Ercole Mazzeo1, Luca Triggiani2, Luca Frassinelli1, Alessia Guarneri3, Sara Bartoncini3, Paolo Antognoni4, Stefania Gottardo5, Diana Greco2, Simona Borghesi6, Sara Nanni6, Alessio Bruni1, Gianluca Ingrosso7, Rolando Maria D'Angelillo8, Beatrice Detti9, Giulio Francolini9, Alessandro Magli10, Andrea Emanuele Guerini2, Stefano Arcangeli11, Luigi Spiazzi12, Umberto Ricardi13, Frank Lohr1, Stefano Maria Magrini2. 1. Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy. 2. Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy. 3. Department of Oncology, Radiation Oncology, Azienda Ospedaliero-Universitaria Città della Salute e Della Scienza, 10126 Turin, Italy. 4. Radiotherapy Deparment, ASST dei Sette Laghi-Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy. 5. Service of Radiotherapy, Istituito Clinico Sant'Ambrogio, 25123 Milan, Italy. 6. Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, 52100 Arezzo, Italy. 7. Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy. 8. Depatment of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy. 9. Unit of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. 10. Department of Radiation Oncology, Udine General Hospital, 33100 Udine, Italy. 11. Department of Radiation Oncology, S. Gerardo Hospital-University of Milan Bicocca, 20900 Monza, Italy. 12. Department of Medical Physics, Spedali Civili Hospital, 25123 Brescia, Italy. 13. Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy.
Abstract
BACKGROUND AND PURPOSE: Two previous "Patterns Of Practice" surveys (POP I and POP II), including more than 4000 patients affected by prostate cancer treated with radical external beam radiotherapy (EBRT) between 1980 and 2003, established a "benchmark" Italian data source for prostate cancer radiotherapy. This report (POP III) updates the previous studies. METHODS: Data on clinical management and outcome of 2525 prostate cancer patients treated by EBRT from 2004 to 2011 were collected and compared with POP II and, when feasible, also with POP I. This report provides data on clinical presentation, diagnostic workup, radiation therapy management, and toxicity as collected within the framework of POP III. RESULTS: More than 50% of POP III patients were classified as low or intermediate risk using D'Amico risk categories as in POP II; 46% were classified as ISUP grade group 1. CT scan, bone scan, and endorectal ultrasound were less frequently prescribed. Dose-escalated radiotherapy (RT), intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), and hypofractionated RT were more frequently offered during the study period. Treatment was commonly well tolerated. Acute toxicity improved compared to the previous series; late toxicity was influenced by prescribed dose and treatment technique. Five-year overall survival, biochemical relapse free survival (BRFS), and disease specific survival were similar to those of the previous series (POP II). BRFS was better in intermediate- and high-risk patients treated with ≥ 76 Gy. CONCLUSIONS: This report highlights the improvements in radiotherapy planning and dose delivery among Italian Centers in the 2004-2011 period. Dose-escalated treatments resulted in better biochemical control with a reduction in acute toxicity and higher but acceptable late toxicity, as not yet comprehensively associated with IMRT/IGRT. CTV-PTV margins >8 mm were associated with increased toxicity, again suggesting that IGRT-allowing for tighter margins-would reduce toxicity for dose escalated RT. These conclusions confirm the data obtained from randomized controlled studies.
BACKGROUND AND PURPOSE: Two previous "Patterns Of Practice" surveys (POP I and POP II), including more than 4000 patients affected by prostate cancer treated with radical external beam radiotherapy (EBRT) between 1980 and 2003, established a "benchmark" Italian data source for prostate cancer radiotherapy. This report (POP III) updates the previous studies. METHODS: Data on clinical management and outcome of 2525 prostate cancerpatients treated by EBRT from 2004 to 2011 were collected and compared with POP II and, when feasible, also with POP I. This report provides data on clinical presentation, diagnostic workup, radiation therapy management, and toxicity as collected within the framework of POP III. RESULTS: More than 50% of POP III patients were classified as low or intermediate risk using D'Amico risk categories as in POP II; 46% were classified as ISUP grade group 1. CT scan, bone scan, and endorectal ultrasound were less frequently prescribed. Dose-escalated radiotherapy (RT), intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), and hypofractionated RT were more frequently offered during the study period. Treatment was commonly well tolerated. Acute toxicity improved compared to the previous series; late toxicity was influenced by prescribed dose and treatment technique. Five-year overall survival, biochemical relapse free survival (BRFS), and disease specific survival were similar to those of the previous series (POP II). BRFS was better in intermediate- and high-risk patients treated with ≥ 76 Gy. CONCLUSIONS: This report highlights the improvements in radiotherapy planning and dose delivery among Italian Centers in the 2004-2011 period. Dose-escalated treatments resulted in better biochemical control with a reduction in acute toxicity and higher but acceptable late toxicity, as not yet comprehensively associated with IMRT/IGRT. CTV-PTV margins >8 mm were associated with increased toxicity, again suggesting that IGRT-allowing for tighter margins-would reduce toxicity for dose escalated RT. These conclusions confirm the data obtained from randomized controlled studies.
Entities:
Keywords:
Pattern Of Practice; prostate cancer; radiotherapy
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