Acute side effects after definitive stereotactic body radiation therapy (SBRT) for patients with clinically localized or locally advanced prostate cancer: a single institution prospective study
, , , , y | 13 jul 2021
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Article Category: Research Article
Publicado en línea: 13 jul 2021
Páginas: 474 - 481
Recibido: 10 mar 2021
Aceptado: 30 may 2021
DOI: https://doi.org/10.2478/raon-2021-0031
© 2021 Kliton Jorgo, Csaba Polgar, Gabor Stelczer, Tibor Major, Laszlo Gesztesi, Peter Agoston, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Dose-volume parameters of rectum and bladder with constraints
| Organs at risks | Dose constrain | Mean | Median (range) |
|---|---|---|---|
| D 0.04cm3 (Gy) | 38 | 37.6 | 37.8 (32.3–41.5) |
| D 20cm3 (Gy) | 26 | 18.8 | 19.2 (8.0–27.6) |
| D 0.04cm3 (Gy) | 44 | 40.4 | 40.4 (30.7–48.6) |
| D 15cm3 (Gy) | 18.3 | 29.1 | 18.9 (6.9–29.1) |
| V 26Gy (%) | 65 | 9.1 | 7.3 (0.9–41.9) |
Dose constraints for organs at risk
| Rectum | D0.04ccm < 38 Gy, D20ccm < 25 Gy |
|---|---|
| Bladder | V26% < 65% |
| Bladder wall | D0.04ccm < 44 Gy |
| Sigma | D0.04ccm < 44 Gy, V30Gy < 1ccm |
| Small intestine | D0.04ccm < 35 Gy, V30Gy < 1ccm, D5ccm < 19.5 Gy |
| Hip joint | V40% < 5%, D10ccm < 30 Gy |
| Testicle | D20% < 2Gy |
| Penis root | V29.5Gy < 50%, D0.04ccm < 50 Gy |
Patient, tumour and treatment characteristics
| Characteristic | Number (%) |
|---|---|
| Median | 73 |
| Range | 54–85 |
| T1 | 45 (22%) |
| T2a | 35 (17.1%) |
| T2b | 52 (25.3%) |
| T2c | 58 (28.3%) |
| T3a | 7 (3.4%) |
| T3b | 8 (3.9%) |
| ≤ 6 7 | 60 (29.3%) 108 (52.7%) |
| ≥ 8 | 37 (17%) |
| Median | 15 |
| Range | 2–137 |
| < 10 | 108 (52.7%) |
| 10–20 | 67 (32.7%) |
| ≥ 20 | 30 (14.6%) |
| Low | 23 (11.2%) |
| Intermediate | 120 (58.6%) |
| High | 62 (30.2) |
| No | 88 (42.9%) |
| Short (≤ 6 months) | 61 (29.8%) |
| Long (> 6 months) | 56 (27.3%) |
| 22 (10.7%) | |
| 37.5 Gy |
26 (12.7%) |
| 40 Gy | 179 (87.3%) |
Radiation Therapy Oncology Group acute radiation morbidity scoring scheme20
| Organ tissue | Grade 0 | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|---|
| No change | Increased frequency or change in quality of bowel habits not requiring medication/ rectal discomfort not requiring analgesics | Diarrhea requiring parasympatholytic drugs/mucous discharge not necessitating sanitary pads/rectal or abdominal pain requiring analgesics | Diarrhea requiring parenteral support/severe mucous or blood discharge necessitating sanitary pads/abdominal distention (flat plate radiograph demonstrates distended bowel loops) | Acute or subacute obstruction, fistula or perforation; GI bleeding requiring transfusion; abdominal pain or tenesmus requiring tube decompression or bowel diversion | |
| No change | Frequency of urination or nocturia twice pretreatment habit/dysuria, urgency not requiring medication | Frequency of urination or nocturia that is less frequent than every hour. Dysuria, urgency, bladder spasm requiring local anesthetic | Frequency with urgency and nocturia hourly or more frequently/dysuria, pelvis pain or bladder spasm requiring regular, frequent narcotic/gross hematuria with/ without clot passage | Hematuria requiring transfusion/acute bladder obstruction not secondary to clot passage, ulceration, or necrosis |
