Reduced acute toxicity associated with the use of volumetric modulated arc therapy for the treatment of adenocarcinoma of the prostate

Phosphatase and tensin homolog (PTEN) gene acts as a tumour suppressor gene. Mutations of this gene are a step in the development of many cancers. Sufferers can have large fields of symptomatic hamartomatous skin change especially in sun exposed areas. RT has been reported to cause increased acute toxicity in this cohort. A 78-year-old fit male had a confirmed PTEN variant LRG_311t1 Exon 5, c353A>C. Symptomatic skin lesions of left frontal scalp and left nasal ala were confirmed on punch biopsy to be basal cell carcinoma (BCC) and he was referred for definitive radiotherapy (RT). He was treated with lesion based superficial radiotherapy to the left nasal ala to a total dose of 50 Gy in 25 fractions given at 5 fractions per week using a Xstrahl 300 machine via a 3cm circle applicator at 30cm source surface distance with a generating energy of 100 kV. The left frontal scalp was treated with a field-based volumetric modulated arc therapy technique to a planning target volume (PTV) of 74.8cm3 to 45 Gy with a simultaneous integrated boost PTV to 55 Gy of 4.1 cm3 to the BCC, all in 25 fractions. He developed the expected desquamation, erythema and mucositis within the nasal field and desquamation and erythema in the left temple. The PTEN mutation had no visible increase on the acute side effect profile compared with those without the mutation. After more than 6 months, the areas treated with RT remained clear of symptomatic hamartomatous skin change with no late toxicities. To our knowledge this is the longest benefit received of any treatment for fields of symptomatic hamartomatous skin change associated with PTEN mutation. It is also a report of not observing increased acute toxicity of RT in the definitive treatment of skin cancer in those with proven PTEN mutation. This one case adds evidence that definitive RT to skin may be delivered safely in this cohort. More studies with multiple patients with longer follow up are needed to confirm that those suffering with PTEN mutation can be safely and successfully treated with definitive RT for skin cancer and fields of symptomatic hamartomatous skin change with no increase in late effects.

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Moderate Hypofractionation and Simultaneous Integrated Boost With Volumetric Modulated Arc Therapy for Prostate Cancer: Report of Feasibility and Acute Toxicity

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1011 ◽

2012 ◽

Vol 84 (3) ◽

pp. S383-S384

Author(s):

F. Alongi ◽

A. Fogliata ◽

S. Arcangeli ◽

S. Castiglioni ◽

G. Taverna ◽

...

Keyword(s):

Prostate Cancer ◽

Acute Toxicity ◽

Volumetric Modulated Arc Therapy ◽

Simultaneous Integrated Boost ◽

Arc Therapy ◽

Integrated Boost ◽

Moderate Hypofractionation

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Feasibility and Acute Toxicity of Supine Craniospinal Irradiation With Image Guided Volumetric Modulated Arc Therapy in Pediatric Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.1850 ◽

2015 ◽

Vol 93 (3) ◽

pp. E509-E510

Author(s):

K. Wong ◽

O.M. Ragab ◽

A. Aguilar ◽

N.G. Dholakia ◽

A.J. Olch

Keyword(s):

Acute Toxicity ◽

Pediatric Patients ◽

Volumetric Modulated Arc Therapy ◽

Craniospinal Irradiation ◽

Image Guided ◽

Arc Therapy

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Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters

Strahlentherapie und Onkologie ◽

10.1007/s00066-021-01782-5 ◽

2021 ◽

Author(s):

Leif Hendrik Dröge ◽

Franziska-Felicitas von Sivers ◽

Markus Anton Schirmer ◽

Hendrik Andreas Wolff

Keyword(s):

Cervical Cancer ◽

Small Bowel ◽

Acute Toxicity ◽

Volumetric Modulated Arc Therapy ◽

Late Toxicity ◽

Conformal Radiotherapy ◽

Clinical Results ◽

Special Consideration ◽

3D Conformal Radiotherapy ◽

Arc Therapy

Abstract Purpose Intensity-modulated radiotherapy (IMRT) for cervical cancer yields favorable results in terms of oncological outcomes, acute toxicity, and late toxicity. Limited data are available on clinical results with volumetric modulated arc therapy (VMAT). This study’s purpose is to compare outcome and toxicity with VMAT to conventional 3D conformal radiotherapy (3DCRT), giving special consideration to the influence of patient- and treatment-related parameters on side effects. Materials and methods Patients with cervical cancer stage I–IVA underwent radiotherapy alone or chemoradiotherapy using 3DCRT (n = 75) or VMAT (n = 30). Survival endpoints were overall survival, progression-free survival, and locoregional control. The National Cancer Institute Common Terminology Criteria for Adverse Events and the Late Effects of Normal Tissues criteria were used for toxicity assessment. Toxicity and patient- and treatment-related parameters were included in a multivariable model. Results There were no differences in survival rates between treatment groups. VMAT significantly reduced late small bowel toxicity (OR = 0.10, p = 0.03). Additionally, VMAT was associated with an increased risk of acute urinary toxicity (OR = 2.94, p = 0.01). A low body mass index (BMI; OR = 2.46, p = 0.03) and overall acute toxicity ≥grade 2 (OR = 4.17, p < 0.01) were associated with increased overall late toxicity. Conclusion We demonstrated significant reduction of late small bowel toxicity with VMAT treatment, an improvement in long-term morbidity is conceivable. VMAT-treated patients experienced acute urinary toxicity more frequently. Further analysis of patient- and treatment-related parameters indicates that the close monitoring of patients with low BMI and of patients who experienced relevant acute toxicity during follow-up care could improve late toxicity profiles.

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