Abstract
Simple SummaryModerately hypofractionated radiotherapy (HFRT) has been shown to be isoeffective compared to conventional regimens in the treatment of prostate cancer (PCa). In addition, dose-escalation improves biochemical or metastasis control with minimal toxicity, although no overall survival benefit has been demonstrated. This work reports the results of HFRT on biochemical control, overall survival, toxicity and quality of life in patients with localized PCa treated with a dose-escalated schedule (66 Gy, 3 Gy/fraction) using volume modulated arc therapy (VMAT).This retrospective study aimed to provide some clinical outcomes regarding effectiveness, toxicity, and quality of life in PCa patients treated with dose-escalated moderately hypofractionated radiation therapy (HFRT). Patients received HFRT to a total dose of 66 Gy in 22 fractions (3 Gy/fraction) delivered via volume modulated arc therapy (VMAT) in 2011–2016. Treatment effectiveness was measured by the biochemical failure-free survival rate. Toxicity was assessed according to the criteria of the Radiation Therapy Oncology Group (RTOG) and quality of life according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC). In this regard, quality of life (QoL) was measured longitudinally, at a median of 2 and 5 years after RT. Enrolled patients had low-risk (40.2%), intermediate-risk (47.5%), and high-risk (12.3%) PCa. Median follow-up was 75 months. The biochemical failure-free survival rate was 94.2%. The incidence of acute grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicity was 9.84% and 28.69%, respectively. The incidence rate of late grade 2 or higher GI and GU toxicity was 1.64% and 4.10%, respectively. Expanded Prostate Cancer Index Composite (EPIC) scores showed that the majority of patients maintained their QoL. HFRT to 66 Gy with VMAT was associated with adequate biochemical control, low toxicity and good reported GU and GI quality of life.
Highlights
The incidence rate of prostate cancer (PCa) is rapidly increasing, and it has become the most prevalent solid tumor diagnosed in men [1]
We have retrospectively analyzed the medical records of 122 consecutive patients with localized PCa treated with hypofractionated radiation therapy (HFRT) delivered by volume modulated arc therapy (VMAT) from January 2011 to November 2016 in two radiotherapy centers, one in the city of Granada and the other in Cordoba (Spain)
It was possible to include this patient in the exclusive radiotherapy to the prostate with the 66 Gy
Summary
The incidence rate of prostate cancer (PCa) is rapidly increasing, and it has become the most prevalent solid tumor diagnosed in men [1]. Radiation therapy (RT) is the gold standard alternative to surgery for localized PCa. Over the last decade, there have been three major advances in the use of external RT for the management of clinically localized PCa: (a) androgen deprivation therapy (ADT) [2]; (b) image-guided RT (IGRT) with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) [3,4], and c) radiation dose escalation schedules compared with conventional 70–72 Gy (2 Gy per fraction), which has been shown to improve biochemical and distant metastases control with minimum toxicity, but not overall survival [5–9]. Novel RT techniques such as volume modulated arc therapy (VMAT) minimize the dose to the tissues surrounding the tumor, reducing the overall treatment time (OTT) of the radiation dose escalation as VMAT shows similar highly conformed doses, coverage and homogeneity of PTV and OAR savings to other IMRT techniques. Several studies have explored different HFRT schedules to reduce the number of sessions and resource consumption as well as to improve the therapeutic outcome by increasing the dose per fraction (increasing improved tumor control with low side effects) [14–18]
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