Abstract
BackgroundTo evaluate the efficacy of hypofractionated radiotherapy (HyRT) with or without image guided radiotherapy (IGRT) in intermediate risk prostate cancer.Methods105 patients were treated with HyRT, 43,8 Gy and 54,75 Gy were delivered to the seminal vescicles and to the prostate, respectively; 3,65 Gy/fraction three times weekly. All patients underwent 9 months hormonal therapy. Patient position was verified with daily kV cone beam CT in 69 patients (IGRT group). Acute and late toxicities were evaluated according to RTOG scale. Biochemical relapse was defined using PSA nadir + 2 ng/mL. The data were prospectively collected and retrospectively analyzed to evaluate the efficacy of IGRT.ResultsAfter a median follow-up of 31 months the actuarial 3-year bNED was 93,7%. During RT, 10.5% and 7.6% of patients developed ≥Grade 2 rectal and urinary toxicities, respectively. The cumulative incidence of ≥Grade 2 late rectal and urinary toxicities at 3 years were 6,9%, and 10,8%, respectively. The incidence of ≥Grade 2 late rectal toxicities was significant reduced in the IGRT group (1,6% vs. 14,5%, p=0,021). Two patients developed Grade 3 urethral obstruction and one patient developed grade 3 rectal bleeding.ConclusionsHyRT represents a well-tolerated treatment able to achieve a high bNED. The use of daily IGRT is beneficial for reducing the incidence of late toxicities.
Highlights
To evaluate the efficacy of hypofractionated radiotherapy (HyRT) with or without image guided radiotherapy (IGRT) in intermediate risk prostate cancer
The incidence of ≥Grade 2 late rectal toxicities was significant reduced in the IGRT group (1,6% vs. 14,5%, p=0,021)
The use of daily IGRT is beneficial for reducing the incidence of late toxicities
Summary
To evaluate the efficacy of hypofractionated radiotherapy (HyRT) with or without image guided radiotherapy (IGRT) in intermediate risk prostate cancer. External Beam Radiotherapy (RT) is one of the therapeutic options for treating prostate cancer. The use of high dose RT with a conventional fractionation delivered conformally to spare as much normal tissue as possible, results in a significant biochemical control with acceptable toxicities [1]. In the past decade hypofractionated radiotherapy (HyRT) has been proposed as an alternative to conventional fractionation. Because of its intrinsic slow proliferation, would be more sensitive to fractionations than nearby late-responding tissues. According to the Linear-Quadratic Model (LQM), the use of fewer and larger fractions of radiation instead of the conventional daily fractions of 2 Gy, would lead to an expected therapeutic advantage [3]. HyRT is convenient for patients since the overall treatment time is reduced of several weeks depending on the higher dose per fraction, as well as for costs reduction of the health care system
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