Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis

Tenti, Maria Valentina; Ingrosso, Gianluca; Bini, Vittorio; Mariucci, C.; Saldi, Simonetta; Alì, Emanuele; Zucchetti, C.; Bellavita, Rita; Aristei, Cynthia

doi:10.5603/rpor.a2022.0012

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…Tenti et al recently retrospectively analyzed 76 patients treated with a total dose of 60 Gy in 20 fractions or 67.5 Gy in 25 fractions for localized PCa. After a median follow-up of 42.46 months, they obtained a 4y OS and MFS of 91% and 89%, respectively, with acute and late G ≥2 GI toxicity reported in 6.5% and 2.6% of patients, respectively, and acute and late G ≥2 GU toxicity in 31.5% and 3.9% (33). The authors also reported an interesting association between acute GI toxicity and statin medication and ADT, the latter not found in our analysis, and a relation of acute GU toxicity and use of anticoagulants and antiaggregants.…”

Section: Discussionmentioning

confidence: 99%

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Cozzi

Ruggieri

Alì

et al. 2023

In Vivo

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Background/Aim: Radiotherapy represents an important therapeutic option in the management of prostate cancer (PCa). As helical tomotherapy may improve toxicity outcomes, we aimed to evaluate and report the toxicity and clinical outcomes of localized PCa patients treated with moderately hypofractionated helical tomotherapy. Patients and Methods: We retrospectively analyzed 415 patients affected by localized PCa and treated with moderately hypofractionated helical tomotherapy in our department from January 2008 to December 2020. All patients were stratified according to the D'Amico risk classification: low-risk 21%, favorable intermediate-risk 16%, unfavorable intermediate-risk 30.4%, and high-risk 32.6%. The dose prescription for high-risk patients was 72.8 Gy to the prostate (planning tumor volume-PTV1), 61.6 Gy to the seminal vesicles (PTV2), and 50.4 Gy to the pelvic lymph nodes (PTV3) in 28 fractions; for low-and intermediate-risk patients 70 Gy for PTV1, 56 Gy for PTV2, and 50.4 Gy for PTV3 in 28 fractions. Image-guided radiation therapy was performed daily in all patients by mega-voltage computed tomography. Forty-one percent of patients received androgen deprivation therapy (ADT). Acute and late toxicity was assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v.5.0 (CTCAE). Results: Median follow-up was 82.7 months (range=12-157 months) and the median age of patients at diagnosis was 72.5 years (range=49-84 years). The 3, 5, and 7 yr overall survival (OS) rates were 95%, 90%, and 84%, respectively, while 3, 5, and 7 yr disease-free survival (DFS) were 96%, 90%, and 87%, respectively. Acute toxicity was as follows: genitourinary (GU) G1 and G2 in 35.9% and 24%; gastrointestinal (GI) in 13.7% and 8%, with G3 or more acute toxicities less than 1%. The late GI toxicity G2 and G3 were 5.3% and 1%, respectively, and the late GU toxicity G2 and G3 were 4.8% and 2.1%, respectively, and only three patients had a G4 toxicity. Conclusion: Hypofractionated helical tomotherapy for PCa treatment appeared to be safe and reliable, with favorable acute and late toxicity rates and encouraging results in terms of disease control.External beam radiotherapy is a milestone in the treatment of men with prostate cancer (PCa) with curative intent and is associated with long-term disease control in most patients (1). Historically, the standard radiotherapy treatment involves conventional fractionation, with doses of 1.8-2 Gy/day, treatment approximately over 7 weeks, with onerous costs and a negative impact on the patient's quality of life (2, 3). Over the last decade, the constant improvement in radiotherapy techniques, including intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT), has led to more personalized treatment, with the possibility of using doseescalated schedules with significant advantages in terms of biochemical control rates and cost-effectiveness (5, 6). Helical tomotherapy, with a combination of linear accelerator and computed tomography chara...

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Section: Discussionmentioning

confidence: 99%

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Cozzi

Ruggieri

Alì

et al. 2023

In Vivo

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Dosimetric Comparison of Ultra-Hypofractionated and Conventionally Fractionated Radiation Therapy Boosts for Patients with High-Risk Prostate Cancer

Piotrowski

Yartsev

Krawczyk

et al. 2022

Life

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Recent comparison of an ultra-hypofractionated radiotherapy (UF-RT) boost to a conventionally fractionated (CF-RT) option showed similar toxicity and disease control outcomes. An analysis of the treatment plans for these patients is needed for evaluating calculated doses for different organs, treatment beam-on time, and requirements for human and financial resources. Eighty-six plans for UF-RT and 93 plans for CF-RT schemes were evaluated. The biologically equivalent dose, EQD2, summed for the first phase and the boost, was calculated for dose-volume parameters for organs at risk (OARs), as well as for the PTV1. ArcCHECK measurements for the boost plans were used for a comparison of planned and delivered doses. Monitor units and beam-on times were recorded by the Eclipse treatment planning system. Statistical analysis was performed with a significance level of 0.05. Dosimetric parameter values for OARs were well within tolerance for both groups. EQD2 for the PTV1 was on average 84 Gy for UF-RT patients and 76 Gy for CF-RT patients. Gamma passing rate for planned/delivered doses comparison was above 98% for both groups with 3 mm/3% distance to agreement/dose difference criteria. Total monitor units per fraction were 647 ± 94 and 2034 ± 570 for CF-RT and UF-RT, respectively. The total delivery time for boost radiation for the patients in the UF-RT arm was, on average, four times less than the total time for a conventional regimen with statistically equal clinical outcomes for the two arms in this study.

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Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis

Cited by 2 publications

References 31 publications

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Dosimetric Comparison of Ultra-Hypofractionated and Conventionally Fractionated Radiation Therapy Boosts for Patients with High-Risk Prostate Cancer

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