Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer

Journal Article · Tue Jan 15 00:00:00 EST 2019 · Medical Oncology (Online)

DOI:https://doi.org/10.1007/S12032-018-1233-1· OSTI ID:22938454

Jereczek-Fossa, B. A.; Maucieri, A.; Gandini, S. ^[1]; Fodor, C.; Zerini, D.; Riva, G.; Alessandro, O.; Surgo, A.; Volpe, S.; Fanetti, G.; Arculeo, S.; Zerella, M. A.; Parisi, S. ^[2]; Maisonneuve, P. ^[3]; Vavassori, A. ^[2]; Cattani, F.; Cambria, R. ^[4]; Garibaldi, C. ^[5]; Starzyńska, A. ^[6]; others, and

---

1. European Institute of Oncology, Department of Experimental Oncology (Italy)
2. IEO, European Institute of Oncology IRCCS, Department of Radiation Oncology (Italy)
3. IEO, European Institute of Oncology IRCCS, Division of Epidemiology and Biostatistics (Italy)
4. IEO, European Institute of Oncology IRCCS, Unit of Medical Physics (Italy)
5. IEO, European Institute of Oncology IRCCS, Radiation Research Unit (Italy)
6. Medical University of Gdańsk, Department of Oral Surgery (Poland)

To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69–77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.

• OSTI ID: 22938454
• Journal Information: Medical Oncology (Online), Vol. 36, Issue 1; Other Information: Copyright (c) 2019 Springer Science+Business Media, LLC, part of Springer Nature; http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); ISSN 1559-131X
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
FRACTIONATED IRRADIATION
NEOPLASMS
PATIENTS
PROSTATE
RADIOTHERAPY
TOXICITY