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Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients.

Abstract Image-guided intensity modulated radiation therapy (IG-IMRT) allows significant dose reductions to organs at risk in prostate cancer patients. However, clinical data identifying the benefits of IG-IMRT in daily practice are scarce. The purpose of this study was to compare dose distributions to organs at risk and acute gastrointestinal (GI) and genitourinary (GU) toxicity levels of patients treated to 78 Gy with either IG-IMRT or 3D-CRT.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title international journal of radiation oncology, biology, physics
Publication Year Start




PMID- 25752386
OWN - NLM
STAT- MEDLINE
DA  - 20150310
DCOM- 20150430
LR  - 20150310
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 91
IP  - 4
DP  - 2015 Mar 15
TI  - Acute toxicity after image-guided intensity modulated radiation therapy compared 
      to 3D conformal radiation therapy in prostate cancer patients.
PG  - 737-44
LID - 10.1016/j.ijrobp.2014.12.017 [doi]
LID - S0360-3016(14)04492-7 [pii]
AB  - PURPOSE: Image-guided intensity modulated radiation therapy (IG-IMRT) allows
      significant dose reductions to organs at risk in prostate cancer patients.
      However, clinical data identifying the benefits of IG-IMRT in daily practice are 
      scarce. The purpose of this study was to compare dose distributions to organs at 
      risk and acute gastrointestinal (GI) and genitourinary (GU) toxicity levels of
      patients treated to 78 Gy with either IG-IMRT or 3D-CRT. METHODS AND MATERIALS:
      Patients treated with 3D-CRT (n=215) and IG-IMRT (n=260) receiving 78 Gy in 39
      fractions within 2 randomized trials were selected. Dose surface histograms of
      anorectum, anal canal, and bladder were calculated. Identical toxicity
      questionnaires were distributed at baseline, prior to fraction 20 and 30 and at
      90 days after treatment. Radiation Therapy Oncology Group (RTOG) grade >/=1,
      >/=2, and >/=3 endpoints were derived directly from questionnaires. Univariate
      and multivariate binary logistic regression analyses were applied. RESULTS: The
      median volumes receiving 5 to 75 Gy were significantly lower (all P<.001) with
      IG-IMRT for anorectum, anal canal, and bladder. The mean dose to the anorectum
      was 34.4 Gy versus 47.3 Gy (P<.001), 23.6 Gy versus 44.6 Gy for the anal canal
      (P<.001), and 33.1 Gy versus 43.2 Gy for the bladder (P<.001). Significantly
      lower grade >/=2 toxicity was observed for proctitis, stool frequency >/=6/day,
      and urinary frequency >/=12/day. IG-IMRT resulted in significantly lower overall 
      RTOG grade >/=2 GI toxicity (29% vs 49%, respectively, P=.002) and overall GU
      grade >/=2 toxicity (38% vs 48%, respectively, P=.009). CONCLUSIONS: A clinically
      meaningful reduction in dose to organs at risk and acute toxicity levels was
      observed in IG-IMRT patients, as a result of improved technique and tighter
      margins. Therefore reduced late toxicity levels can be expected as well;
      additional research is needed to quantify such reductions.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Wortel, Ruud C
AU  - Wortel RC
AD  - Department of Radiation Oncology, Erasmus Medical Center Cancer Institute,
      Rotterdam, The Netherlands.
FAU - Incrocci, Luca
AU  - Incrocci L
AD  - Department of Radiation Oncology, Erasmus Medical Center Cancer Institute,
      Rotterdam, The Netherlands.
FAU - Pos, Floris J
AU  - Pos FJ
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands.
FAU - Lebesque, Joos V
AU  - Lebesque JV
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands.
FAU - Witte, Marnix G
AU  - Witte MG
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands.
FAU - van der Heide, Uulke A
AU  - van der Heide UA
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands.
FAU - van Herk, Marcel
AU  - van Herk M
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands.
FAU - Heemsbergen, Wilma D
AU  - Heemsbergen WD
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The
      Netherlands. Electronic address: [email protected]
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Aged
MH  - Anal Canal/*radiation effects
MH  - Gastrointestinal Tract/radiation effects
MH  - Humans
MH  - Male
MH  - Organs at Risk/*radiation effects
MH  - Prostatic Neoplasms/*radiotherapy
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Conformal/*adverse effects/methods
MH  - Radiotherapy, Image-Guided/*adverse effects/methods
MH  - Radiotherapy, Intensity-Modulated/*adverse effects/methods
MH  - Rectum/*radiation effects
MH  - Urinary Bladder/*radiation effects
MH  - Urogenital System/radiation effects
EDAT- 2015/03/11 06:00
MHDA- 2015/05/01 06:00
CRDT- 2015/03/11 06:00
PHST- 2014/10/01 [received]
PHST- 2014/12/03 [revised]
PHST- 2014/12/08 [accepted]
AID - S0360-3016(14)04492-7 [pii]
AID - 10.1016/j.ijrobp.2014.12.017 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):737-44. doi:
      10.1016/j.ijrobp.2014.12.017.

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