Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

Purpose

The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose–volume histogram data (DVH data).

Methods

Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70?Gy in 35 fractions. The boost volume containing the prostate and 3?mm safety margins (5?mm craniocaudal) was treated as SIB to a total dose of 76?Gy (2.17?Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76?Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score.

Results

SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38?Gy in all patients and the median volumes receiving at least 65?Gy (V65), 70?Gy (V70), and 75?Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade?4 toxicity was observed. Acute grade?3 toxicity was observed in 20% of patients involving nocturia only. Grade?2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data.

Conclusion

This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity.