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Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity

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Abstract

Objective

Postoperative radiotherapy (RT) is an established treatment for prostate cancer (PC). Though hypofractionation is commonly used for radical treatments, open issues still remain in the postoperative setting due to the lack of long-term data. Aim of this study was to evaluate long-term results of postoperative moderately hypofractionated RT (MHRT).

Methods

We conducted a retrospective analysis including PC patients treated with prostatectomy and postoperative MHRT delivered with volumetric modulated arc therapy (VMAT). Endpoints of the analysis included biochemical relapse-free survival (BRFS), distant metastases free-survival (DMFS), overall survival (OS), and pattern of acute and late toxicity.

Results

181 patients were included. Pathological stage was classified as pT3a in 33.6% and pT3b in 30%. Median PSA value before RT was 0.23 ng/ml and median RT total dose was 70 Gy (65–74.2 Gy) in 25/28 fractions. With a median follow-up of 54.5 months, rates of BRFS at 3 and 5 years were 80.7 and 72.3%. ISUP grade group (HR 1.44, p = 0.015), pathological T stage (HR 2.03; p = 0.009), and pre-RT PSA >0.2 ng/ml (HR 2.64; p = 0.015) were correlated with BRFS. Three and 5‑year DMFS were 87.4 and 80.8%. ISUP grade group (HR 1.50; p = 0.011) and pre-RT PSA (HR 5.34; p = 0.001) were correlated with DMFS. Five (2.7%) and 3 (1.6%) patients reported late grade 3 GU and GI toxicity, respectively.

Conclusion

Our results confirm the long-term safety and efficacy of postoperative MHRT for PC.

Advances in knowledge

The present paper demonstrates the long-term safety and efficacy of MHRT for postoperative prostate cancer. Reduction of treatment time in long-course radiotherapy has advantages in terms of both patients’ quality of life and departmental organization.

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Authors and Affiliations

  1. Humanitas Clinical and Research Center—IRCCS, Radiotherapy and Radiosurgery Dept., via Manzoni 56, 20089, Rozzano, Mi, Italy

    Ciro Franzese, Marco Badalamenti, Davide Baldaccini, Giuseppe D’Agostino, Tiziana Comito, Davide Franceschini, Elena Clerici, Pierina Navarria, Giacomo Reggiori, Stefano Tomatis & Marta Scorsetti

  2. Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele—Milan, Italy

    Ciro Franzese & Marta Scorsetti

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  1. Ciro Franzese
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  2. Marco Badalamenti
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  4. Giuseppe D’Agostino
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Correspondence to Ciro Franzese.

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Conflict of interest

C. Franzese, M. Badalamenti, D. Baldaccini, G. D’Agostino, T. Comito, D. Franceschini, E. Clerici, P. Navarria, G. Reggiori, S. Tomatis, and M. Scorsetti declare that they have no competing interests.

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Franzese, C., Badalamenti, M., Baldaccini, D. et al. Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity. Strahlenther Onkol 197, 133–140 (2021). https://doi.org/10.1007/s00066-020-01691-z

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  • DOI: https://doi.org/10.1007/s00066-020-01691-z

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