Hypofractionated helical tomotherapy (75 Gy at 2.5 Gy per fraction) for localized prostate cancer: long-term analysis of gastrointestinal and genitourinary toxicity
Moonkyoo Kong,1 Seong Eon Hong,1 Sung-Goo Chang2
1Department of Radiation Oncology, 2Department of Urology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea
Background: This study is a report on the long-term analysis of acute and late toxicities for patients with localized prostate cancer treated with hypofractionated helical tomotherapy.
Methods: From January 2008 through August 2013, 70 patients with localized prostate cancer were treated definitively with hypofractionated helical tomotherapy. The helical tomotherapy was designed to deliver 75 Gy in 2.5 Gy per fraction to the prostate gland, 63 Gy in 2.1 Gy per fraction to the seminal vesicles, and 54 Gy in 1.8 Gy per fraction to the pelvic lymph nodes. Incidence rates and predictive factors for radiation toxicities were analyzed retrospectively.
Results: The incidences of grades 0, 1, and 2 acute gastrointestinal (GI) toxicity were 51.4%, 42.9%, and 5.7%, and those of acute genitourinary (GU) toxicity were 7.1%, 64.3%, and 28.6%, respectively. The maximum dose of rectum and bladder V40 and V50 were significant predictive factors for acute GI and GU toxicity. The cutoff value of rectum maximum dose and bladder V40 and V50 by receiver-operating characteristic curves analysis were 76.5 Gy, 17.3%, and 10.2%, respectively. The incidences of grades 0, 1, and 2 late GI toxicity were 82.0%, 14.0%, and 4.0%, and those of late GU toxicity were 18.0%, 56.0%, and 26.0%, respectively. Rectum V70 and bladder V70 and V75 were significant predictive factors for late GI and GU toxicity. The cutoff value of rectum V70 and bladder V70 and V75 by receiver-operating characteristic curves analysis was 2.8%, 2.8%, and 1.0%, respectively.
Conclusion: Hypofractionated helical tomotherapy using a schedule of 75 Gy at 2.5 Gy per fraction had favorable acute and late toxicity rates and no serious complication, such as grade 3 or worse toxicity. To minimize radiation toxicities, constraining the rectum maximum dose to less than 76.5 Gy, rectum V70 to less than 2.8%, bladder V40 to less than 17.3%, bladder V50 to less than 10.2%, bladder V70 to less than 2.8%, and bladder V75 to less than 1.0% would be necessary.
Keywords: prostate cancer, helical tomotherapy, hypofractionated radiotherapy, radiation toxicity, predictive factor
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