Is een goudmarker een goedmaker voor de klachten van de patiënt bij de bestraling van prostaatkanker?

Is the use of fiducial markers during radiotherapy a better solution to the toxicity of patients with a prostate carcinoma? Introduction: Image Guided Intensity Modulated Radio Therapy (IG‐IMRT) is an accurate radiation treatment of prostate cancer. This is because of the use of fiducial markers and MRI. At the University Medical Centrum Groningen, this technique is used to treat patients with prostate cancer since 2009. The study compares IG‐IMRT with Intensity Modulated Radio Therapy (IMRT), which is used since 2005. The main purpose of this study is to investigate the difference in toxicity between the two radiation techniques. Background: The IMRT technique is a more punctual technique with small fields and several radiation angles as to the earlier conventional radiation therapy. The verification was done on the basis of bone structures. IMRT is IG‐IMRT’s forerunner. IG‐IMRT includes an implantation of fiducial markers and a MRI. These two make it possible to create a more precise and smaller contour of the target volume. The fiducial markers are also used at the verification. Methods and Materials: The study is retrospective (IMRT) and prospective (IG‐IMRT). It contained a total of 432 patients (IMRT n=197; IG‐IMRT n=235). All patients received 78 Gy and filled in a toxicity form during the acute period. This form is about the difficulties of micturition and defecation. On the basis of the toxicity form was a grade of toxicity defined with the aid of the revised CTCAE v3.0 criteria. The criteria are subdivided in several domains, which can be investigated separately. Clinicaland treatment variables were also maintained. Results: The urogenital‐ and gastrointestinal early toxicity (week 0 and 1) showed no significant differences between IMRT en IG‐IMRT. The acute urogenital‐ and gastrointestinal toxicity (week 0‐ 20) had no significant differences. The process of urogenital toxicity ≥ grade 2 during the acute period was also equal. However, the amount of patients that started with a grade 0 and kept this gradation during the acute period was different. IG‐IMRT : 63,0% and IMRT: 29,2%. The process of gastrointestinal toxicity showed significant more incontinence defecation symptoms in the IMRT group in week 9‐12 (p=0.035). Atransurethral resection of the prostate had a lowering effect on the micturition toxicity (p=0.046). Furthermore, there is a significant relation between the urogenitaland gastrointestinal toxicity (p=0.003), between the pain at micturation and the pain at defecation (p=0.001) and between the bladder incontinence and the rectal incontinence (p