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 Tomé, Mark A. Ritter

Research output: Contribution to journalArticle

41 Scopus citations

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
Publication statusPublished - Jan 1 2012
Externally publishedYes

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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

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • 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