الفهرس 
Risk stratification of prostate cancerOnly 14 pages are availabe for public view
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Abstract
This is a retrospective study reviewing prostate cancer patients who were treated at Children Cancer Hospital- Egypt (CCHE) using IMRT with cone beam CT setup verification (image guided intensity modulated radiotherapy; IGIMRT). Their ages ranged between 45 and 92 years, with a median age of 71 years. Twenty –patients received radical radiotherapy, while four patients treated post-operatively. Ten patients (50%) out of twenty radically treated, received radical radiotherapy to the prostate and seminal vesicles using IMRT; as they were categorized as having Intermediate recurrence risk, while 10 (50%) having high recurrence risk received pelvic radiotherapy (prostate, seminal vesicle and pelvic lymph nodes) using SIB-IMRT.
The aim of the work is to evaluate the treatment related acute side effects and early outcomes of precise radiotherapy technique with dose escalation in prostate cancer treatment.
The primary end point was to assess the treatment related acute side effects and radiation morbidity, together with assessing the early biochemical, clinical response and survival.
Post-operative patients treated with adjuvant radiotherapy with a dose of 66 Gy to prostatic bed, one patient had grade 2 proctitis (prostate only) while the other with grade 2 proctitis was from those received whole pelvic treatment, two had grade 1 cystitis. All four patients are alive.
In radical radiotherapy group (20 patients), no more than grade 2 urinary acute or late toxicity was detected in our patients. There was no difference of statistical significance between the median V70 for the patients with grade 0 urinary tract toxicity and those with grade 1-2 urinary toxicity whether received whole pelvis or prostate only.
Similarly rectal toxicity; showed no more than grade 2 acute (only one patient had Grade 2 acute rectal toxicity) or late toxicity experienced in our patients. The median V70 volume in cases showing grade 0 rectal toxicity (no rectal toxicity) was compared to that of patients with grade 1-2 in both groups (WPRT vs PORT) and in each group separately, insignificant p- value was found
The cumulative Bladder late effect-free rate at 3 years in the two groups was -100% in prostate only (Intermediate group received IGIMRT) and 67± 27% in the high recurrence risk group received SIB-IGIMRT. This difference was not statistically significant (p=0.116). On the other hand, the rectal late effect-free rate was 100% in both groups as none of our patients has experienced late rectal toxicity.
The Overall 3 years survival rate for the radical radiotherapy (whole group) was 86 ±13.2 %.It was 75 ± 21.7% for the whole pelvis (high risk) group, while it was 100 % for the prostate only (intermediate risk) group.
The biochemical-free survival rates were 67± 27% and 100% for the whole pelvis (high risk) and prostate only (intermediate risk) group respectively. The difference was not statistically significant (p=0.56).
Conclusions and Recommendations
Higher radiation dose has been confirmed to be associated with improved tumor-control outcome in localized prostate cancer patients, as radiation dose was one of the important predictors of long- term biochemical tumor control. Consequently, radiation toxicity with such dose escalation increased when using conventional or 3DCRT techniques but not with IG-IMRT.