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phase 3 trials. However, evidences in post-operative
setting are scarce. We report our experience about
feasibility and acute toxicity of a moderate
hypofractionated intensity modulated radiotherapy
(Hypo-IMRT) schedule for prostate cancer (PC) after
radical prostatectomy.
Material and Methods
From October 2015 to July 2016, 23 patients (pts) were
included for adjuvant (60,9%) or salvage radiation therapy
(39,1%). They were classified with
NCCN
criteria in: low (2
pts), intermediate (13 pts) and high risk (8 pts). Median
age was 63 years (range 55-77 years). Median PSA
pretreatment was 0.31ng/mL (range 0.04 – 4.38ng/mL).
Pathological characteristics are summarized in Table 1.
Two internal gold-fiducial markers were placed
transperineally guided by transrectal ultrasound, in every
patient before treatment. CTV was countered according
to RTOG guidelines and expanded 3 mm posteriorly and 5
mm in all other direction to create the PTV. All patients
underwent treatment with IMRT up to a total dose of
62.5Gy in 25fx (2,5Gy/day) in a Novalis linac. Daily
verification was performed with IGRT-Exactrac®, and 6D-
robotic couch. Six (26%) patients received androgen
deprivation. Acute toxicity was assessed according to
RTOG/EORTC criteria and was recorded weekly during
treatment and one month after radiation therapy.
Gleason score:
6 7(3+4) 7(4+3) 8-10 9% 35% 26% 30%
Seminal vesicles invasion:
-Yes -No 17% 83%
Extracapsular extension:
-Yes -No 61% 39%
Positive
Margin
: -Yes -No 48% 52%
Perineural invasion:
-Yes -
No 52% 48%
Linfovascular invasion:
-Yes -No 22%
78%
Results
All patients received complete treatment. There were no
complications during marker placement. With a median
follow-up of 3.7 months (range 1-13 months ), the
RTOG/EORTC acute urinary toxicities were grade 1 in 34,7
% and grade 2 in 21,7 %. Neither urinary stress nor
incontinence was influenced by radiation therapy.
Maximal acute gastrointestinal toxicities were grade 1 in
13%. There was no adverse events ≥ grade 3.
Conclusion