Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prosta
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ongi1 · A. Fogliata2 · P. Navarria1 · A. Tozzi1 · P. Mancosu1 · F. Lobefalo1 · G. Reggiori1 · A. Clivio2 · L. Cozzi2 · M. Scorsetti1 1 Department of Radiotherapy, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan 2 Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona
Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer Report of feasibility and acute toxicity
Prostate cancer (PC) is the most common cancer diagnosed in men and the second cause of cancer mortality after lung primary tumor [1]. Treatment recommendations in PC include several options and external beam radiation therapy (EBRT) is considered a standard treatment option in different large subsets of PC patients. Conventional prostate radiotherapy is delivered in fractions of 1.8–2.0 Gy. Nevertheless, over the last few years, hypofractionation has been adopted as a fractionation strategy of EBRT in PC [2]. The radiobiologic assumption is that PC cells have a higher sensitivity to fraction size, due to lower alpha/beta (α/β) ratio, than late responding organs at risk such as the rectum or bladder [3, 4, 5]. Based on this hypothesis, hypofractionation in PC has the potential to improve the therapeutic window with the advantage to dramatically reduce the total treatment time, while maintaining the same clinical outcomes of conventional EBRT. Thus, short schedules can represent an effective option for PC patients and also a cost-saving choice for the health care system [2, 6]. Recently, moderate hypofractionation combined with the simultaneous integrated boost (SIB) technique, irradiating different volumes at different dose levels in the same session, has been applied to various cancer sites, including the pelvis for PC [7, 8].
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Strahlentherapie und Onkologie 11 · 2012
Advances in EBRT techniques, e.g., intensity-modulated radiotherapy (IMRT) with fixed beams or arcs, allow the implementation of new treatment approaches to PC; with IMRT, the healthy tissue surrounding the prostate can be better spared compared to conventional RT, reflecting this dosimetric advantage in potentially lower side effects [6]. The volumetric modulated arc therapy (VMAT), in its form of RapidArc (RA) based on the original investigations of Otto [9], has been recently introduced in clinical practice, after intensive validation at the planning level where it was compared to IMRT and other approaches in a series of studies on various indications [10, 11, 12]. It is also important to mention the importance of image guidance (IG) during EBRT, e.g., with cone-beam CT (CBCT). This enables patient positioning errors to be followed and corrected with high precision. In PC, where internal organ movement is a key point for patient positioning and target localization [13], IG permits the safe delivery of higher doses per fraction. The aims of the present study are to assess the feasibility of treating PC patients with moderate hypofractionation and SIB with VMAT (RA) an
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