Hermando, O.

Mercedes, L.

Potdevin, G.

Rodriguez, A.

Rubio, C.

Saugar, E. Sánchez

Valero, J.

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Moderate hypofractionation prostate cancer treatment with IMRT, IGRT and internal fiducials 

S98 reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S91–S103
Moderate hypofractionation prostate cancer treatment with IMRT, IGRT and internal ﬁducials
E. Sánchez Saugar1, A. Rodriguez2, J. Valero2, O. Hermando2, L. Mercedes2, G. Potdevin2, C. Rubio2
1 Hospital Universitario Madrid SanChinarro, Oncología Radioterápica, Spain
2 Hospital Universitario Madrid SanChinarro, Spain
Introduction. Hypofractionated treatments are an attractive strategy for institutions and patients with prostate cancer (PC).
Purpose. This study attempts to determine biochemical relapse-free survival (BRFS), overall survival and acute and late toxicities
with moderate hypofractionated stereotactic radiotherapy treatments in patients with PC.
Methods. Between March 2009 and February 2013, 115 patients with PC were treated with moderate hypofractionated stereotactic
radiotherapy: 45 low, 68 intermediate and 2 high risk. Previously, an internal marker (Visicoil®) was placed within the prostate
gland transperineally, guided by transrectal ultrasound, and external infrared spheras were used during the CT simulation. All
patients received 70Gy in 28 fractions (2.5Gy/day) with intensity modulated radiation therapy (IMRT) with “sliding windows”, in
the Novalis Linac (Brainlab®), adapted to stereotactic treatments. Daily veriﬁcation of the internal marker was performed with
IGRT Exactrac® system, using a 6D robotic couch, an infrared camera and orthogonal X-rays. Toxicity was assessed according to
RTOG criteria and biochemical relapse was deﬁned as Nadir+2.
Results. Median follow up was 21 months (2–43). Overall survival was 98.98% and BRFS was 96.94% in the 98 patients analyzed.
Maximal acute urinary toxicities were grade 1 in 66.9% and grade 2 in 2.6% of patients. Grade 1 gastrointestinal toxicities were
observed in 2.6% of patients. There were no grade 3, 4 or 5 events. Late toxicities were evaluated in 95 patients. Urinary toxicities
grade 1 and 2 were 7.3% and 1.03% respectively. No late urinary toxicities higher than grade 2 and late gastrointestinal toxicities
have been reported.
Conclusions. Moderate hypofractionated stereotactic radiotherapy with IMRT, IGRT and internal markers is a feasible, safe and
accurate treatment for PC. The toxicity proﬁle was similar to previous studies reported and the BRFS rate was very high, although
longer follow up is needed.
http://dx.doi.org/10.1016/j.rpor.2013.03.815
Osteopaenia and osteoporosis among localized prostate cancer patients treated with long-term androgen depri-
vation and radiotherapy
V. Macías Hernández1, K. Matskov1, P. Tamayo2, D. Ciprian Nieto3, C. Cigarral 1, O. Alonso Rodriguez1,
P. Soria Carreras1, A. Nieto Palacios1, A. Rodriguez Gutierrez1, L. Pérez Romasanta1
1 Complejo Asistencial Universitario de Salamanca, Oncología Radioterápica, Spain
2 Complejo Asistencial Universitario de Salamanca, Medicina Nuclear, Spain
3 Complejo Asistencial Universitario de Salamanca, Unidad de Investigación, Spain
Background. In men, age is associated with a decrease in testosterone and estradiol levels, resulting in an annual decrease in bone
mass of around 1%. Prostate cancer (PCa) patients might have a lower bone mineral density (BMD) than age-matched controls,
although the mechanism is not clear. In addition, a signiﬁcant number of patients receive androgen-deprivation therapy (ADT),
which has adverse effects; of these, one of the most important is the loss of bone mineral. This enhances the risk of additional
morbidity, such as bone fractures with a decreased quality of life.
Objectives. To determine the prevalence of osteopaenia and osteoporosis in PCa patients treated with long-term ADT (>12 months)
and curative radiotherapy.
Methods. From 7-2011 to 1-2013 the lumbar spine, femoral neck and total hip BMD was measured by dual X-ray absorptiometry
in 52 patients before ADT and radiotherapy. The same procedure was repeated 12 months later. Osteopaenia and osteoporosis
were deﬁned by a T score of −1.0 to −2.5 and ≤−2.5, respectively (NHANES).
Results. Mean age was 70±7 years. Before treatment 17 men (32.7%) had osteopaenia, 6 had osteoporosis (11.5%) and 29 had
normal values (55.8%). Median follow-up was 10 months (2–17). To date, nineteen patients had repeated the exam after one year
ADT. Of those, before treatments osteopaenia was found in 9/19 men (47.4%), osteoporosis in 2/19 (10.5%) and within normal
values in 7/19 (36.8%). The ﬁgures 1 year later were 10/19 (52.6%), 2/19 (10.5%) and 7/19 (36.8%), respectively.
Conclusions. Before treatments, one-third and one-tenth of PCa patients who were planned to receive long-term
ADT± radiotherapy had osteopaenia and osteoporosis, respectively. The ﬁgures did not changed by much after 1-year ADT.
http://dx.doi.org/10.1016/j.rpor.2013.03.816


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Moderate hypofractionation prostate cancer treatment with IMRT, IGRT and internal fiducials

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