Dominant Intraprostatic Lesion of intermediate risk patients

irradiated with extra boost using IMRT-SIB-IGRT by Tomotherapy

E. Garibaldi, E. Delmastro, ^D. Gabriele, *S. Bresciani, C. Ortega and
P. Gabriele.
Radiotherapy, *Medical Physics and Oncology Units of Candiolo
Cancer Center - IRCCS, Candiolo (Turin), and ^ Human Physiology Unit
of Neuroscience Department University of Turin, Italy
Introduction: Local recurrence in prostate cancer most frequently occurs
within or close to the primary tumor, often at level of one or more macroscopic
lesions defined as dominant intra-prostatic lesions (DIL). Multi-parametric MRI
(with T2 weighted, DWI and DCE sequences) is the golden standard to detect
and to guide DIL contouring. In prostate cancer, irradiation of DIL with a boost
dose is a widespread but still experimental protocol. In our Centre we have
performed a phase II randomized dose escalation study on DIL identified by
functional MRI. The aim of this abstract is to present our experience of DIL
irradiation up to an Equivalent Dose (EQD2) of 93,2 Gy with Helical
Tomotherapy focusing on the technical and clinical feasibility of the procedure,
on early and intermediate toxicities examinations reported during the follow-up
and on oncologic outcome.
Material and methods: Between March 2011 and June 2014, 12 stage II
patients with intermediate-risk prostate cancer were enrolled in our protocol of
DIL dose escalation by Tomoterapy. All patients were submitted to a
multiparametric MRI, (including T2 weighted, DCE and DWI series), in order to
evaluate and visualize DIL. The prescribed doses were 75,2 Gy in 32 fractions
of 2.35 Gy per day (EQD2 = 80.5 Gy, considering the / ratio between 1 and
4) on prostate gland; between 67,2 Gy and 75.2 Gy in 32 fraction of 2.1 or 2.35
Gy (EQD2 between 70 and 80.5 Gy) on seminal vesicle; 83.2 Gy in 32 fractions
of 2.6 per die (EQD2 = 93.2 Gy) on DIL; 54.4 Gy in 32 fractions of 1.7 Gy per
die (EQD2 = 51.2 Gy) on pelvic volume.
Results: With an average follow up was 18 months (range 4-45), the acute
gastrointestinal (GI) toxicity > G2 was 8.3% (1/12 patients), and the acute
genitourinary (GU) toxicity > G2 was 16.6% (2/12 patients). No rectal acute
toxicity > G2 neither overall severe acute toxicity > G3 was observed. Late
toxicity was evaluable in 8 patients: in these patients no late toxicity > G2 was
observed. At last follow up the biochemical disease free survival was 100%.
Conclusion: The irradiation of whole prostate and seminal vesicles up to an
EQD2 of 80.5 Gy and of DIL up to 93.2 Gy was clinically feasible and safe
without acute severe toxicity. Although with a short follow-up a severe late
toxicity is currently absent yet. However in order to evaluate late toxicity and
definitive outcome a longer follow up is needed.
Paper supported by the grant 5%1000 (2008-2009) of the Financial Ministry
of the Italian Republic.

Corresponding author: E. Garibaldi, Radiotherapy Unit, Candiolo Cancer Center

(elisabetta.garibaldi@ircc.it)