Out of 39 patients, 22 patients refused undergoing a biopsy at 2-years post-radiotherapy. Out of 17 patients who underwent re-biopsy, 15 biopsies (88%) resulted completely negative, 1 (6%) positive and 1 (6%) indeterminate, but both the last two patients did not show evidence of NU7026 nmr biochemical disease. Figure 4 Freedom from biochemical failure survival. Discussion Our study represents the first prospective

trial reporting results of the highest dose escalation using doses of 86 Gy at 2 Gy/fraction, for the IMRT treatment of patients with localized intermediate-risk prostate cancer without ADT. Out of 39, 7 patients (18%) reported G2 late GI toxicity, one patient (2.5%) reported G3 late GI toxicity and one patient (2.5%) reported G4 late GI toxicity. In this feasibility see more study, ≥G2 late GI toxicity was higher than expected from cases treated at our Institute with IMRT at doses of 80 Gy and from the literature [15–18]. However, the observed actuarial ≥ G2 late GI toxicity (21%) was lower to that found in the study RTOG 9406 conducted by Michalski et al. [29] reporting a rate of ≥ G2 GI complication ranging from 30% to 33% for 24 months at dose level V (78 Gy) but higher than that (4%) reported by Cahlon et al. [17]. The higher observed ≥ G2 late GI toxicity might be due to the lack of specific dose constraints for rectum volume within the PTV and to the fact that also seminals vesicles buy Luminespib received the full treatment dose.

In fact a statistically significant correlation was observed between dose volume histograms of

the volume of rectum enclosed in the PTV and ≥ G2 late GI toxicity. It is worth noting that patients were enrolled in this study before the publication of Quantec [30], where it is stated that “Reducing the V75 by just 5% from 15% to 10% has a significant impact in the predicted complication probability …” but “the proposed dose–volume constraints might be unachievable … but every effort should be made to be as close as possible to the constraints especially in the high doses”. Nevertheless, methods allowing the reduction of the PTV, such as CBCT and/or markers for IGRT, could further reduce the incidence of rectal toxicity [31, 32], considering that the prostate and the anterior rectal wall, i.e. the area most susceptible to receive an high dose, cannot be seen using EPID images Unoprostone only. In randomized dose-escalation trials employing 3D-CRT the incidence of ≥ G2 late GI toxicity ranged between 17% and 32% [3–7]. This GI toxicity are similar to our results, even if in our trial higher doses were delivered. Moreover, pre-radiotherapy ADT has been reported as a protective factor for GI late toxicity due to the expected reduction of PTV volume [33]. No patients experienced G4 late GU toxicity and three patients (8%) developed G3 late GU toxicity, two of which were previously treated for urethral stricture. The observed 5-year incidence of ≥ G2 late GU toxicity was 12.