Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference?

Published on Nov 1, 2019in International Braz J Urol1.541
· DOI :10.1590/S1677-5538.IBJU.2018.0842
Gustavo Arruda Viani4
Estimated H-index: 4
(USP: University of São Paulo),
Ana Carolina Hamamura2
Estimated H-index: 2
(USP: University of São Paulo),
Alexandre C Faustino2
Estimated H-index: 2
(USP: University of São Paulo)
Sources
Abstract
PURPOSE: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. MATERIALS AND METHODS: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modifi ed RTOG criteria. The biochemical control was defi ned by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. RESULTS: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for ≥ grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no signifi cant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No signifi cant differences for OS and DMFS were observed comparing treatment groups. CONCLUSION: IMRT reduces signifi cantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.
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References17
Newest
#1Karen E. HoffmanH-Index: 42
#2K. Ranh Voong (University of Texas MD Anderson Cancer Center)H-Index: 8
Last. Deborah A. KubanH-Index: 71
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PurposeHypofractionated radiotherapy delivers larger daily doses of radiation and may increase the biologically effective dose delivered to the prostate. We conducted a randomized trial testing the hypothesis that dose-escalated, moderately hypofractionated intensity-modulated radiation therapy (HIMRT) improves prostate cancer control compared with conventionally fractionated IMRT (CIMRT) for men with localized prostate cancer.Patients and MethodsMen were randomly assigned to 75.6 Gy in 1.8-Gy f...
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#1Andre Konski (UPenn: University of Pennsylvania)H-Index: 55
The use of radiotherapy in the treatment of prostate cancer has evolved from treatments utilizing large fields with hand placed blocks to radiotherapy treatments given with a linear accelerator moving around the patient on a robotic arm. These technologic developments have allowed radiation dose escalations resulting in improvements in disease and patient reported outcomes with longer biochemical diseasefree survival (DFS) as well as improved quality of life. Increased costs have accompanied the...
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#1B.W. Fischer-Valuck (WashU: Washington University in St. Louis)H-Index: 1
#2Yuan James Rao (WashU: Washington University in St. Louis)H-Index: 14
Last. Jeff M. MichalskiH-Index: 85
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Radiation therapy (RT) is a curative treatment modality for localized prostate cancer. Over the past two decades, advances in technology and imaging have considerably changed RT in prostate cancer treatment. Treatment has evolved from 2-dimensional (2D) planning using X-ray fields based on pelvic bony landmarks to 3-dimensional (3D) conformal RT (CRT) which uses computed tomography (CT) based planning. Despite improvements with 3D-CRT, dose distributions often remained suboptimal with portions o...
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#1Rafael GadiaH-Index: 6
#2Elton Trigo Teixeira Leite (USP: University of São Paulo)H-Index: 4
Last. Bernardo GaricocheaH-Index: 3
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Abstract Objective The addition of androgen deprivation therapy (ADT) to conventional radiation therapy improves overall survival (OS) in intermediate- and high-risk prostate cancer. The benefit of ADT to added to dose-escalated radiotherapy is less clear. The aim of this study was to report disease control outcomes and to identify prognostic variables associated with favorable outcomes in patients with intermediate- and high-risk prostate cancer treated with dose-escalated radiation therapy wit...
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#3Elizabeth O'Meara (Radiation Therapy Oncology Group)H-Index: 8
Last. Akila N. Viswanathan (Harvard University)H-Index: 51
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Context There has been rapid adoption of newer radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton therapy despite greater cost and limited demonstrated benefit compared with previous technologies. Objective To determine the comparative morbidity and disease control of IMRT, proton therapy, and conformal radiation therapy for primary prostate cancer treatment. Design, Setting, and Patients Population-based study using Surveillance, Epidemiology, and End Results–M...
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#2Caio Viani ArrudaH-Index: 2
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Objective null The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer's perspective. null Methods null We built a Markov model to delineate the health states after treatment with IMRT and ...
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The overall aging of the world population has contributed to the continuous upward trend in the incidence of prostate cancer (PC). Trials on PC therapy have been extensively performed, but no study has analyzed the overall trends and characteristics of these trials, especially for those carried out in China. This study aimed to provide insights on the future direction of drug development in PC, thus supplying essential supportive data for stakeholders, including researchers, patients, investors,...
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Purpose Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to improve penile cancer patients' outcomes, based on expert's opinion and evidence from medical literature. Methods Fifty-one Brazilian experts (clinical oncologists, radiation oncologists, urologists, and pathologists) assembled and voted 104 multiple-choice questions, confronted the results with the literature, and ranked...
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