TY - THES A1 - Schortmann, Max T1 - Toxizität und klinische Ergebnisse der moderat hypofraktionierten und bildgeführten Teletherapie des lokalisierten Prostatakarzinoms an der Klinik und Poliklinik für Strahlentherapie des Universitätsklinikums Würzburg – Eine retrospektive Analyse – T1 - Toxicity and clinical outcomes of the moderately hypo-fractionated and image-guided teletherapy of localized prostate cancer at the department of radiotherapy at the university hospital of Würzburg – a retrospective analysis – N2 - Ziel der Arbeit war es, onkologische und toxizitätsbezogene Langzeitdaten der moderat hypofraktionierten, Cone-beam-CT geführten intensitätsmodulierten Radiotherapie mit simultan integriertem Boost als primäre Therapieform beim lokalisierten Prostatakarzinom zu generieren und mithin zur Diskussion um den Stellenwert dieser Therapieform beizutragen. Dazu wurden die Daten von 346 Patienten mit lokalisiertem Prostatakarzinom, welche im Zeitraum von 2005-2015 an der Klinik für Strahlentherapie des Uniklinikums Würzburg bestrahlt wurden, ausgewertet. Die vorliegende Arbeit zeigt, dass die Bestrahlung mit 2 Gy Äquivalenzdosen von 80,4 beziehungsweise 83 Gy eine Zeit- und kostensparende Alternative zu konventionellen Fraktionierungsregimen bei guten onkologischen Ergebnissen und vertretbarer Toxizität darstellt. Verglichen mit anderen Therapieprotokollen fällt insbesondere die niedrige Rate an später gastrointestinaler Toxizität auf. Diese konnte durch strikte Rektumschonung erreicht werden. Die Applikation einer Antihormontherapie führt bei Hochrisikopatienten zu signifikant besserer biochemischer Kontrolle. Darüber hinaus könnte auch die Bildführung sowie die Applikation eines simultan integrierten Boosts das biochemisch rezidivfreie Überleben positiv beeinflusst haben. Das in Würzburg entwickelte Zielvolumenkonzept mit simultan integriertem Boost scheint sich günstig bezüglich der Rektumtoxizität auszuwirken. N2 - This dissertation aimed at generating oncological and toxicity-related long-term outcomes of the moderately hypo-fractionated, cone-beam-ct guided intensity modulated radiotherapy with simultaneous integrated boost as a primary therapy for localized prostate cancer. This may contribute to the ongoing discussion about the value of this form of treatment. We therefore analysed the data of 346 patients, who were treated from 2005-2015 at the department of radiotherapy at the university hospital of Würzburg. Our study shows, that a treatment at 2 Gy equivalent-doses of 80.4 or 83 Gy respectively, is a time and cost-effective alternative to conventional regimes of fractionation, while having acceptable toxicity rates and good oncological results. In comparison to other protocols, especially the low rate of late gastrointestinal toxicity is remarkable. This has been achieved through strict protection of the rectum. The application of an anti-hormone therapy led to a significant improvement of the biochemical recurrence-free survival rate at high-risk patients. Moreover, the image guidance as well as the application of a simultaneous integrated boost may have improved the biochemical recurrence free survival. The target-volume-concept with simultaneous integrated boost, which has been developed in Würzburg, seems to have a positive impact on rectal toxicity. KW - Prostatakrebs KW - Strahlentherapie Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249483 ER - TY - JOUR A1 - Tamihardja, Jörg A1 - Schortmann, Max A1 - Lawrenz, Ingulf A1 - Weick, Stefan A1 - Bratengeier, Klaus A1 - Flentje, Michael A1 - Guckenberger, Matthias A1 - Polat, Bülent T1 - Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis JF - Strahlentherapie und Onkologie N2 - Purpose Evaluation of long-term outcome and toxicity of moderately hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost treatment planning and cone beam CT-based image guidance for localized prostate cancer. Methods Between 2005 and 2015, 346 consecutive patients with localized prostate cancer received primary radiotherapy using cone beam CT-based image-guided intensity-modulated radiotherapy (IG-IMRT) and volumetric modulated arc therapy (IG-VMAT) with a simultaneous integrated boost (SIB). Total doses of 73.9 Gy (n = 44) and 76.2 Gy (n = 302) to the high-dose PTV were delivered in 32 and 33 fractions, respectively. The low-dose PTV received a dose (D95) of 60.06 Gy in single doses of 1.82 Gy. The pelvic lymph nodes were treated in 91 high-risk patients to 45.5 Gy (D95). Results Median follow-up was 61.8 months. The 5‑year biochemical relapse-free survival (bRFS) was 85.4% for all patients and 93.3, 87.4, and 79.4% for low-, intermediate-, and high-risk disease, respectively. The 5‑year prostate cancer-specific survival (PSS) was 94.8% for all patients and 98.7, 98.9, 89.3% for low-, intermediate-, and high-risk disease, respectively. The 5‑year and 10-year overall survival rates were 83.8 and 66.3% and the 5‑year and 10-year freedom from distant metastasis rates were 92.2 and 88.0%, respectively. Cumulative 5‑year late GU toxicity and late GI toxicity grade ≥2 was observed in 26.3 and 12.1% of the patients, respectively. Cumulative 5‑year late grade 3 GU/GI toxicity occurred in 4.0/1.2%. Conclusion Moderately hypofractionated radiotherapy using SIB treatment planning and cone beam CT image guidance resulted in high biochemical control and survival with low rates of late toxicity. KW - simultaneous integrated boost KW - cone beam CT KW - hypofractionation KW - intensity-modulated radiation therapy KW - image-guided radiation therapy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232509 SN - 0179-7158 VL - 197 ER -