ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

performed 45 days after treatment. Liver, kidney and pancreatic
function were assessed by blood tests. Results: All patients
completed treatment, which was well tolerated. Gastrointestinal
acute toxicity was evaluated in all patients and was the
following: G1 in five patients (nausea and/or moderate diarrhea
not requiring drugs); G2 in one patient with extensive
irradiation volume (diarrhea requiring drugs); no G3-G4
toxicity was observed. Genitourinary acute toxicity was G4 in
one patient, with acute urinary obstruction requiring catheter,
but this occurrence appeared after only three sessions (at a dose
of 7.05 Gy), and it resolved quickly with antibiotics, steroids
and alpha 1 blockers; in addition, this patient had a history of
previous episodes of acute urinary obstruction requiring
catheter. Hematological toxicity was G1 in two patients (slight
decrease of white and red blood count and hemoglobin) and
G0 in the others. In one patient, there was a slight increase of
pancreatic amylase. Late toxicity was not evaluated because of
the limited follow-up (three months). MRI, performed in one
patient, revealed remission of previously positive lymph nodes.
Prostate-specific antigen level was evaluated and decreased in
all patients. Discussion and Conclusion: Our initial experience
shows that HT enables a good daily check of internal anatomy
to ensure proper set-up for patients. Under this observation,
treatment of extensive volumes, near dose-limiting for OAR,
and dose escalation on target volume, can be performed with
reduced acute toxicity. These results are however preliminary
and further follow-up is necessary to evaluate outcome and late
toxicity.
1 Malinverni G, Landoni C, Stasi M , Picchio M, Gatti M,
Delmastro E, Bona C, Gabriele P and Fazio F: Clinical
application of 11C-choline PET in patients with biochemical
relapse of prostate cancer. ECCO Meeting, Parigi, 2005.
2 Jereczek-Fossa BA, Beltramo G, Fariselli L, Fodor C,
Santoro L, Vavassori A, Zerini D, Gherardi F, Ascione C,
Zanetti IB, Mauro R, Bregantin A, Bianchi LC, De Cobelli
O and Orecchia R: Robotic image-guided stereotactic
radiotherapy, for isolated recurrent primary, lymph node or
metastatic prostate cancer. Int J Radiat Oncol Biol Phys,
2011.
3 Engels B, Soete G, Tournel K, Bral S, De Coninck P,
Verellen D and Storme G: Helical tomotherapy with
simultaneous integrated boost for high-risk and lymph nodepositive
prostate cancer: early report on acute and late
toxicity. Technol Cancer Res Treat 8(5): 353-359, 2009.
168
INTRAOPERATIVE RADIOTHERAPY FOR
LOCALLY ADVANCED PROSTATE CANCER:
TREATMENT TECHNIQUE AND
PRELIMINARY OUTCOMES
1900
ANTICANCER RESEARCH 31: 1807-1956 (2011)
Andrea Vavassori 1 , Barbara Jereczek-Fossa 1 ,
Federica Cattani 2 , Cristiana Fodor 4 , Federica Gherardi 1 ,
Dario Zerini 1 , Agnese Cecconi 1 , Veronica Dell’acqua 1 ,
Raffaella Cambria 2 , Elena Rondi 2 , Cristina Garibaldi 2 ,
Stefania Comi 2 , Sabrina Vigorito 2 , Roberta Lazzari 1 ,
Ottavio Decobelli 3 , Gennaro Musi 3 , Federica Mazzoleni 3 ,
Epifanio Scardino 3 , Victor Matei 3 , Fabrizio Verweij 3 and
Roberto Orecchia 1
1 Radioterapia Oncologica, 2 Fisica Sanitaria, 3 Urologia and
4 Data Manager, Istituto Europeo Di Oncologia, Milano, Italy
Aim: To present a technique adopted for intraoperative
radiotherapy (IORT) for locally advanced prostate cancer and
preliminary outcomes. Patients and Methods: Between June
2005 and December 2010, 50 consecutive patients with nonmetastatic,
intermediate-risk or locally advanced, prostate
cancer were treated with IORT before prostatectomy as part
of their surgical procedure. The median age was 65 years. The
median iPSA was 14 ng/ml and the median bioptic Gleason
score was 7. According to NCCN 2010, the risk group
distribution was as follows: four patients at intermediate risk
(8%), 43 patients at high risk (86%) and three patients at very
high risk (6%). A total of 21 patients (42 %) were treated with
neoadjuvant hormonal therapy. Immediately before IORT,
prostate dimensions and rectum depth were measured with
intraoperative ultrasound in order to select the electron beam
energy and the applicator size properly and to estimate the
doses to target and organs at risk. IORT was delivered by a
mobile linear accelerator in the operating room, using 8-10
MeV electron energies and 5-7 cm diameter applicators. The
prescribed dose was 12 Gy at the 90% isodose. According to
the pathological findings, it would be possible to administer
further adjuvant radio- or hormonal therapy: three months
later, postoperative external beam radiotherapy (EBRT) was
prescribed to the prostatic bed alone and whole pelvis in cases
of pT3-4 pN0 and pN1 disease, respectively. Results:
According to the Memorial Sloan Kettering Cancer Center
nomograms, the mean preoperative probability of organconfined
disease, extracapsular disease and lymph node
involvement were 15%, 45% and 22%, respectively.
Postoperative histological findings were as follows: median
GS 8, pT2 disease in 8 patients, pT3 in 37 patients, pT4 in 5
patients, pN0 in 27 patients and pN1 in 23 patients. One
patient died from postoperative pulmonary embolism. Organconfined
disease with negative surgical margins (R0) was
diagnosed in four patients and no further radiation treatment
was prescribed. Adjuvant pelvic and prostatic bed EBRT was
administered to 21 and 19 patients, respectively. No patient
had major acute rectal toxicity. Twenty-three patients had G1-
G2 urinary acute toxicity and two patients had G3 acute
urinary toxicity (iatrogenic monolateral urethral stricture and
acute urinary retention, respectively). No increased risk of