Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate can...Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer.展开更多
Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with dail...Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements;2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation;3) the daily CBCT image was fused with the planning CT image using the prostate outline;and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan;the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, -0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.展开更多
文摘Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer.
文摘Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements;2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation;3) the daily CBCT image was fused with the planning CT image using the prostate outline;and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan;the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, -0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.
