Adjuvant Radiation Therapy for T3N0 Breast Cancer Patients Older Than 75 Years After Mastectomy: A SEER Analysis.

INTRODUCTION: Breast cancer patients with tumors > 5 cm but without nodal disease who undergo mastectomy present a clinical challenge regarding the appropriate adjuvant treatment. Traditionally, postmastectomy radiation therapy (PMRT) was the standard of care. However, recent studies have suggested local failure rates without PMRT might be low enough to omit RT. This might be especially true in the elderly. PATIENTS AND METHODS: Women aged ≥ 75 years with a diagnosis of T3N0 breast cancer who had undergone mastectomy were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 database. The study period was limited to 2006 to 2009 for more modern sampling. Multivariable proportional hazards modeling was used to examine the association of treatment and mortality, adjusting for demographic and clinicopathologic factors. RESULTS: A total of 635 patients were identified. The median follow-up period was 43 months. PMRT was given to 31.2% of the patients aged 75 to 79 years, 21.5% of those aged 80 to 84 years, and 11.7% of the patients aged ≥ 85 years (P < .001). The receipt of PMRT showed a trend toward improved overall survival on bivariable analysis (hazard ratio [HR], 0.58; P < .001) and multivariable analysis (HR, 0.78; P = .14). The 5-year overall survival was 64.2% for those who had received PMRT and 44.8% for those who had not. A nonsignificant trend was seen toward improved breast cancer-specific survival at 5 years on bivariable analysis (HR, 0.63; P = .09) but not on multivariable analysis. The interaction of age and PMRT receipt could have confounded the results. Patient age and tumor grade were significant indicators of the survival prognosis in these patients. CONCLUSION: The results of the present analysis of the SEER database suggest that PMRT might still be beneficial in women aged > 75 years with T3N0 disease but also supports continuing efforts to confirm whether it could be safe to omit. It is likely that efforts to subdivide this population using other factors (eg, comorbidity) will be important. The search for refined inclusion and exclusion criteria for adjuvant RT remains an important field of research both clinically and economically.

Older Patients With Early-stage Breast Cancer: Adjuvant Radiation Therapy and Predictive Factors for Cancer-related Death.

PURPOSE: Studies have shown that older women are undertreated for breast cancer. Few data are available on cancer-related death in elderly women aged 70 years and older with pathologic stage T1a-b N0 breast cancer and the impact of prognostic factors on cancer-related death. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was queried for women aged 70 years or above diagnosed with pT1a or pT1b, N0 breast cancer who underwent breast conservation surgery from 1999 to 2003. The Kaplan-Meier survival analysis was performed to evaluate breast cause-specific survival (CSS) and overall survival (OS), and the log-rank test was employed to compare CSS/OS between different groups of interest. Multivariable analysis (MVA), using Cox proportional hazards regression analysis, was performed to evaluate the independent effect of age, race, stage, grade, ER status, and radiation treatment on CSS. Adjusted hazard ratios were calculated from the MVA and reflect the increased risk of breast cancer death. Competing-risks survival regression was also performed to adjust the univariate and multivariable CSS hazard ratios for the competing event of death due to causes other than breast cancer. RESULTS: Patients aged 85 and above had a greater risk of breast cancer death compared with patients aged 70 to 74 years (referent category) (adjusted hazard ratio [HRs]=1.98). Race had no effect on CSS. Patients with stage T1bN0 breast cancer had a greater risk of breast cancer death compared with stage T1aN0 patients (adjusted HR=1.35; P=0.09). ER negative patients had a greater risk of breast cancer death compared with ER positive patients (adjusted HR=1.59; P<0.017). Patients with higher grade tumors had a greater risk of breast cancer death compared with patients with grade 1 tumors (referent category) (adjusted HRs=1.69 and 2.96 for grade 2 and 3, respectively). Patients who underwent radiation therapy had a lower risk of breast cancer death compared with patients who did not (adjusted HR=0.55; P<0.0001). CONCLUSIONS: Older patients with higher grade, pT1b, ER-negative breast cancer had increased risk of breast cancer-related death. Adjuvant radiation therapy may provide a CSS benefit in this elderly patient population.

Excellent Long-term Breast Preservation Rate After Accelerated Partial Breast Irradiation Using a Balloon Device.

