Yonsei Med J.  2015 Mar;56(2):510-518. 10.3349/ymj.2015.56.2.510.

Toxicity of Tomotherapy-Based Simultaneous Integrated Boost in Whole-Pelvis Radiation for Prostate Cancer

• You SH
• Lee JY
• Lee CG

• KMID: 2070032
• DOI: http://doi.org/10.3349/ymj.2015.56.2.510

Abstract

PURPOSE
The validity of tomotherapy-based simultaneous integrated boost (TOMOSIB) was assessed in terms of acute intestinal/urinary toxicity by comparing with 3-dimensional conformal radiotherapy (3DCRT) in cases of whole-pelvis radiation therapy (WPRT) for prostate cancer.
MATERIALS AND METHODS
Thirty-eight consecutive patients who underwent curative WPRT were retrospectively reviewed. Twenty six (68.4%) received 3DCRT and the others (31.6%) were treated with TOMOSIB. A local boost to the prostate circumferential area was added to WPRT sequentially for 3DCRT and concomitantly for TOMOSIB. The total median prostate or prostatic bed dose was 64.8 Gy including median 45.0 Gy of WPRT. Acute toxicities were assessed according to RTOG criteria.
RESULTS
Overall intestinal toxicity was lower in TOMOSIB group than 3DCRT group (p=0.008). When it was divided into rectum and non-rectum intestine (NRI), TOMOSIB showed borderline superiority only in NRI toxicity (p=0.047). For the urinary toxicity, there was no significant difference between two groups (p=0.796). On dosimetric analysis for the rectum and bladder, dose delivered to 80% (p<0.001) and volume receiving 25-40 Gy (p<0.001) were remarkably higher in 3DCRT. For the NRI, only maximum dose showed significant results between two groups (p<0.001).
CONCLUSION
Intestinal toxicity should be verified with more detailed anatomic categorization such as rectum and NRI. TOMOSIB could not reduce urinary toxicity because of inevitably high dose exposure to the prostatic urethra. Current dosimetry system did not properly reflect intestinal/urinary toxicity, and suitable dosimetric guidelines are needed in TOMOSIB.

Keyword

Acute toxicity; radiation; prostate cancer; helical tomotherapy

MeSH Terms

Adenocarcinoma/pathology/*radiotherapy
Aged
Humans
Intestine, Small/*radiation effects
Male
Middle Aged
Pelvis/*radiation effects
Prostatic Neoplasms/pathology/*radiotherapy
Radiation Injuries
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated/*adverse effects/methods
Rectum/radiation effects
Retrospective Studies
Urinary Bladder/*radiation effects

Figure

• 

  Fig. 1 The cumulative incidence of the Grade 2 or higher intestinal toxicity from the 1st to the 8th week during radiotherapy (TOMOSIB vs. 3DCRT).TOMOSIB, tomotherapy-based simultaneous integrated boost; 3DCRT, 3-dimensional conformal radiotherapy.

• 

  Fig. 2 The cumulative incidence of the Grade 2 or higher toxicity for the rectum (A) and the NRI (B) from the 1st to the 8th week during radiotherapy (TOMOSIB vs. 3DCRT). NRI, non-rectum intestine; TOMOSIB, tomotherapy-based simultaneous integrated boost; 3DCRT, 3-dimensional conformal radiotherapy.

• 

  Fig. 3 The cumulative incidence of the Grade 2 or higher urinary toxicity from the 1st to the 8th week during radiotherapy (TOMOSIB vs. 3DCRT). TOMOSIB, tomotherapy-based simultaneous integrated boost; 3DCRT, 3-dimensional conformal radiotherapy.

• 

  Fig. 4 A typical example of dose-volume histogram at completion of whole-pelvis radiation for (A) TOMOSIB and (B) 3DCRT. CTV, clinical target volume; 3DCRT, 3-dimensional conformal radiotherapy; TOMOSIB, tomotherapy-based simultaneous integrated boost.

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