Abstract

This paper describes the first-year biochemical (prostate-specific antigen [PSA]) response of 91 irradiated patients enrolled in a single-institution randomized trial comparing hypofractionated (HFRT) and conventionally fractionated (CFRT) external beam radiotherapy. Forty-four patients in the CFRT treatment arm were irradiated with 74 Gy in 37 fractions (2 Gy per fraction), and 47 in the HFRT arm were treated with 57 Gy, given in 13 fractions of 3 Gy plus 4 fractions of 4.5 Gy. The clinical target volume includes the prostate and a base of seminal vesicles. The proportions of patients who reached PSA nadir (nPSA) lower than or equal to 1.0 ng/mL (nPSA1) and 0.5 ng/mL (nPSA05) were compared. There were 2 non-cancer-related deaths (1 in the CFRT and 1 in the HFRT treatment arms). Biochemical relapse after irradiation was defined in five cases (3 in the CFRT and 2 in the HFRT treatment arms) during a 12-month follow-up. The remaining 84 patients were analyzed. The proportions of patients reaching nPSA1 were 50% and 54.5% in the CFRT and HFRT treatment arms, respectively (chi-square P=0.843). The percentages of patients reaching nPSA05 were 25% and 18.2%, respectively (chi-square P=0.621). The trends toward increasing proportions of biochemical responders (both nPSA1 and nPSA05) during 12 months after radiotherapy were observed, but the difference between trends for treatment arms did not reach a statistical significance. The preliminary results presented here demonstrate that HFRT schedule induces biochemical response rates comparable to those in the CFRT schedule during the first-year follow-up.

Highlights

  • The randomized dose-escalation trials demonstrate a significant improvement in freedom from biochemical failure (FFBF) for intermediate and high-risk prostate cancer with the increase of conventionally fractionated radiotherapy dose [1,2,3]

  • Biochemical relapse after irradiation was defined in five cases (3 in the conventionally fractionated (CFRT) and 2 in the HFRT treatment arms) during a 12-month follow-up

  • There was no significant difference in proportions of patients between CFRT and HFRT treatment arms, who achieved either nPSA1 or nPSA05

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Summary

Introduction

The randomized dose-escalation trials demonstrate a significant improvement in freedom from biochemical failure (FFBF) for intermediate and high-risk prostate cancer with the increase of conventionally fractionated radiotherapy dose [1,2,3]. Fractionated dose escalation, results in treatment protraction, which negatively impacts patient’s lifestyle and possibly lowers biological benefit. Hypofractionation in the treatment of prostate cancer offers a shorter treatment course and increased convenience for patients. Hypofractionation in the treatment of prostate cancer offers an improved therapeutic ratio due to a presumed higher sensitivity of prostate cancer tissues to higher fraction dose. If the α/β value for prostate is reliably lower than that for late-responding rectal damage (3 Gy), hypofractionated regimens could be designed with fewer but larger doses, which maintain equivalent late toxicity while yielding improved tumor control. Several nonrandomized and 3 randomized trials have addressed this issue, but the data about benefit of hypofractionation in the treatment of prostate cancer are still scarce

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