BACKGROUND: Accelerated partial breast irradiation (APBI) using a balloon device has been well tolerated. A recent retrospective population-based study showed an increase in the rate of subsequent mastectomy for patients who undergo APBI compared with whole breast radiation therapy. Our aim was to analyze the long-term results of patients treated with APBI at our institution to determine the salvage mastectomy and locoregional recurrence rates and cosmesis outcomes. MATERIALS AND METHODS: After institutional review board approval, we conducted a retrospective review of 111 patients treated from June 2003 to October 2014 at our institution for early-stage breast cancer using a balloon device. After lumpectomy and nodal staging, the patients underwent APBI with high-dose rate iridium-192 brachytherapy. A computed tomography-based 3-dimensional plan was created, and a dose of 34 Gy in 10 fractions was given twice daily, 6 hours apart, over 5 days. Follow-up examinations were performed 2 to 3 times annually by either a surgeon and/or a radiation oncologist. Annual mammograms were obtained. The patients included postmenopausal women with node-negative early-stage invasive ductal carcinoma with a tumor size < 3 cm (n = 93) or ductal carcinoma in situ (n = 18). Cosmesis was evaluated using the Harvard criteria, as excellent, good, fair, or poor. RESULTS: At a median follow-up period of 66 months (range, 1-139 months) after completing treatment, with a minimum of 5 years of follow-up data for 62 patients (55.9%), the incidence of ipsilateral breast tumor recurrence (IBTR) was 2.7% (n = 3) and the incidence of ipsilateral axilla nodal recurrence was 1.8% (n = 2). The ipsilateral breast preservation rate was 97.3%. The salvage mastectomy rate was 2.7% (n = 3), and the 5-year salvage mastectomy-free rate was 98.7% (95% confidence interval, 91.0%-99.8%). No distant failure developed, and no breast cancer-related deaths occurred. The 5-year overall survival rate was 91.7% (95% confidence interval, 83.2%-96.0%), and the 10-year breast cancer-specific survival rate was 100%. Of the 3 cases of IBTR, 2 were estrogen receptor negative (P = .076). The mean interval to IBTR was 78.7 ± 27.5 months from treatment completion. A significant association was noted between African-American ethnicity and IBTR (P = .0398). Excellent to good cosmesis was observed in 98.1% of the patients. The maximum skin dose (mean value) for patients with excellent, good, and fair cosmesis was 302.2 Gy, 315.4 Gy, and 372.5 Gy (88.9%, 92.7%, and 109.5% of the prescription dose), respectively. The maximum skin dose was < 340 Gy (100% of the prescribed dose) in 69.9% of patients with excellent to good cosmesis. CONCLUSION: The long-term follow-up data of patients receiving APBI with a balloon device showed a low salvage mastectomy rate with durable long-term breast preservation. Excellent local control with good cosmesis was noted in these postmenopausal patients treated with APBI.

Equivalent Survival With Mastectomy or Breast-conserving Surgery Plus Radiation in Young Women Aged < 40 Years With Early-Stage Breast Cancer: A National Registry-based Stage-by-Stage Comparison.

BACKGROUND: Studies have shown that young patients with early-stage breast cancer (BC) are increasingly undergoing mastectomy instead of breast-conserving therapy (BCT) consisting of lumpectomy and radiation. We examined the difference in outcomes in young women (aged < 40 years) who had undergone BCT versus mastectomy. MATERIALS AND METHODS: The Surveillance, Epidemiology, and End Results database was queried for women aged < 40 years with stage I or II invasive BC treated with surgery from 1998 to 2003. Breast cancer-specific survival (BCSS) and overall survival (OS) were evaluated using Kaplan-Meier survival analysis and the log-rank test between treatment types. RESULTS: Of the 7665 women, 3249 received BCT and 2627 underwent mastectomy without radiation. When separated by stage (I, IIA, and IIB), with a median follow-up duration of 111 months, the BCT and mastectomy-only groups showed no statistically significant differences in BCSS and OS. Overall, the age group of 35 to 39 years (66% of total) was associated with better 10-year BCSS (88%) and OS (86.1%) compared with the younger patients aged 20 to 34 years (34% of total). The latter group had a 10-year BCSS and OS of 84.1% and 82.3%, respectively (P < .001 for both BCSS and OS). However, when the patients of each age group were further subdivided by stage, the BCT group continued to show noninferior BCSS and OS compared with the mastectomy group in all subgroups. CONCLUSION: The results of our study suggest that although young age might be a poor prognostic factor for BC, no evidence has shown that these patients will have better outcomes after mastectomy than after BCT.

