26-29 Novembre 2008 Chieti- Pescara - Salute per tutti

XVIII Congresso Nazionale Società Italiana di Urologia OncologicaAbstract n. 105 COMUNICAZIONE (sessionedel 27/11/2008, Comunicazioni Miscellanea 1)PHASE I-II STUDY OF HYPOFRACTIONATED SIMULTA-NEOUS INTEGRATED BOOST WITH TOMOTHERAPY FORPROSTATE CANCERDi Muzio N. 1 , Fiorino C. 2 , Cozzarini C. 1 , Alongi F. 1 , BroggiS., Berardi G. 1 , Mangili P. 2 , Guazzoni G. 3 , Valdagni R. 4 ,Calandrino R. 2 , Fazio F. 1,5,61Radiotherapy, Scientific Institute San Raffaele, Milan, Italy;2Medical Physics, Scientific Institute San Raffaele, Milan, Italy;3Urology, Scientific Institute San Raffaele, Milan, Italy; 4 ProstateProgram-Scientific Direction, National Institute of Tumours, Milan,Italy; 5 Nuclear Medicine, Scientific Institute San Raffaele, Milan,Italy; 6 IBFM-CNR, ItalyIntroduction: To report planning and acute/early late toxicitydata of the first 60 patients treated within a phase I-II studywith moderate hypofractionation by Helical Tomotherapy.Materials and Methods: Different Clinical Target Volumes weredefined during countouring: CTV1: Pelvic nodes; CTV2:upper portion of seminal vesicles (SV); CTV3: lower portion ofSV; CTV4: prostate; OP: overlap between PTV4 and rectum.Different doses to each PTV were simultaneously delivered in28 fractions(moderately hypofractionated). Based on NCCNclassification, for 31 low risk patients :56, 61.6 and 71.4 Gyfor PTV2-4 respectively; for 20 intermediate risk patients:51.8, 61.6, 65.5 and 74.2 Gy for PTV1-4 respectively; for 9high risk patients: 51.8, and 65.5 Gy for PTV1-2 and 74.2 Gyfor PTV3-4. For all patients the dose to OP was 65.5 Gy.Results: Tomotherapy provided improved dose distributions, allowingan excellent sparing of rectum and intestinal cavity whileassuring very homogeneous dose distributions within each PTV.Acute genito-urinary (GU) toxicity was as follows: 21/60(35%)G1, 12/60(20%) G2, 2/60(3%) G3. Acute rectal toxicities were:18/60(30%) G1. Twelve (20%) patients showed G1 upper intestinal(uGI) toxicity. No patients experienced ? G2 acute rectal oruGI side effects. Concerning late toxicity, with a median followupof 13 months, 2/60 experienced G3 GU while no ? G3 GIwere reported (with only 2/60 G2 proctitis).Conclusions: This study shows excellent results with regard toacute toxicity and promising early late toxicity rates. Furtherfollow up is needed to assess definitive late toxicity andtumour control outcome.Abstract n. 106 COMUNICAZIONE SELEZIONATA(sessione del 28/11/2008, Comunicazioni selezionate -Terapia chirurgica, Radioterapia)COMPARISON OF ACUTE TOXICITY PROFILE BETWEEN3 MODALITY OF PELVIC RT: TOMOTHERAPY, INTENSITYMODULATED AND THREE DIMENSIONAL CONFORMALRADIATION THERAPY WITH PELVIC LYMPH NODESIRRADIATION IN POST-OPERATIVE PROSTATE CANCERPATIENTSAlongi F. 1 , Fiorino C. 2 , Cozzarini C. 1 , Broggi S. 2 , Di MuzioN. 1 , Perna L. 2 , Calandrino R. 2 , Fazio F. 1-3-41Radiotherapy, Scientific Institute San Raffaele, Milan; 2 Physics,Scientific Institute San Raffaele, Milan; 3 Nuclear Medicine,Scientific Institute San Raffaele, Milan; 4 IBFM-CNRIntroduction: To compare the incidence of acute genito-urinary(GU),upper gastrointestinal (uGI) and rectal (lGI) injuriesbetween Tomotherapy, intensity modulated radiation therapy(IMRT) and three dimensional conformal radiotherapy(3DCRT)in patients with localized prostate cancer treatedwith prostatic bed and pelvic lymph nodes irradiation, afterradical prostatectomy.Materials and Methods: Between February 2000 and February2008, 144 consecutive