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Late Side Effects After Image Guided Intensity Modulated Radiation Therapy Compared to 3D-Conformal Radiation Therapy for Prostate Cancer: Results From 2 Prospective Cohorts.

Abstract Technical developments in the field of external beam radiation therapy (RT) enabled the clinical introduction of image guided intensity modulated radiation therapy (IG-IMRT), which improved target conformity and allowed reduction of safety margins. Whether this had an impact on late toxicity levels compared to previously applied three-dimensional conformal radiation therapy (3D-CRT) is currently unknown. We analyzed late side effects after treatment with IG-IMRT or 3D-CRT, evaluating 2 prospective cohorts of men treated for localized prostate cancer to investigate the hypothesized reductions in toxicity.
PMID
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Authors

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




PMID- 27055398
OWN - NLM
STAT- MEDLINE
DCOM- 20170623
LR  - 20171109
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 95
IP  - 2
DP  - 2016 Jun 1
TI  - Late Side Effects After Image Guided Intensity Modulated Radiation Therapy
      Compared to 3D-Conformal Radiation Therapy for Prostate Cancer: Results From 2
      Prospective Cohorts.
PG  - 680-9
LID - 10.1016/j.ijrobp.2016.01.031 [doi]
LID - S0360-3016(16)00052-3 [pii]
AB  - PURPOSE: Technical developments in the field of external beam radiation therapy
      (RT) enabled the clinical introduction of image guided intensity modulated
      radiation therapy (IG-IMRT), which improved target conformity and allowed
      reduction of safety margins. Whether this had an impact on late toxicity levels
      compared to previously applied three-dimensional conformal radiation therapy
      (3D-CRT) is currently unknown. We analyzed late side effects after treatment with
      IG-IMRT or 3D-CRT, evaluating 2 prospective cohorts of men treated for localized 
      prostate cancer to investigate the hypothesized reductions in toxicity. METHODS
      AND MATERIALS: Patients treated with 3D-CRT (n=189) or IG-IMRT (n=242) to 78 Gy
      in 39 fractions were recruited from 2 Dutch randomized trials with identical
      toxicity scoring protocols. Late toxicity (>90 days after treatment) was derived 
      from self-assessment questionnaires and case report forms, according to Radiation
      Therapy Oncology Group/European Organization for Research and Treatment of Cancer
      (RTOG-EORTC) scoring criteria. Grade >/=2 endpoints included gastrointestinal
      (GI) rectal bleeding, increased stool frequency, discomfort, rectal incontinence,
      proctitis, and genitourinary (GU) obstruction, increased urinary frequency,
      nocturia, urinary incontinence, and dysuria. The Cox proportional hazards
      regression model was used to compare grade >/=2 toxicities between both
      techniques, adjusting for other modifying factors. RESULTS: The 5-year cumulative
      incidence of grade >/=2 GI toxicity was 24.9% for IG-IMRT and 37.6% following
      3D-CRT (adjusted hazard ratio [HR]: 0.59, P=.005), with significant reductions in
      proctitis (HR: 0.37, P=.047) and increased stool frequency (HR: 0.23, P<.001). GU
      grade >/=2 toxicity levels at 5 years were comparable with 46.2% and 36.4%
      following IG-IMRT and 3D-CRT, respectively (adjusted HR: 1.19, P=.33). Other
      strong predictors (P<.01) of grade >/=2 late toxicity were baseline complaints,
      acute toxicity, and age. CONCLUSIONS: Treatment with IG-IMRT reduced the risk of 
      late grade >/=2 complications, whereas GU toxicities remained comparable. This
      clinically relevant observation demonstrates that IMRT and image-guidance should 
      therefore be the preferred treatment option, provided that margin reduction is
      implemented with caution.
CI  - Copyright (c) 2016 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, Antoni van
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - van der Heide, Uulke A
AU  - van der Heide UA
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Lebesque, Joos V
AU  - Lebesque JV
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Aluwini, Shafak
AU  - Aluwini S
AD  - Department of Radiation Oncology, Erasmus Medical Center Cancer Institute,
      Rotterdam, The Netherlands.
FAU - Witte, Marnix G
AU  - Witte MG
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Heemsbergen, Wilma D
AU  - Heemsbergen WD
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van
      Leeuwenhoek Hospital, 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
DEP - 20160122
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
CIN - Strahlenther Onkol. 2017 May;193(5):431-432. PMID: 28321456
MH  - Aged
MH  - Cohort Studies
MH  - Gastrointestinal Tract/radiation effects
MH  - Humans
MH  - Male
MH  - Patient Reported Outcome Measures
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Prostatic Neoplasms/*radiotherapy
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Conformal/*adverse effects
MH  - Radiotherapy, Image-Guided/*adverse effects
MH  - Radiotherapy, Intensity-Modulated/*adverse effects
MH  - Urogenital System/radiation effects
EDAT- 2016/04/09 06:00
MHDA- 2017/06/24 06:00
CRDT- 2016/04/09 06:00
PHST- 2015/12/07 00:00 [received]
PHST- 2016/01/08 00:00 [revised]
PHST- 2016/01/18 00:00 [accepted]
PHST- 2016/04/09 06:00 [entrez]
PHST- 2016/04/09 06:00 [pubmed]
PHST- 2017/06/24 06:00 [medline]
AID - S0360-3016(16)00052-3 [pii]
AID - 10.1016/j.ijrobp.2016.01.031 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2016 Jun 1;95(2):680-9. doi:
      10.1016/j.ijrobp.2016.01.031. Epub 2016 Jan 22.