Second cancer, breast cancer, and cardiac mortality in stage T1aN0 breast cancer patients with or without external beam radiation therapy: a national registry study.

INTRODUCTION/BACKGROUND: With improved BC screening and treatment, the risk for long-term toxicities of treatments must be considered, especially in good prognosis patients. In this study we examined the outcome, risks of second cancers, and cardiac mortality with RT for early-stage BC from recent years. MATERIALS AND METHODS: Analysis of the SEER database was conducted for women who had stage T1aN0 BC as their first primary malignancy between 1990 and 1997 and were treated with partial or complete mastectomy with or without external beam RT. The overall survival (OS), BC-specific survival (BCSS), cardiac cause-specific survival (CCS), and deaths from second cancers in the chest area were compared between the RT and no-RT groups. RESULTS: Of the 6515 women identified, 2796 received RT and 3719 did not. The median age group (60-64 years) and follow-up lengths (approximately 15 years) were similar. Compared with the RT group, the no-RT group was associated with lower 10-year OS (85.5% vs. 79.3%; P < .0001), BCSS (97.3% vs. 96.4%; P = .04), and CCS (97.0% vs. 93.8%; P < .0001). In the RT group, left-sided BC was not associated with higher cardiac mortality. There were no statistically significant incidences in mortality due to subsequent cancers. The most common second cancer mortality included 114 (2%) lung, 25 (0.4%) lymphoma, 19 (0.3%) leukemia, 3 (0.05%) soft tissue, and 2 (0.03%) esophagus. CONCLUSION: This review of SEER data suggests that secondary malignancy in the chest area and cardiac mortality are rare after RT in the 1990s for T1aN0 BC.

Is there a cause-specific survival benefit of postmastectomy radiation therapy in women younger than age 50 with T3N0 invasive breast cancer? A SEER database analysis: outcomes by receptor status/race/age: analysis using the NCI Surveillance, Epidemiology, and End Results (SEER) database.

OBJECTIVE: Postmastectomy radiation therapy (PMRT) remains controversial for patients with pathologic stage T3N0 (pT3N0) breast cancer. A Surveillance, Epidemiology, and End Results (SEER) database analysis suggested that PMRT might benefit patients older than age 50. However, the relevance between estrogen receptor (ER), progesterone receptor (PR), race, and PMRT in patients younger than age 50 is unknown. METHODS: The impact of PMRT treatment on cause-specific survival (CSS) and overall survival (OS) were analyzed for women in the SEER database from 1998 to 2007. Approximately half (47%) of the 1104 patients who met the study requirements received PMRT. We performed univariate analysis to compare CSS between the PMRT and no-PMRT groups for all patients and further stratified by age, race, tumor size, tumor grade, and ER/PR status. RESULTS: No difference in CSS or OS was detected between women treated with or without PMRT. Black/other race, ER-, and PR-, all suggested a trend toward decreased CSS. In univariate analysis, PMRT seems to be beneficial in patients younger than age 40 (hazard ratio=0.65; P=0.25; a nonsignificant trend in favor of PMRT). CONCLUSIONS: This SEER database analysis of patients younger than age 50 and with pT3N0 breast cancer showed that PMRT did not significantly affect CSS at 5 years; however, it implied a trend of benefit for patients younger than 40. The findings that patients with African heritage and negative ER/PR status showing decreased CSS warrant further investigation to determine the role of personalized PMRT in these high-risk cohorts.

Breast cancer in men: prognostic factors, treatment patterns, and outcome.

PURPOSE: The aim of this study was to review the clinical presentation and to evaluate prognostic factors, treatment modalities, outcome, and second malignancy in male breast cancer patients. A chart review was conducted of all men treated for breast cancer between January 1991 and December 2007. Cox proportional hazards regression model and Kaplan-Meier curve were used to determine prognostic factors and plot survival probabilities. Invasive carcinoma was diagnosed in 22 patients and ductal carcinoma in situ in 7 patients. With mortality as the endpoint, tumor size indicated hazard ratio (HR) of 1.5 for each 1-cm increase in tumor size (p = .03). Overall stage and increased age were associated with increased risk of mortality (HR = 2.1, p = .055; HR = 1.09 for a 1-year increase in age, p = .08, respectively). Adjuvant radiation therapy yielded an HR of 0.1 (p = .058), indicating a favorable association with the survival. Advanced age, higher stage, and increasing tumor size were unfavorable to survival in male breast carcinoma. The benefit of adjuvant radiation therapy should be addressed in future collaborative studies.