with clinically localized prostate cancerpatients submitted to radical prostatectomy were also irradiatedto prostate bed and pelvis lymph nodes in our Institute. Ofthe 144 patients, 80 had undergone 3DCRT.Of the remnant 63 patients 44 were treated with Hi-Tomotherapy and 19 with IMRT with linear accelerator. Themedian age was 64.7 and 65,6 for 3DCRT and Tomotherapy-IMRT group respectively. The median dose to the prostatic bedwas 72.8 Gy(65.8-77.4) with 1.8Gy per fraction in 3DCRTgroup and 70.3Gy (64.4-76) with 2-2.55Gy per fraction in theTomotherapy-IMRT group. The dose to pelvis nodes was50.1Gy (45-54Gy) with 1.8Gy per fraction in 3DCRT groupand 50.1Gy (50-54 Gy) with 1.85-2 Gy per fraction in theTomotherapy-IMRT group.After radical prostatectomy, the median time to RT was 397 and429 days respectively in 3DCRT and Tomotherapy-IMRT group.Acute GU, uGI e lGI toxicities after radiation treatment wereevaluated using Radiation Therapy and OncologyGroup/European Onganization for Research and Treatment ofCancer(RTOG/EORTC) medical scoring system.Results: Patients treated with Tomotherapy or IMRT had alower incidence of the acute GU, uGI and lGI injuries thanwho had undergone 3CRT. In 3DCRT and Tomotherapy-IMRTgroups the incidences of radiation injuries are for GU G1-353.8 % versus 44.4 % and for G2-3 12.5 % versus 6.3 %respectively for the two groups. For uGI G1-3 toxicities were53.8 % versus 44.4 % and for uGI G2-3 were 22.5 % versus4.8 %(p.0,0035) respectively for the two groups. For lGI G1-3 toxicities were 42.5 % versus 41.3 % and for lGI G2-3 8..8% versus 1.6 % (p=0.065).Comparing 3DCRT versus only Tomotherapy acute toxicitiesare as follow: G2-3 GU 12.5 % versus 4.5 % G2-3UGI 22.5 %versus 2.3 % ,G2-3 lGI 8.8 % versus 0.0 %.Conclusions: The results of our study of 144 patients haveshown that acute GU, uGI and IGI toxicties are reducted withTomotherapy and IMRT when were treated prostatic bed andpelvis nodes after radical prostatectomy.Tomotherapy and IMRT approach resulted also in a greatersafely to minimize uGI G2-3 acute injuries.This advantage was also evidenced in the comparision between3DCRT and Tomotherapy with statistical impact for thelast approach on reduction G2-3 UGI and lGI acute toxicities.Longer term data are awaited for late toxicity profiles and clinicalefficacy in Tomotherapy and IMRT patients.Abstract n. 107 COMUNICAZIONE (sessionedel 29/11/2008, Comunicazioni Prostata 3)FEASIBILITY AND PRELIMINARY RESULTS OF (11)CCHOLINE-PET/CT GUIDED TOMOTHERAPY FOR LYMPHNODES RELAPSES IN PROSTATE CANCER PATIENTSAlongi F. 1 , Di Muzio N. 1 , Picchio M. 3 , Landoni C. 3 ,Cozzarini C. 1 , Fiorino C. 2 , Fazio F. 1-3-41Radiotherapy, Scientific Institute San Raffaele, Milan; 2 Physics,Scientific Institute San Raffaele, Milan; 3 Nuclear Medicine, ScientificInstitute San Raffaele, Milan; 4 IBFM-CNRBackground: To establish the feasibility of Tomotherapy treatment(HTT)in terms of acute and late toxicity.Materials and Methods: From January 2005 to March 2008, 21patients(pts) with biochemical recurrence, based on evidenceof lymph-node metastases on [(11)C]choline-PET/CT scanwere treated with high dose moderate hypofractionated HTT.Pts were previously underwent RP (18) and or RT (13): 3 radical,10 post-operative with salvage/adjuvant intent. In 19/21and 3/21 with minimum follow up longer than 3 months[(11)C]choline-PET/CT detected para-aortic and or pelvic, andmediastinal LNM respectively. The treatment plan was based on98Archivio Italiano di Urologia e Andrologia 2008, 80, 3, Supplemento 1