Ashesh B Jani1, Andy Su, Michael T Milano. 1. Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA. jani@rover.uchicago.edu
Abstract
OBJECTIVES: To provide a single-institution analysis of the influence of pelvic intensity-modulated radiotherapy (RT) on acute genitourinary (GU) and gastrointestinal (GI) toxicity. METHODS: The records of 610 consecutive patients with prostate cancer receiving RT were reviewed. Of these 610 patients, 49 had received a prostate boost preceded by pelvic RT (PRT), 15 intensity-modulated PRT (IM-PRT), and 34 four-field PRT (4F-PRT). The dosimetric endpoints for the bladder, rectum, and target for the PRT plans were compared using the paired t test; similar dosimetric analyses were done for the composite plans. Acute GU and GI toxicity were compared using the chi-square test. Ordered logit regression analyses were performed using all major treatment factors as covariates. RESULTS: The bladder and rectum dosimetric endpoints were improved for IM-PRT compared with 4F-PRT for the PRT portion of the treatment plan (P = 0.06 and P = 0.03, respectively) and for the composite treatment plan (P = 0.04 and P = 0.01, respectively), at the expense of greater target inhomogeneity in the PRT portion of the treatment plan (P < 0.01). GU toxicity was significantly lower in the IM-PRT group (P < 0.001), and GI toxicity was similar in both groups (P = 0.637). The regression analyses showed that intensity-modulated RT for the pelvic portion of treatment was the only factor significantly predicting for GU toxicity (P = 0.05); no major treatment factor reached significance in predicting GI toxicity. CONCLUSIONS: Compared with 4F-PRT, the use of IM-PRT improved dosimetric outcomes, was not associated with a reduction in acute GI toxicity, and was associated with a reduction in acute GU toxicity in the treatment of prostate cancer.
OBJECTIVES: To provide a single-institution analysis of the influence of pelvic intensity-modulated radiotherapy (RT) on acute genitourinary (GU) and gastrointestinal (GI) toxicity. METHODS: The records of 610 consecutive patients with prostate cancer receiving RT were reviewed. Of these 610 patients, 49 had received a prostate boost preceded by pelvic RT (PRT), 15 intensity-modulated PRT (IM-PRT), and 34 four-field PRT (4F-PRT). The dosimetric endpoints for the bladder, rectum, and target for the PRT plans were compared using the paired t test; similar dosimetric analyses were done for the composite plans. Acute GU and GI toxicity were compared using the chi-square test. Ordered logit regression analyses were performed using all major treatment factors as covariates. RESULTS: The bladder and rectum dosimetric endpoints were improved for IM-PRT compared with 4F-PRT for the PRT portion of the treatment plan (P = 0.06 and P = 0.03, respectively) and for the composite treatment plan (P = 0.04 and P = 0.01, respectively), at the expense of greater target inhomogeneity in the PRT portion of the treatment plan (P < 0.01). GU toxicity was significantly lower in the IM-PRT group (P < 0.001), and GI toxicity was similar in both groups (P = 0.637). The regression analyses showed that intensity-modulated RT for the pelvic portion of treatment was the only factor significantly predicting for GU toxicity (P = 0.05); no major treatment factor reached significance in predicting GI toxicity. CONCLUSIONS: Compared with 4F-PRT, the use of IM-PRT improved dosimetric outcomes, was not associated with a reduction in acute GI toxicity, and was associated with a reduction in acute GU toxicity in the treatment of prostate cancer.
Authors: Bruce L Jacobs; Jonathan G Yabes; Samia H Lopa; Dwight E Heron; Chung-Chou H Chang; Florian R Schroeck; Justin E Bekelman; Jeremy M Kahn; Joel B Nelson; Amber E Barnato Journal: Cancer Date: 2017-03-16 Impact factor: 6.860
Authors: Bruce L Jacobs; Yun Zhang; Ted A Skolarus; John T Wei; James E Montie; Florian R Schroeck; Brent K Hollenbeck Journal: Urology Date: 2012-12 Impact factor: 2.649
Authors: Bruce L Jacobs; Yun Zhang; Ted A Skolarus; John T Wei; James E Montie; David C Miller; Brent K Hollenbeck Journal: Eur Urol Date: 2012-07-06 Impact factor: 20.096