MammoSite multilumen catheter: dosimetry considerations.

PURPOSE: To explore the dosimetric advantages of the new MammoSite multilumen (ML) balloon for breast brachytherapy treatment compared to conventional single lumen (SL) device plan. MATERIALS AND METHODS: Patients deemed appropriate for accelerated partial breast irradiation (APBI) were implanted with the MammoSite ML balloon. Two plans were generated in each patient for the same target coverage (PTV_EVAL) and dose to normal structures were plotted. The first plan used only the central single lumen with single-dwell position (SL), and the second plan (ML) was generated using the other lumens of the device. Dose distributions of the SL and ML plans were compared. RESULTS: For the same PTV_EVAL, the ML balloon improved dose coverage at the tip and base of the applicator compared to SL plan. The skin and rib doses were reduced using the ML plan versus SL plan for the same PTV_EVAL in-patient 2, where the skin-balloon distance was 7 mm and the rib-balloon distance was <1 cm. For patient 1, the skin and rib distances were greater than 1 cm and the ML plan did not further minimize the dose to normal structures. CONCLUSION: In our initial experience, dosimetric goals can be better achieved using the ML MammoSite balloon when normal structures (skin and ribs) are close to PTV_EVAL with a distance of <7 mm and rib distance of <1 cm. The multiple lumen of ML balloon can optimize dose and reduce excessive dose to rib and skin and therefore minimize the long-term toxicities of rib discomfort, skin fibrosis and fat necrosis.

Prostate and seminal vesicle volume based consideration of prostate cancer patients for treatment with 3D-conformal or intensity-modulated radiation therapy.

PURPOSE: The purpose of this article was to determine the suitability of the prostate and seminal vesicle volumes as factors to consider patients for treatment with image-guided 3D-conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT), using common dosimetry parameters as comparison tools. METHODS: Dosimetry of 3D and IMRT plans for 48 patients was compared. Volumes of prostate, SV, rectum, and bladder, and prescriptions were the same for both plans. For both 3D and IMRT plans, expansion margins to prostate+SV (CTV) and prostate were 0.5 cm posterior and superior and 1 cm in other dimensions to create PTV and CDPTV, respectively. Six-field 3D plans were prepared retrospectively. For 3D plans, an additional 0.5 cm margin was added to PTV and CDPTV. Prescription for both 3D and IMRT plans was the same: 45 Gy to CTV followed by a 36 Gy boost to prostate. Dosimetry parameters common to 3D and IMRT plans were used for comparison: Mean doses to prostate, CDPTV, SV, rectum, bladder, and femurs; percent volume of rectum and bladder receiving 30 (V30), 50 (V50), and 70 Gy (V70), dose to 30% of rectum and bladder, minimum and maximum point dose to CDPTV, and prescription dose covering 95% of CDPTV (D95). RESULTS: When the data for all patients were combined, mean dose to prostate and CDPTV was higher with 3D than IMRT plans (P < 0.01). Mean D95 to CDPTV was the same for 3D and IMRT plans (P > 0.2). On average, among all cases, the minimum point dose was less for 3D-CRT plans and the maximum point dose was greater for 3D-CRT than for IMRT (P < 0.01). Mean dose to 30%, rectum with 3D and IMRT plans was comparable (P > 0.1). V30 was less (P < 0.01), V50 was the same (P > 0.2), and V70 was more (P < 0.01) for rectum with 3D than IMRT plans. Mean dose to bladder was less with 3D than IMRT plans (P < 0.01). V30 for bladder with 3D plans was less than that of IMRT plans (P < 0.01). V50 and V70 for 3D plans were the same for 3D and IMRT plans (P > 0.2). Mean dose to femurs was more with 3D than IMRT plans (P < 0.01). For a given patient, mean dose and dose to 30% rectum and bladder were less with 3D than IMRT plans for prostate or prostate+SV volumes <65 (38/48) and 85 cm3 (39/48), respectively (P < 0.01). The larger the dose to rectum or bladder with 3D plans, the larger also was the dose to these structures with IMRT (P < 0.001). For both 3D and IMRT plans, dose to rectum and bladder increased with the increase in the volumes of prostate and seminal vesicles (P < 0.02 to 0.001). CONCLUSIONS: Volumes of prostate and seminal vesicles provide a reproducible and consistent basis for considering patients for treatment with image-guided 3D or IMRT plans. Patients with prostate and prostate+SV volumes <65 and 85 cm3, respectively, would be suitable for 3D-CRT. Patients with prostate and prostate+SV volumes >65 and 85 cm3, respectively, might get benefit from IMRT.

Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence.

PURPOSE: To identify possible risk factors for development of clinically significant seroma (CSS) (seroma requiring intervention) and to report on incidence of infection after intraoperative placement of MammoSite for breast brachytherapy. METHODS AND MATERIALS: Fifty-eight postmenopausal patients with early stage breast cancer and no nodal metastases, treated with partial breast irradiation using the MammoSite catheter from June 2003 to November 2007 were analyzed retrospectively for CSS predictive factors and incidence of infection. After a lumpectomy, a MammoSite catheter was placed by intraoperative open-cavity technique (OCT). All the patients received wound care and prophylactic antibiotics. A dose of 3400 cGy was prescribed at 1cm from the surface of the balloon and was delivered at 340 cGy twice daily 6h apart for 5 days. The patients with seroma who underwent intervention were considered to have CSS. On the basis of the characteristics and symptoms associated with seroma, interventions, such as aspiration, core biopsy, or re-excision of the lumpectomy cavity were performed either to relieve symptoms or to rule out a local recurrence. RESULTS: Fifty-seven of the 58 patients were eligible for analysis. One patient, who died 4 weeks after treatment from unrelated causes, was excluded from final analysis. All the patients were postmenopausal, with a median age of 71 years (range, 53-88 years). Eighteen of the 57 patients (31.5%) had CSS; 9 of them had re-excision of the lumpectomy cavity. Pathology in all revealed evidence of fat necrosis, chronic inflammatory cells, and fibrosis. There was no evidence of tumor recurrence in any of these patients. Technical and nontechnical parameters were analyzed to determine possible risk factors for CSS, and none were found to be statistically significant. No patient developed acute postprocedural infection. CONCLUSIONS: Meticulous wound care and postoperative antibiotics prevented acute infection. Infection was not a contributing factor for seroma formation in these patients. Placement of the MammoSite catheter by OCT did not increase the risk of CSS development, in postmenopausal breast cancer patients.

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image-guided IMRT.

PURPOSE: The purpose of this study was to analyze the relationship between prostate, bladder, and rectum volumes on treatment planning CT day and prostate shifts in the XYZ directions on treatment days. METHODS: Prostate, seminal vesicles, bladder, and rectum were contoured on CT images obtained in supine position. Intensity modulated radiation therapy plans was prepared. Contours were exported to BAT-ultrasound imaging system. Patients were positioned on the couch using skin marks. An ultrasound probe was used to obtain ultrasound images of prostate, bladder, and rectum, which were aligned with CT images. Couch shifts in the XYZ directions as recommended by BAT system were made and recorded. 4698 couch shifts for 42 patients were analyzed to study the correlations between interfraction prostate shifts vs bladder, rectum, and prostate volumes on planning CT. RESULTS: Mean and range of volumes (cc): Bladder: 179 (42-582), rectum: 108 (28-223), and prostate: 55 (21-154). Mean systematic prostate shifts were (cm, +/-SD) right and left lateral: -0.047 +/- 0.16 (-0.361-0.251), anterior and posterior: 0.14 0.3 (-0.466-0.669), and superior and inferior: 0.19 +/- 0.26 (-0.342-0.633). Bladder volume was not correlated with lateral, anterior/posterior, and superior/inferior prostate shifts (P > 0.2). Rectal volume was correlated with anterior/posterior (P < 0.001) but not with lateral and superior/inferior prostate shifts (P > 0.2). The smaller the rectal volume or cross sectional area, the larger was the prostate shift anteriorly and vice versa (P < 0.001). Prostate volume was correlated with superior/inferior (P < 0.05) but not with lateral and anterior/posterior prostate shifts (P > 0.2). The smaller the prostate volume, the larger was prostate shift superiorly and vice versa (P < 0.05). CONCLUSIONS: Prostate and rectal volumes, but not bladder volumes, on treatment planning CT influenced prostate position on treatment fractions. Daily image-guided adoptive radiotherapy would be required for patients with distended or empty rectum on planning CT to reduce rectal toxicity in the case of empty rectum and to minimize geometric miss of prostate.

