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Clinical outcome and toxicity evaluation of simultaneous integrated boost pelvic IMRT/VMAT at different dose levels combined with androgen deprivation therapy in prostate cancer patients

Authors Daoud MA, Aboelnaga EM, Alashry MS, Fathy S, Aletreby MA

Received 6 May 2017

Accepted for publication 14 July 2017

Published 12 October 2017 Volume 2017:10 Pages 4981—4988

DOI https://doi.org/10.2147/OTT.S141224

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Ingrid Espinoza

Mohamed A Daoud,1,2 Engy M Aboelnaga,1 Mohamed S Alashry,1 Salwa Fathy,3 Mostafa A Aletreby2,4

1Department of Clinical Oncology and Nuclear Medicine, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 2Department of Oncology, Fakeeh Hospital, Jeddah, Saudi Arabia; 3Department of Radiation, Oncology and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, 4Department of Medical Physics, Kasr Alainy Faculty of Medicine, Al Manial, Egypt

Background: The role of dose escalation in patients receiving long-term androgen deprivation therapy (ADT) is still a controversial issue. The aim of the current study was to evaluate whether dose escalation for ≥76–80 Gy had any advantage in terms of biochemical disease-free survival (BDFS), distant metastasis-free survival (DMFS), or overall survival outcomes over the dose levels from 70 to <76 Gy.
Patients and methods: The study included a cohort of 24 patients classified with high- and intermediate-risk localized prostate cancer. All patients received ADT, starting at 4–6 months before radiation therapy and continued for a total period of 12–24 months in high-risk patients. The treatment plan was given in two phases. In the first phase, the nodal planning target volume (PTV) and the prostate PTV received 48.6 and 54 Gy, respectively, over 27 fractions. The treatment was applied through intensity-modulated radiation therapy or volumetric modulated arc therapy with a simultaneous integrated boost technique.
Results: More than half of the patients were in T3–T4 stage, 79.1% of the patients were in the high-risk category, and all patients received ADT. The rate of acute grade II gastrointestinal and genitourinary toxicities in all patients were 41.7% and 62.5%, respectively. The rate of freedom from grade II rectal toxicity at 2 years was 89% and 83% for patients treated with dose levels <76 and ≥76 Gy, respectively. The rate of BDFS at 2 years was 90% and 85% for doses <76 and ≥76 Gy, respectively. The DMFS at 2 years was 100% and 76% for dose levels <76 and ≥76 Gy, respectively.
Conclusion: In the current study, there were no significant differences in the BDFS and DMFS between patients treated with a dose of <76 and ≥76 Gy, including elective pelvic lymph nodes irradiation combined with ADT.

Keywords: androgen deprivation therapy, dose escalation, cancer prostate, combined therapy, radiation dose, intermediate and high risk

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