Purpose: To compare radiotherapy-induced toxicity for localized prostate-cancer (PCa) treated with versus without daily image-guidance. Patients and Methods: We identified consecutive intermediate and high-risk localized PCa patients treated with definitive radiotherapy using intensity-modulated radiotherapy (IMRT) with variable duration of androgen-deprivation therapy (ADT) within 2015-2016 (Arm-A) and 2005-2007 (Arm-B). Arm-A cases received daily online imaging guidance (IGRT) using cone-beam computed tomography (CBCT) unlike Arm-B candidates with no daily IGRT. After reporting demographic, clinico-pathological features and treatment details, we compared acute (within 3 months post-therapy) and late RT-induced toxicities between study groups graded by RTOG/CTCAE criteria. Uni/multivariate analyses (UVA/MVA) were performed to identify independent predictors for RT-related side-effects. Results: We were able to identify 257 cases who met our inclusion criteria. Overall, median age was 73 years (48-85), 67% had intermediate-risk and 47% received ADT. Arm-A included 72 patients who received IMRT delivered using volumetric-modulated arc therapy (VMAT), whereas, Arm-B was formed of 185 cases who utilized step-and-shoot static IMRT. Clinico-pathological features and treatment details were non-different across study arms except that Arm-A had more Grade Group 3, higher median total dose (79.2 vs. 74 Gy) and more pelvic lymph-nodes RT (p <0.05). Although acute toxicity was similar across groups, Arm-B encountered higher late toxicity score, more intense late genitourinary side-effects (P=0.008), with non-different late lower-gastrointestinal toxicities. On MVA, lack of daily CBCT, African-American race and higher comorbidities were independently predictive for late toxicities. Conclusion: IMRT with daily CBCT permitted safe delivery of dose-escalated IMRT with improved toxicity profile for higher-risk prostate cancer.
Ghanem, A., Elsaid, A., Elshaikh, M., & Khedr, G. (2021). Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer. Asian Pacific Journal of Cancer Prevention, 22(1), 61-68. doi: 10.31557/APJCP.2021.22.1.61
MLA
Ahmad I Ghanem; Amr A Elsaid; Mohamed A Elshaikh; Gehan A Khedr. "Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer". Asian Pacific Journal of Cancer Prevention, 22, 1, 2021, 61-68. doi: 10.31557/APJCP.2021.22.1.61
HARVARD
Ghanem, A., Elsaid, A., Elshaikh, M., Khedr, G. (2021). 'Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer', Asian Pacific Journal of Cancer Prevention, 22(1), pp. 61-68. doi: 10.31557/APJCP.2021.22.1.61
VANCOUVER
Ghanem, A., Elsaid, A., Elshaikh, M., Khedr, G. Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer. Asian Pacific Journal of Cancer Prevention, 2021; 22(1): 61-68. doi: 10.31557/APJCP.2021.22.1.61
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