The potential for dose dumping in normal tissues with IMRT for pelvic and H&N cancers.

The purpose of this study is to understand the potential for dose dumping in normal tissues (>85% of prescription dose) and to analyze effectiveness of techniques used in reducing dose dumping during IMRT. Two hundred sixty-five intensity modulated radiation therapy (IMRT) plans for 55 patients with prostate, head-and-neck (H&N), and cervix cancers with 6-MV photon beams and >5 fields were reviewed to analyze why dose dumping occurred, and the techniques used to reduce dose dumping. Various factors including gantry angles, depth of beams (100-SSD), duration of optimization, severity of dose-volume constraints (DVC) on normal structures, and spatial location of planning treatment volumes (PTV) were reviewed in relation to dose dumping. In addition, the effect of partial contouring of rectum in beam's path on dose dumping in rectum was studied. Dose dumping occurred at d(max) in 17 pelvic cases (85% to 129%). This was related to (1) depth of beams (100 SSD [source-to-skin distance]), (2) PTV located between normal structures with DVC, and (3) relative lack of rectum and bladder in beam's path. Dose dumping could be reduced to 85% by changing beam angles and/or DVC for normal structures in 5 cases and by creating "phantom structures" in 12 cases. Decreasing the iterations (duration of optimization) also reduced dose dumping and monitor units (MUs). Part of uncontoured rectum, if present in the field, received a higher dose than the contoured rectum with DVC, indicating that complete delineation of normal structures and DVC is necessary to prevent dose dumping. In H&N, when PTV extends inadvertently into air beyond the body even by a few millimeters, dose dumping occurred in beam's path (220% for 5-field and 170%, 7-field plans). Keeping PTV margins within body contour reduced this type of dose dumping. Beamlet optimization, duration of optimization, spatial location of PTV, and DVC on PTV and normal structures has the potential to cause dose dumping. However, these factors are an integral part of IMRT inverse planning. Therefore, understanding these aspects and use of appropriate technique/s would reduce or eliminate the dose dumping and minimize time to obtain optimum plan.

Single course IMRT plan to deliver 45 Gy to seminal vesicles and 81 Gy to prostate in 45 fractions.

We treat prostate and seminal vesicles (SV) to 45 Gy in 25 fractions (course 1) and boost prostate to 81 Gy in 20 more fractions (course 2) with Intensity Modulated Radiation Therapy (IMRT). This two-course IMRT with 45 fractions delivered a non-uniform dose to SV and required two plans and two QA procedures. We used Linear Quadratic (LQ) model to develop a single course IMRT plan to treat SV to a uniform dose, which has the same biological effective dose (BED) as that of 45 Gy in 25 fractions and prostate to 81 Gy, in 45 fractions. Single course IMRT plans were compared with two-course IMRT plans, retrospectively for 14 patients. With two-course IMRT, prescription to prostate and SV was 45 Gy in 25 fractions and to prostate only was 36 Gy in 20 fractions, at 1.8 Gy/fraction. With 45-fraction single course IMRT plan, prescription to prostate was 81 Gy and to SV was 52 or 56 Gy for a alpha/beta of 1 and 3, respectively. 52 Gy delivered in 45 fractions has the same BED of 72 Gy3 as that of delivering 45 Gy in 25 fractions, and is called Matched Effective Dose (MED). LQ model was used to calculate the BED and MED to SV for alpha/beta values of 1-10. Comparison between two-course and single course IMRT plans was in terms of MUs, dose-max, and dose volume constraints (DVC). DVC were: 95% PTV to be covered by at least 95% of prescription dose; and 70, 50, and 30% of bladder and rectum should not receive more than 40, 60, and 70% of 81 Gy. SV Volumes ranged from 2.9-30 cc. With two-course IMRT plans, mean dose to SV was non-uniform and varied between patients by 48% (54 to 80 Gy). With single-course IMRT plan, mean dose to SV was more uniform and varied between patients by only 9.6% (58.2 to 63.8 Gy), to deliver MED of 56 Gy for alpha/beta - 1. Single course IMRT plan MUs were slightly larger than those for two-course IMRT plans, but within the range seen for two-course plans (549-959 MUs, n=51). Dose max for single-course plans were similar to two-course plans. Doses to PTV, rectum and bladder with single course plans were as per DVC and comparable to two-course plans. Single course IMRT plan reduces IMRT planning and QA time to half.