Postoperative Hypofractionated Radiation Therapy in Prostate Carcinoma: A Systematic Review

Siepe, G.; Buwenge, M.; Nguyen, Nam P.; Macchia, G.; Deodato, Francesco; Cilla, Savino; Mattiucci, Gian Carlo; Capocaccia, Ilaria; Cammelli, S.; Guido, A.; Arcelli, A.; Ntreta, M.; Guerri, Sara; Morganti, Alessio Giuseppe

doi:10.21873/anticanres.12343

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…Consistent with these findings, at the time of the final analysis, the impact of our schedule in terms of biochemical control reflects in a 3-year bRFS of 73% rate in agreement with literature data ranging from 72.9% to 85.5% at 2–3 years 20 , confirming the efficacy of our treatment schedule.…”

Section: Discussionsupporting

confidence: 91%

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Hypofractionated postoperative helical tomotherapy in prostate cancer: a mono-institutional report of toxicity and clinical outcomes

Cuccia

Mortellaro²,

Serretta

et al. 2018

CMAR

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PurposeThis is a mono-institutional study of acute and late toxicities and early biochemical control of a retrospective series of 75 prostate cancer patients treated with moderate postoperative hypofractionation delivered by helical tomotherapy (HT).Patients and methodsFrom April 2013 to June 2017, 75 patients received adjuvant (n=37) or salvage (n=38) treatment, delivering to prostate bed a total dose of 63.8 Gy (equivalent dose in 2-Gy fractions=67.4 Gy) using 2.2 Gy fractions. Whole-pelvis irradiation was performed in 63% of cases (median dose, 49.3 Gy; range, 48–55.1 Gy). Concurrent hormonal therapy was administered in 46% of cases. Common Terminology Criteria for Adverse Events (version 4.0) was adopted for acute and late genitourinary (GU) and gastrointestinal (GI) toxicity evaluations. Biochemical progression was defined as PSA level increase of ≥0.2 or more above the postoperative radiotherapy (RT) nadir.ResultsAcute GU toxicities were as follows: G1 in 46% and G2 in 4%, detecting no G≥3 events. For GI toxicity, we recorded G1 in 36% and G2 in 18%. With a median follow-up of 30 months (range, 12–58 months), we found late toxicity G2 GI in 6.6% and G≥2 GU in 5.3%, including two patients who underwent surgical incontinence correction. Acute GI≥2 toxicity and diabetes were found to be predictive of late GI≥2 toxicity (P=0.04 and P=0.0019). Actuarial 2- and 3-year biochemical recurrence-free survivals were 88% and 73%, respectively, for the entire population.ConclusionIn our experience, moderate hypofractionated postoperative RT with HT was feasible and safe, with reports of low incidence of toxicity and promising biochemical control rates.

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Section: Discussionsupporting

confidence: 91%

“…Our clinical experience with postprostatectomy moderate hypofractionation using HT confirmed that, with this delivery technique, toxicities are quite low and similar to those observed in other hypofractionation studies in this setting. 20 …”

Section: Discussionmentioning

confidence: 99%

Hypofractionated postoperative helical tomotherapy in prostate cancer: a mono-institutional report of toxicity and clinical outcomes

Cuccia

Mortellaro²,

Serretta

et al. 2018

CMAR

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“…There was larger heterogeneity regarding late effects, which may be attributed to difference in follow-up and treatment technique. Another systematic review by Siepe et al [38] included 17 studies, of which seven were retrospective. Each of three-dimensional conformal radiotherapy and volumetric modulated arc therapy was used in two series, while 12 trials treated men with IMRT, of which five employed a simultaneous integrated boost.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…The authors attributed the high late toxicity to outdated radiotherapy techniques in some of the included trials. They concluded that the use of androgen deprivation therapy and inclusion of regional lymph nodes did not worsen toxicity [38] .…”

Section: Evidence Synthesismentioning

confidence: 99%

Hypofractionated Postoperative Radiotherapy for Prostate Cancer: Is the Field Ready Yet?

Mahase

Nagar

2020

European Urology Open Science

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Context Radiotherapy (RT) is a valid adjuvant treatment for men with high-risk pathological features after radical prostatectomy and a salvage treatment for biochemical recurrence. A major inconvenience is that RT takes course over 7–8 wk in these settings, which has been shown to limit its use. Retrospective and pilot prospective investigations suggest that hypofractionation may provide noninferior outcomes but report variable results regarding toxicities. Additionally, our evolving understanding of prostate cancer radiobiology suggests that hypofractionated regimens may not increase toxicity. Objective We examine and review the rationale and clinical evidence of hypofractionated RT in the adjuvant and salvage settings for prostate cancer. Evidence acquisition We reviewed relevant literature, with a particular focus on recent studies employing hypofractionated RT. Evidence synthesis Hypofractionated RT in the adjuvant or salvage setting is not a standard option for prostate cancer RT outside of an investigational trial. While smaller studies show conflicting data regarding toxicity, initial evidence from larger clinical trials appears to demonstrate that hypofractionated postoperative RT is as effective and safe as conventionally fractionated courses. Conclusions With the growing acceptance of hypofractionation across other cancer sites and the rise of extreme hypofractionation for definitive prostate cancer treatment, hypofractionated postoperative therapy for prostate cancer is poised to become an option, as it may reduce the burden on men and treatment centers while maintaining clinical efficacy and safety. Prospective trials are currently ongoing to address efficacy and safety concerns. Patient summary Postoperative radiotherapy is a potentially curative treatment for patients with high-risk disease or recurrence after surgery. Shortening of the treatment regimen with the availability of modern treatment delivery techniques in conjunction with the integration of molecular imaging information to refine treatment volumes may improve therapeutic benefit without increasing toxicity.

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“…Although hypofractionation is standard of care in the primary PCa setting, data on hypofractionated sEBRT are scarce. A recently published systematic review supports the tolerance of hypofractionated sEBRT, but stresses the importance of conducting RCTs comparing hypofractionated with standard fractionated sEBRT [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol

et al. 2022

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Background Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases. Methods The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of < 1.0 ng/mL and a recent negative PSMA PET/CT scan. Participants will be randomised in a 1:1 ratio between the conventional fractionated treatment arm (35 × 2 Gy) and the experimental hypofractionated treatment arm (20 × 3 Gy). The primary endpoint is the 5-year progression-free survival after treatment. The secondary endpoints include toxicity, quality of life and disease specific survival. Discussion Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed. Trial registration This study is registered at ClinicalTrials.gov (Identifier: NCT04642027). Registered on 24 November 2020 – Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants.

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Postoperative Hypofractionated Radiation Therapy in Prostate Carcinoma: A Systematic Review

Abstract: Acute toxicity does not seem to be increased in patients receiving postoperative HFRT, but the results of late-GU toxicity are conflicting. Further prospective studies are needed before including postoperative HFRT in clinical practice.

Cited by 7 publications

References 31 publications

Hypofractionated postoperative helical tomotherapy in prostate cancer: a mono-institutional report of toxicity and clinical outcomes

Hypofractionated postoperative helical tomotherapy in prostate cancer: a mono-institutional report of toxicity and clinical outcomes

Hypofractionated Postoperative Radiotherapy for Prostate Cancer: Is the Field Ready Yet?

Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol

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