Volumetric Image-guided Highly Conformal Radiotherapy of the Prostate Bed: Toxicity Analysis

Aim: To evaluate toxicity of high conformal image-guided radiotherapy of the prostate bed.

Background: Radiotherapy of the prostate bed has a pivotal role in the post-operative and salvage settings, but few clinical data are available on the use of daily image guidance in combination with highly conformal techniques, and data on long-term results are lacking.

Materials And Methods: We analyzed 118 patients irradiated on the prostate bed using conformal plans processed with a micro-multileaf collimator, and daily checking treatment set-up with a cone-beam CT system. Correlation between toxicity and clinical-dosimetric parameters was assessed by the Cox regression model and log-rank test. Survival analyses were performed with the Kaplan-Meier method.

Results: Median follow-up was 54.08 months. Late grade ≥2 gastro-intestinal (GI) and genito-urinary (GU) toxicity were 3.4% and 4.2%, respectively. Actuarial 4-year late grade ≥2 GI and GU toxicities were 4% and 6%, respectively. Four-year relapse-free survival was 87%. At log-rank test, acute grade ≥2 GI toxicity is associated with the use of antihypertensives ( = 0.03), and there is a trend toward significance between the use of anticoagulants and late grade ≥2 GI toxicity ( = 0.07). At Cox analysis, acute grade ≥2 GU toxicity is correlated with the percentage of bladder volume receiving more than 65 Gy ( = 0.02, HR 1.87 CI 1.25-2.8), and the maximal dose to the rectum is correlated to the development of late grade ≥2 GI toxicity ( = 0.03, HR 2.75 CI 1.10-6.9).

Conclusions: Conformal volumetric image-guided radiotherapy of the prostate bed leads to low toxicity rates.