Abstract
Background
As the use of hypofractionation has spread in the setting of curative prostate radiotherapy, few data are available in the post-operative scenario. This study reports a mono-institutional experience of moderate post-operative hypofractionated radiotherapy for prostate cancer.
Methods
In February 2021, we retrospectively assessed the outcomes of 129 patients who received between April 2013 and May 2020 hypofractionated post-operative radiotherapy using Helical Tomotherapy. Toxicity was assessed using CTCAE criteria v4.0. Survival endpoints were calculated with Kaplan–Meier method.
Results
Median age and follow-up were, respectively, 67 years and 43 months. Adjuvant and salvage treatment were delivered to 63.5% and 36.4% of patients to a median total dose of 63.8 Gy (61.6–65.25 Gy) in 29 fractions (2.12–2.25 Gy/fraction). Pelvic lymph-nodes irradiation was performed in 67.4% of cases. ADT was added in 50%. Acute toxicity was: G1 and G2 GU events in 36% and 9.3% of cases; G1 and G2 GI events in 29.4% and 13.9%. Late GU toxicity occurred in 12.4% of cases: 3.1% G1, 7.7% G2 and 1.5% G3 events; GI toxicity consisted of 1.5% G1 and 7.7% G2 events. Biochemical relapse occurred in 26.3% of cases, recording no significant differences between adjuvant and salvage (p = 0.67), with 4- and 5-years bRFS rates of 78.7% and 75.6%. Two patients died of progressive disease and eight for non-oncological causes resulting in 3-years overall survival and cancer-specific survival rates of 98% and 98.4%.
Conclusions
Our experience supports the use of moderate hypofractionation for prostate bed radiotherapy, with minimal toxicity and promising results in terms of clinical outcomes.
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GF, FC and SDA manuscript drafting; GT, SDA and GM data collection and analysis; GF, VS and GS study conception; GF and ALC manuscript revision; all authors approved the final version of the manuscript.
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Appendix
Appendix
See Tables 1, 2, 3 and 4 and Figs. 1, 2, 3 and 4.
Late G ≥ 2 toxicity-free survival
Biochemical relapse—free survival
Biochemical relapse—free survival curves for adjuvant and salvage radiotherapy
Overall survival
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Ferrera, G., D’Alessandro, S., Cuccia, F. et al. Post-operative hypofractionated radiotherapy for prostate cancer: a mono-institutional analysis of toxicity and clinical outcomes. J Cancer Res Clin Oncol 148, 89–95 (2022). https://doi.org/10.1007/s00432-021-03816-y
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DOI: https://doi.org/10.1007/s00432-021-03816-y