Risk-adapted moderate hypofractionation of prostate cancer

Abstract

PurposeProstate cancer (PCA) is highly heterogeneous in terms of its oncologic outcome. We therefore aimed to tailor radiation treatment to the risk status by using three different hypofractionated radiation regimen differing in applied dose, use of rectum spacer, inclusion of pelvic lymph nodes (pLN) and use of androgen deprivation therapy (ADT). Here we report on acute toxicity, quality of life (QOL) and oncologic outcome at a median follow-up of 12 months.MethodsA total of 221 consecutive PCA patients received hypofractionated intensity-modulated radiotherapy (IMRT). Low-risk (LR) patients were planned to receive 60 Gy in 20 fractions (EQD2α/β1.5 = 77.1 Gy), intermediate-risk (IR) patients 63 Gy in 21 fractions (EQD2α/β1.5 = 81 Gy), and high-risk (HR) patients 67.5 Gy in 25 fractions (EQD2α/β1.5 = 81 Gy) to the prostate and 50 Gy in 25 fractions to the pLN. Acute rectal toxicity was assessed by endoscopy. In addition, toxicity was scored using CTC-AE 4.0 and IPSS score, while QOL was assessed using QLQ-PR25 questionnaires.ResultsAcute CTC reactions were slightly higher in the HR regimen but reverted to baseline at 3 months. GI G2 toxicity was 4%, 0% and 12% for the LR, IR and HR regimen. Compared to IR patients, the increase in toxicity in HR patients was statistically significant (p = 0.002) and mainly caused by a higher incidence of diarrhea presumably due to pelvic EBRT. QOL scores of all domains were worse for the HR regimen (not significant).ConclusionRisk-adapted moderate hypofractionation is associated with low GI/GU toxicity. Given the higher rate of pelvic metastases in HR patients, slightly higher transient acute reactions should be outweighed by possible oncological benefits.

Treatment of low-risk prostate cancer: a retrospective study with 477 patients comparing external beam radiotherapy and I-125 seeds brachytherapy in terms of biochemical control and late side effects

“…It has to be noted that the high proportion of 87% of patients treated with 3D conformal EBRT no longer matches the reality in our institution, as all prostate cancer patients are nowadays treated with VMAT and hypofractionated radiotherapy according to the CHHiP trial [ 19 ] and as displayed by Schörghofer et al. [ 25 ] in 20 fractions with 3‑Gy single dose.…”

Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists

“…Only 18.3% of the participants use hypofractionated schemes, although recent trials [1][2][3][4] showed that moderate hypofractionation is feasible. Some authors even opt for a risk-adapted moderate hypofractionation [23]. The majority of participants (72.5%) still use conventional fractionation.…”

Moderately HRT vs. CRT for localized prostate cancer using image-guided VMAT with SIB: evaluation of acute and late toxicities

“…Datta et al conclude that in the investigated trials, such as the PROFIT [14], IRE [28][29][30][31], RTOG [30], CHHiP [17], and HYPRO [32] studies, HRT leads to similar or even improved results regarding biochemical outcomes and toxicity. Also, Schörghofer et al [33] report that moderate HRT lowers GU and GI toxicity through all risk classifications. Additionally, the recently published study from Hoffman et al, which includes a follow-up of 8 years, finds improved tumor control through HRT.…”