Summary of acute genitourinary (GU) and gastrointestinal (GI) toxicities published in trials using SBRT for prostate cancer treatment
| Study | No. of patients | Dose | Grade 1–2 GU (%) | Grade ≥ 3 GU (%) | Grade 1–2 GI (%) | Grade ≥ 3 GI (%) |
|---|---|---|---|---|---|---|
| Madsen, 2007 |
40 | 6.7 Gy x 5 fx | 49 | 2.5 | 39 | 0 |
| Katz, 2010 |
304 | 7/7.25 Gy x 5 fx | 79 | 0 | 78 | 0 |
| Boike, 2011 |
45 | 9.5/10 Gy x 5 fx | 51 | 0 | 55 | 0 |
| Freeman, 2011 |
41 | 7/7.25 Gy x 5 fx | 32 | 2.5 | 16 | 0 |
| Jabarri, 2012 |
38 | 9.5 Gy x 4/2 fx | 71 | 0 | 32 | 0 |
| McBride, 2012 |
45 | 7.5/7.25 Gy x 5 fx | 74 | 0 | 38 | 0 |
| Loblaw, 2013 |
84 | 7 Gy x 5 fx | 88 | 1 | 77 | 0 |
| Bolzicco, 2013 |
100 | 7 Gy x 5 fx | 46 | 0 | 45 | 0 |
| Oliai, 2013 |
70 | 7–7.4 Gy x 5 fx | 63 | 4 | 26 | 3 |
| Mantz, 2014 |
102 | 8 Gy x 5 fx | 58 | 2 | 0 | 0 |
| Chen, 2014 |
100 | 7/7.25 Gy x 5 fx | 71 | 0 | 21 | 0 |
| Anwar, 2016 |
50 | 10.5 9.5 Gy Gy x x 2 2 fx fx and boost | 85 | 0 | 52 | 0 |
| Hannan, 2016 |
91 | 9–10 Gy x 5 fx | 70 | 0 | 58 | 2 |
| Brand, 2019124 | 415 | 7.25 Gy x 5 fx | 78 | 3 | 63 | 1 |
| 1Widmark, 2019 |
589 | 6.1 Gy x 7 fx | 48 | 5 | 51 | 1 |
| Present study | 205 | 7.5/8 Gy x 5 fx | 81 | 1.5 | 38 | 0 |
| All studies | 2319 | Total Number dose: of 33.5fxs: -50 5–Gy 7 | 32–88 | 0–5 | 0–78 | 0–3 |
Median volumes and dose coverages of prostate and seminal vesicles clinical- and planning target volumes (CTVpros, CTVpsv, PTVpros, PTVpsv) of 205 prostate cancer patients treated with stereotactic radiation therapy
| CTVpros | PTVpros | CTVpsv | PTVpsv | |
|---|---|---|---|---|
| Volume, cm3 (range) | 52.1 | 70.6 | 80.4 | 108.1 |
| (15.9–134.7) | (25.1–166.6) | (30.8–208.5) | (45.4–259.3) | |
| Dose coverage % (range) | 99.1 | 95.8 | 100 | 99.5 |
| (94.7–100) | (88.8–99.9) | (97.6–100) | (95.2–100) |
Acute toxicities after prostate and seminal vesicles intensity-modulated, stereotactic irradiation with SIB technique (N = 205)
| Toxicity | Grade | Toxicity at the end of treatment N = 205 (%) | Toxicity 3 months after treatment N = 205 (%) |
|---|---|---|---|
| 0 | 128 (62.4) | 195 (95) | |
| Gastrointestinal | 1 2 | 65 (31.7) 12 (5.9) | 9 (4.5) 1 (0.5) |
| 3 | 0 (0) | 0 (0) | |
| 0 | 35 (17.1) | 153 (74.6) | |
| Genitourinary | 1 2 | 63 (30.7) 104 (50.7) | 30 (14.7) 20 (9.7) |
| 3 | 3 (1.5) | 2 (1) |
Acute side effects at the end of radiation therapy according to the risk groups
| Toxicity | Grade | Low risk N = 23 (%) | Intermediate risk N = 120 (%) | High risk N = 62 (%) |
|---|---|---|---|---|
| 0 | 8 (35) | 83 (69) | 37 (60) | |
| 1 | 14 (61) | 29 (24) | 22 (35) | |
| Gastrointestinal | ||||
| 2 | 1 (4) | 8 (7) | 3 (5) | |
| 3 | 0 (0) | 0 (0) | 0 (0) | |
| 0 | 1 (4) | 26 (74.6) | 8 (13) | |
| 1 | 10 (43) | 25 (14.7) | 28 (45) | |
| Genitourinary | ||||
| 2 | 12 (54) | 66 (9.7) | 26 (42) | |
| 3 | 0 (0) | 3 (2) | 0 (0) |