Abstract
PurposeHypofractionated radiotherapy for prostate cancer is well established for definitive treatment, but not well defined in the postoperative setting. The purpose of this analysis was to assess oncologic outcomes and toxicity in a large cohort of patients treated with conventionally fractionated three-dimensional (3D) conformal radiotherapy (CF) and hypofractionated volumetric modulated arc therapy (HF) after radical prostatectomy.MethodsBetween 1994 and 2019, a total of 855 patients with prostate carcinoma were treated by postoperative radiotherapy using CF (total dose 65–72 Gy, single fraction 1.8–2 Gy) in 572 patients and HF (total dose 62.5–63.75 Gy, single fraction 2.5–2.55 Gy) in 283 patients. The association of treatment modality with biochemical control, overall survival (OS), and gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using logistic and Cox regression analysis.ResultsThere was no difference between the two modalities regarding biochemical control rates (77% versus 81%, respectively, for HF and CF at 24 months and 58% and 64% at 60 months; p = 0.20). OS estimates after 5 years: 95% versus 93% (p = 0.72). Patients undergoing HF had less frequent grade 2 or higher acute GI or GU side effects (p = 0.03 and p = 0.005, respectively). There were no differences in late GI side effects between modalities (hazard ratio 0.99). Median follow-up was 23 months for HF and 72 months for CF (p < 0.001).ConclusionFor radiation therapy of resected prostate cancer, our analysis of this largest single-centre cohort (n = 283) treated with hypofractionation with advanced treatment techniques compared with conventional fractionation did not yield different outcomes in terms of biochemical control and toxicities. Prospective investigating of HF is merited.
Highlights
Patient populationRadical prostatectomy with or without lymphadenectomy is a widely used therapeutic option for localized prostate cancer (PCA) [1, 2]
The following inclusion criteria had to be met: Prostate cancer treated with radical prostatectomy (RPE) with or without lymph node dissection (LND), pT2-4 without evidence of lymph node involvement or distant metastases (c/pN0M0), Documented preoperative, postoperative, and preirradiation prostate specific antigen (PSA) values and Adjuvant or salvage radiotherapy: salvage RT was defined as PSA persisting or rising ≥ 0.2 ng/mL after surgery; patients with preradiation PSA ≤ 0.2 ng/mL were classified as having received adjuvant radiotherapy
There was a difference in the administration of Androgen-deprivation therapy (ADT) as well as a higher percentage of patients with pelvic lymph node irradiation in patients treated with moderate HF compared with patients treated with conformal radiotherapy (CF)
Summary
Patient populationRadical prostatectomy with or without lymphadenectomy is a widely used therapeutic option for localized prostate cancer (PCA) [1, 2]. External beam radiotherapy has shown a significant oncologic advantage in terms of reducing these recurrences in both the adjuvant and salvage settings [1, 4, 5]. Hypofractionation (HF) provides a logistic advantage of shorter overall treatment time, allowing more patients to be treated with given resources. This shortens waiting times, benefitting patients and providers alike, in addition to lowering costs per treatment [6]. HF for PCA is already well established, both in terms of oncological efficacy and safety [7, 8]. No large randomized prospective studies on postoperative HF have been published yet. Some retrospective studies on postoperative HF have been published [9–15], but have included only small cohorts
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