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

Table II.
Median value
3DCRT V40 V50 V60 V70 V72
5-Field 65 55 40 25 20
7-Field 60 38 30 23 20
No G3 acute urinary toxicity was observed. Mild to moderate
incontinence was reported in 2.5% of cases for each group,
and urethral stenosis in 1.5% of the whole patient series. Table
III shows cancer-specific survival (CSS), overall survival (OS),
metastasis-free survival (MFS) and biochemical relapse-free
survival (b-NED) at five and at ten years, after a median
follow-up of 86.5 (range 25-142) months.
Table III.
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
Parameter Five years Ten years
CSS 99% 92%
OS 94.1% 67%
MFS 93.8% 80%
b-NED 87% 77%
Conclusion: 3DCRT technique can be considered a safe and
effective treatment for patients affected by localized prostate
cancer. The 7-field technique has a significantly better late
rectal toxicity than 5-field 3DCRT. Although no correlation
was found between dose-volume parameters and G3 late rectal
toxicity, we suggest that a low dose of radiation therapy given
to an extended rectal wall volume causes perfusion damage
and represents the basis for mucosal ulcer and severe rectal
bleeding.
180
RADICAL PROSTATECTOMY AND
INTRAOPERATIVE RADIATION THERAPY
FOR CLINICALLY LOCALLY ADVANCED
PROSTATE CANCER: CLINICAL ASPECTS
AND RESULTS OF A PROSPECTIVE SERIES
Giansilvio Marchioro 1 , Marco Krengli 2 , Alessandro Volpe 1 ,
Matteo Vidali 3 , Roberto Tarabuzzi 1 , Stefano Zaramella 1 ,
Michele Billia 1 , Francesco Varvello 1 , Monica Zacchero 1 ,
Elisa De Lorenzis 1 , Andrea Ballarè 2 , Debora Beldì 2 ,
Giuseppina Apicella 2 , Bruno Frea 4 and Carlo Terrone 1
Departments of 1 Urology and 2 Radiotherapy Medicine and
3 Clinical Chemistry Unit, Maggiore della Carità Hospital,
University of Piemonte Orientale, Novara, Italy;
4 Urology Department, Santa Maria della Misericordia
Hospital, University of Udine, Udine, Italy
Aim: Intraoperative radiation therapy (IORT) is a new
technique that can deliver high doses of radiation during
surgical treatment. Four years ago, we started a prospective
feasibility study of IORT during radical prostatectomy (RP)
for locally advanced prostate cancer (PCa). Here we report
data on morbidity, toxicity (RTOG scoring criteria), functional
and oncologic outcomes of our prospective series. Patients and
Methods: From September 2005, 72 patients with locally
advanced PCa were treated with IORT during RP. A total of
67 patients had follow up ≥6 months. Inclusion criteria were:
age 25% (Kattan’s nomograms) and no
inflammatory bowel disease. During surgery, the prostate was
exposed with dissection of endopelvic fascia and puboprostatic
ligaments. The distance between the prostate and
rectum was measured with ultrasound. A collimator
(Mobetron, Intraop, California, U.S.A.) with a median
diameter of 5.5 (range 4.5-7) cm and an angle ‘bevel’ of 15-
30˚ was introduced into the surgical field and a dose of 10-12
Gy with 9-12 MeV was delivered. The dose was prescribed to
a 90% isodose. The volume treated included prostate, seminal
vesicles and periprostatic area. RP was then completed and an
extended lymphadenectomy was performed. Postoperative RT
treatment three months after IORT, based on histological
findings, was planned for 38/44 patients. A 3D conformal
technique was used and a dose of 50 Gy (2 Gy/day) was
delivered. Hormonal therapy (HT) was prescribed when
indicated. Results: The median patient age was 67.2 (IQR
62.3-73.0, min-max 51-75) years and median PSA at
diagnosis was 21.8 (IQR 6.6-31.1, min-max 2.0-67.5) ng/ml.
Biopsy Gleason score ranged from 4 to 9. A total of 23
patients (35%) received neoadjuvant treatment. The majority
of patients had clinically locally advanced PCa (78%). We
observed no intra- or perioperative complications. The median
dose absorbed by the rectum was 4.6 (range: 0.4-9.1) Gy.
Pathological stage was: T2 in 21 patients, T3 in 40 patients
and T4 in 5 patients. Positive lymph nodes were detected in
17 patients (25.7%) and positive surgical margins (PSM) in 41
patients (61%). A total of 56 patients (85%) underwent
postoperative RT treatment, with a median follow-up of 24
months (6-46). Rectal and urinary RT toxicity are detailed in
Table I, according to the RTOG scale.
Table I.
N=66 Grade, N (%)
Toxicity G0 G1 G2 G3
Gastrointestinal, acute 52 (78.8) 7 (10.6) 6 (9.1) 1 (1.5)
late 60 (90) 2 (3) 3 (4.5) 1 (1.5)
Genitourinary, acute 44 (66.6) 13 (19.6) 8 (12.3) 1 (1.5)
late 57 (86.5) 1 (1.5) 6 (9) 2 (3)
1907