How Much Daily Image-guided Volumetric Modulated Arc Therapy Is Useful for Proctitis Prevention With Respect to Static Intensity Modulated Radiotherapy Supported by Topical Medications Among Localized Prostate Cancer Patients?

Anticancer Res. 2021 Apr;41(4):2101-2110. doi: 10.21873/anticanres.14981.


Background/aim: To evaluate if topical support therapy during static-intensity modulated radiotherapy (sIMRT) course is able to equal the characteristic minimum risk for radiation proctitis of Image-guided volumetric modulated arc therapy (IG-VMAT) treatment among localized prostate cancer patients.

Patients and methods: Rectal toxicity data of the above patients were retrospectively collected throughout three different clinical periods at our Radiotherapy Deparment: from October 2011 to December 2012, prostate cancer patients were treated with sIMRT and in advance supported by means of daily topical corticosteroids; from January 2013 to November 2016, topical corticosteroids were replaced by daily hyaluronic acid enemas; from December 2016 to May 2018 eligible patients were treated with newly introduced IG-VMAT supported by only on-demand topical corticosteroids.

Results: Among 359 eligible patients, IG-VMAT was proven generally more effective than sIMRT supported by topical medications in terms of proctitis reduction, although without clinical and practical relevance.

Conclusion: Topical medications might have a role in radiation proctitis prevention.

Keywords: Static intensity modulated radiotherapy; beclomethasone dipropionate; hyaluronic acid enema; hypofractionated radiotherapy; image guided volumetric modulated arc radiotherapy; prostate cancer; radiation induced adverse events; radiation proctitis; topical support therapy.

MeSH terms

  • Administration, Topical
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / administration & dosage*
  • Beclomethasone / administration & dosage
  • Enema / methods
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Italy
  • Male
  • Middle Aged
  • Organ Sparing Treatments / methods
  • Proctitis / etiology
  • Proctitis / prevention & control*
  • Prostatic Neoplasms / drug therapy*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / radiotherapy*
  • Radiation Dose Hypofractionation
  • Radiation Injuries / prevention & control
  • Radiotherapy Planning, Computer-Assisted / methods
  • Radiotherapy, Image-Guided / adverse effects
  • Radiotherapy, Image-Guided / methods
  • Radiotherapy, Intensity-Modulated* / adverse effects
  • Radiotherapy, Intensity-Modulated* / methods
  • Retrospective Studies


  • Anti-Inflammatory Agents
  • Hyaluronic Acid
  • Beclomethasone