Hip stiffness following mixed conformal neutron and photon radiotherapy: A dose-volume relationship

• Published in: International journal of radiation oncology, biology, physics Vol. 35; no. 4; pp. 693 - 699
• Main Authors: Chuba, Paul J., Sharma, Renu, Yudelev, Mark, Duclos, Marie, Shamsa, Falah, Giacalone, Susan, Orton, Colin G., Maughan, Richard L., Forman, Jeffrey D.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1996; Elsevier
• Subjects: Aged; Biological and medical sciences; Dose-Response Relationship, Radiation; Fast-neutron radiation; Hip - radiation effects; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Neutrons - adverse effects; Photons - adverse effects; Prostatic Neoplasms - radiotherapy; Radiotherapy - adverse effects; Radiotherapy Dosage; Radiotherapy side effects; Tumors of the urinary system; Urinary tract. Prostate gland; Fast-neutron radiation; Radiotherapy side effects; Human; Urinary system disease; Prostate disease; Lower limb; Malignant tumor; Radiotherapy; Hip; Dose activity relation; Photon irradiation; Treatment; Neutron irradiation; Stiffness; Dosimetry; Biological effect; Male genital diseases; Prostate
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(96)00136-8

To determine the relationship between dose, volume, and the incidence of hip stiffness in patients who received conformal neutron irradiation for prostate cancer. A series of dose-searching studies using neutron irradiation for prostate cancer were performed to determine the optimal dose, fraction size, field size, technique, and proportions of photon and neutron dose. Neutron doses ranged from 9 to 20 Gy and photon doses ranged from 0 to 38 Gy. Data were analyzed by using a hip stiffness grading scale. Hip stiffness was recorded on follow-up examination in 30% of patients (40 out of 132) treated with fast neutrons or mixtures of fast neutron and photon radiation for prostate cancer. Hip stiffness was categorized as none (Grade 0, 92 patients), mild (Grade 1, 24 patients), moderate (Grade 2, 10 patients), or severe (Grade 3, 6 patients). The incidence of hip stiffness differed significantly by dose and volume in the five dose levels studied (p < 0.001). By using a mixture of conformal neutron and photon irradiation and limiting the total neutron dose to less than 13 Gy, hip stiffness toxicity could be reduced to acceptable levels.