• Michael Pinkawa, Marc D Piroth, Richard Holy, Victoria Djukic, Jens Klotz, Barbara Krenkel, and Michael J Eble.
• Klinik für Strahlentherapie, RWTH Aachen, Aachen, Germany. mpinkawa@ukaachen.de
• Strahlenther Onkol. 2011 Aug 1; 187 (8): 479-84.

PurposeThe aim was to evaluate treatment-related morbidity after intensity-modulated (IMRT) and image-guided (IGRT) radiotherapy with a total dose of 76 Gy in comparison to conventional conformal radiotherapy (3DCRT) up to 70.2-72 Gy for patients with prostate cancer.Patients And MethodsAll patients were prospectively surveyed prior to, on the last day, as well as after a median time of 2 and 16 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Criteria for the 78 matched pairs after IMRT vs. 3DCRT were patient age, use of antiandrogens, treatment volume (± whole pelvis), prognostic risk group, and urinary/bowel/sexual quality of life (QoL) before treatment.ResultsQoL changes after dose-escalated IMRT were found to be similar to QoL changes after 3DCRT in all domains. Only sexual function scores more than 1 year after RT decreased slightly more after 3DCRT in comparison to IMRT (mean 9 vs. 6 points; p = 0.04), with erections firm enough for intercourse in 14% vs. 30% (p = 0.03). Painful bowel movements were reported more frequently after 3DCRT vs. IMRT 2 months after treatment (≥ once a day in 10% vs. 1%; p = 0.03), but a tendency for higher rectal bleeding rates was found after IMRT vs. 3DCRT more than 1 year after RT (≥ rarely in 20% vs. 9%; p = 0.06).ConclusionCombination of dose escalation with technological advances (IMRT and IGRT) is not associated with increased morbidity for patients with prostate cancer.

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