Purpose: to report genitourinary (GU) toxicity profile in prostate patients treated

with simultaneous integrated boost (SIB) with volumetric modulated arc therapy
(VMAT) in a radical moderate hypofractionated regimen.
Matherial and methods: a total of 60 patients were analyzed. The population was
stratified into low 42% (25/60), intermediate 27% (16/60), and high-risk 31% (19/60)
groups. Target volumes, expanded to define the planning volumes (PTVs), were
clinical target volume (CTV) 1: prostate; CTV2: CTV1 + seminal vesicles; CTV3:
CTV2 + pelvic nodes. Low-risk patients received 73.5 Gy to PTV1; intermediate-risk
73.5 Gy to PTV1 and 66 Gy to PTV2; high-risk 73.5 Gy to PTV1, 66 Gy to PTV2,
and 54 Gy to PTV3. All treatments were performed in 30 fractions. The median
follow-up was 24 months (range 12 - 30 months). According to common terminology
criteria for adverse events (CTCAE) v4.0, acute and late toxicity were prospectively
collected and retrospectively evaluated.
Results: Acute GU toxicity was recorded as follow: G0 in 26% (16/60), G1 in 32%
(19/60), G2 in 42% (25/60). No case of acute toxicity G3 was registered. During
treatment, median week onset of GU toxicity was 3 th (range 2th - 5th). Late GU toxicity
was recorded as follow: G0 in 33% (20/60), G1 in 50% (30/60), G2 in 17% (10/60).
No case of toxicity G3 was registered.
At logistic regression analysis, significant correlations between GU toxicity and the
volume of bladder irradiation V50 Gy > 45% (p 0.03) and V60 Gy > 35% (p 0.001)
were found. A planning bladder volume < 250 cc is related to G2 acute toxicity.

Conclusion: the current moderate hypofractionation schedule was shown to be safe,

with acceptable GU moderate toxicity without severe effects. Longer follow-up is
needed to assess clinical outcomes.