.01.2012, p. 184-190.

Research output: Contribution to journalArticle

Adkison, Jarrod B. ; McHaffie, Derek R. ; Bentzen, Søren M. ; Patel, Rakesh R. ; Khuntia, Deepak ; Petereit, Daniel G. ; Hong, Theodore S. ; Tome, Wolfgang A. ; Ritter, Mark A. / Phase i trial of pelvic nodal dose escalation with hypofractionated IMRT for high-risk prostate cancer. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 1. pp. 184-190.
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AU - Bentzen, Søren M.

AU - Patel, Rakesh R.

AU - Khuntia, Deepak

AU - Petereit, Daniel G.

AU - Hong, Theodore S.

AU - Tome, Wolfgang A.

AU - Ritter, Mark A.

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N2 - 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 5 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.

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KW - Pelvic lymph node dose escalation

KW - Rectal balloon

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