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Long-term Outcomes of a Dose-reduction Trial to Decrease Late Gastrointestinal Toxicity in Patients with Prostate Cancer Receiving Soft Tissue-matched Image-guided Intensity-modulated Radiotherapy.

Abstract We experienced an unexpected high incidence of gastrointestinal (GI) toxicity in patients undergoing image-guided intensity-modulated radiotherapy (IG-IMRT) using helical tomotherapy in our initial 2.2 Gy/fraction schedule for prostate cancer; hence, a dose-reduction trial from 2.2 Gy to 2 Gy/fraction was conducted using modified planning target volume (PTV) contouring.
PMID
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Authors

Mayor MeshTerms

Radiotherapy Dosage

Keywords

IMRT

Prostate cancer IGRT

gastrointestinal toxicity

helical tomotherapy

rectal bleeding

Journal Title anticancer research
Publication Year Start




PMID- 29277799
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 1791-7530 (Electronic)
IS  - 0250-7005 (Linking)
VI  - 38
IP  - 1
DP  - 2018 Jan
TI  - Long-term Outcomes of a Dose-reduction Trial to Decrease Late Gastrointestinal
      Toxicity in Patients with Prostate Cancer Receiving Soft Tissue-matched
      Image-guided Intensity-modulated Radiotherapy.
PG  - 385-391
AB  - BACKGROUND/AIM: We experienced an unexpected high incidence of gastrointestinal
      (GI) toxicity in patients undergoing image-guided intensity-modulated
      radiotherapy (IG-IMRT) using helical tomotherapy in our initial 2.2 Gy/fraction
      schedule for prostate cancer; hence, a dose-reduction trial from 2.2 Gy to 2
      Gy/fraction was conducted using modified planning target volume (PTV) contouring.
      PATIENTS AND METHODS: We compared 130 patients treated using 2.2 Gy/fraction
      (Group A) and 144 treated using the 2 Gy/fraction (Group B) with modified PTV
      (excluding rectal volume) with a median follow-up period of 62 months. Prescribed
      dose was 72.6-74.8 Gy in 33-34 fractions (Group A) and 72-74 Gy in 36-37
      fractions (Group B). RESULTS: Patients in Group B had a reduced rectal and
      bladder V10-V70 and were irradiated at the maximal dose. Their cumulative
      incidence of grade </=2 GI toxicity at 5 years improved from 10.1% [95%
      confidence interval (CI), 4.9-15.3%] to 1.4% (0-3.3%). Grade 2</= urinary
      toxicity also decreased from 5.5% (1.5-9.4%) in Group A to 1.4% (0-3.3%,
      p=0.0167) in Group B. The biochemical failure-free 5-year survival rate was 89.1%
      (95%CI=83.6-95.4%) and 87.5% (82.0-92.9%, p=0.75) in groups A and B,
      respectively. CONCLUSION: The reduced dose fraction schedule decreased the
      incidence of late GI toxicity without compromising prostate-specific antigen
      control. Careful target volume definition and fraction size are important even
      for IG-IMRT.
CI  - Copyright(c) 2018, International Institute of Anticancer Research (Dr. George J. 
      Delinasios), All rights reserved.
FAU - Sasaki, Naomi
AU  - Sasaki N
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan.
FAU - Yamazaki, Hideya
AU  - Yamazaki H
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan [email protected]
FAU - Shimizu, Daisuke
AU  - Shimizu D
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan.
FAU - Suzuki, Gen
AU  - Suzuki G
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan.
FAU - Masui, Koji
AU  - Masui K
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan.
FAU - Nakamura, Satoaki
AU  - Nakamura S
AD  - Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural
      University of Medicine, Kyoto, Japan.
FAU - Okabe, Haruumi
AU  - Okabe H
AD  - Department of Radiology, Ujitakeda Hospital, Uji, Japan.
FAU - Nishikawa, Tatsuyuki
AU  - Nishikawa T
AD  - Department of Radiology, Ujitakeda Hospital, Uji, Japan.
FAU - Yoshida, Ken
AU  - Yoshida K
AD  - Department of Radiology, Osaka Medical College, Takatsuki, Japan.
LA  - eng
PT  - Journal Article
PL  - Greece
TA  - Anticancer Res
JT  - Anticancer research
JID - 8102988
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Gastrointestinal Diseases/etiology/*prevention & control
MH  - Gastrointestinal Tract/pathology/radiation effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prostate-Specific Antigen/blood
MH  - Prostatic Neoplasms/*radiotherapy
MH  - Radiation Injuries/*prevention & control
MH  - *Radiotherapy Dosage
MH  - Radiotherapy, Conformal/*adverse effects
MH  - Radiotherapy, Image-Guided/*adverse effects
MH  - Radiotherapy, Intensity-Modulated/*adverse effects
MH  - Treatment Outcome
MH  - Urinary Tract/pathology/radiation effects
OTO - NOTNLM
OT  - *IMRT
OT  - *Prostate cancer IGRT
OT  - *gastrointestinal toxicity
OT  - *helical tomotherapy
OT  - *rectal bleeding
EDAT- 2017/12/27 06:00
MHDA- 2018/01/05 06:00
CRDT- 2017/12/27 06:00
PHST- 2017/10/06 00:00 [received]
PHST- 2017/10/19 00:00 [revised]
PHST- 2017/10/20 00:00 [accepted]
PHST- 2017/12/27 06:00 [entrez]
PHST- 2017/12/27 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - 38/1/385 [pii]
AID - 10.21873/anticanres.12234 [doi]
PST - ppublish
SO  - Anticancer Res. 2018 Jan;38(1):385-391. doi: 10.21873/anticanres.12234.