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Acute and late toxicity and preliminary outcomes report of moderately hypofractionated helical tomotherapy for localized prostate cancer: a mono-institutional analysis

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Abstract

Aims

To assess toxicity and clinical outcomes of moderately hypofractionated helical tomotherapy (HT) for the curative treatment of localized prostate cancer (PC).

Methods

From December 2012 to May 2018, 170 patients were treated with definitive intent for PC. Thirty-four percent were low risk, 30% intermediate risk (IR) and 36% high risk (HR). All patients received 70 Gy in 28 fractions to the prostate; 61.6 Gy were delivered to the seminal vesicles for IR; pelvic lymph nodes irradiation for a total dose of 50.4 Gy was added in the HR subgroup. Toxicity was assessed using CTCAE V4.0, and biochemical failure was defined following Phoenix criteria. Time-to-event data were analyzed using the Kaplan–Meier method and log-rank test.

Results

The median follow-up was 36 months (range 12–78); acute toxicity was as follows: G1 and G2 in 27.6% and 19.4% for GI; 53% and 24% for GU. No G ≥ 3 event was observed. For late toxicity, G ≥ 3 GI and GU rates were, respectively, 3% and 2.4% at 3 years and 3% and 4.8% at 4 years; no G4 occurred. A statistical correlation between acute or late G3 incidence and clinical or dosimetric parameters was not found. At the time of analysis, 2- and 3-year biochemical relapse-free survival rates were 90% and 87.5% and 2- and 3-year overall survival rates were 96.4% and 90%, respectively. The log-rank test revealed no difference between the risk groups in terms of biochemical control (p = 0.16).

Conclusions

Moderately hypofractionated RT with HT for localized prostate cancer reported excellent outcomes with mild acute and late toxicity incidence, with promising biochemical control rates.

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References

  1. Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, Shipley WU (2005) Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 294(10):1233–1239 (erratum in: JAMA. 2008 Feb 27;299(8):899–900)

    Article  CAS  Google Scholar 

  2. Dearnaley DP, Jovic G, Syndikus I, Khoo V, Cowan RA, Graham JD, Aird EG, Bottomley D, Huddart RA, Jose CC, Matthews JH, Millar JL, Murphy C, Russell JM, Scrase CD, Parmar MK, Sydes MR (2014) Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol 15(4):464–473. https://doi.org/10.1016/S1470-2045(14)70040-3

    Article  PubMed  Google Scholar 

  3. Dasu A, Toma-Dasu I (2012) Prostate α/β revisited: an analysis of clinical results from 14168 patients. Acta Oncol 51:963–974

    Article  Google Scholar 

  4. Voong KR, Lal LS, Kuban DA, Pugh TJ, Swint JM, Godby J, Choi S, Lee AK, Schlembach PJ, Frank SJ, McGuire SE, Hoffman KE (2017) Long-term economic value of hypofractionated prostate radiation: secondary analysis of a randomized trial. Adv Radiat Oncol 2(3):249–258. https://doi.org/10.1016/j.adro.2017.07.010

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lee WR, Koontz BF (2018) Moderate hypofractionation for prostate cancer. Transl Androl Urol 7(3):321–329. https://doi.org/10.21037/tau.2017.12.07

    Article  PubMed  PubMed Central  Google Scholar 

  6. Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, Bentzen S, Chang M, Efstathiou J, Greany P, Halvorsen P, Koontz BF, Lawton C, Leyrer CM, Lin D, Ray M, Sandler H (2019) Hypofractionated radiation therapy for localized prostate cancer: executive summary of an ASTRO, ASCO and AUA evidence-based guideline. J Urol 201(3):528–534. https://doi.org/10.1097/JU.0000000000000071

    Article  PubMed  Google Scholar 

  7. Kupelian PA, Willoughby TR, Reddy CA, Klein EA, Mahadevan A (2007) Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland clinic experience. Int J Radiat Oncol Biol Phys 68(5):1424–1430

    Article  Google Scholar 

  8. Kotecha R, Marwaha G, Hearn JW, Weller MA, Kupelian P, Reddy CA, Ciezki JP, Stephans K, Tendulkar RD (2014) A comparison of long-term treatment-related toxicities between moderately hypofractionated and conventionally fractionated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 90(1, Supplement):S423–S424

    Article  Google Scholar 

  9. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, Stoyanova R, Movsas B, Greenberg RE, Uzzo RG, Ma C, Buyyounouski MK (2013) Randomized trial of hypofractionated external beam radiotherapy for prostate cancer. J Clin Oncol 31:3860–3868

    Article  Google Scholar 

  10. Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, Shah AB, D’Souza DP, Michalski JM, Dayes IS, Seaward SA, Hall WA, Nguyen PL, Pisansky TM, Faria SL, Chen Y, Koontz BF, Paulus R, Sandler HM (2016) Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol 34:2325–2332

    Article  Google Scholar 

  11. Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, Bauman GS, Bahary JP, Ahmed S, Cheung P, Tai KH, Wu JS, Parliament MB, Tsakiridis T, Corbett TB, Tang C, Dayes IS, Warde P, Craig TK, Julian JA, Levine MN (2017) Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol 35:1884–1890

    Article  CAS  Google Scholar 

  12. Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, Graham J, Kirkbride P, Logue J, Malik Z, Money-Kyrle J, O’Sullivan JM, Panades M, Parker C, Patterson H, Scrase C, Staffurth J, Stockdale A, Tremlett J, Bidmead M, Mayles H, Naismith O, South C, Gao A, Cruickshank C, Hassan S, Pugh J, Griffin C, Hall E, CHHiP Investigators (2016) Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 17(8):1047–1060. https://doi.org/10.1016/s1470-2045(16)30102-4(Erratum in: Lancet Oncol. 2016 Aug;17 (8):e321)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Di Muzio NG, Fodor A, Noris Chiorda B, Broggi S, Mangili P, Valdagni R, Dell’Oca I, Pasetti M, Deantoni CL, Chiara A, Berardi G, Briganti A, Calandrino R, Cozzarini C, Fiorino C (2016) Moderate hypofractionation with simultaneous integrated boost in prostate cancer: long-term results of a phase I–II study. Clin Oncol (R Coll Radiol) 28(8):490–500. https://doi.org/10.1016/j.clon.2016.02.005

    Article  Google Scholar 

  14. Magli A, Moretti E, Tullio A, Giannarini G, Tonetto F, Urpis M, Crespi M, Foti C, Prisco A, Polsinelli M, De Giorgi G, Bravo G, Scalchi P, Trovò M (2018) Hypofractionated simultaneous integrated boost (IMRT-SIB) with pelvic nodal irradiation and concurrent androgen deprivation therapy for high-risk prostate cancer: results of a prospective phase II trial. Prostate Cancer Prostatic Dis 21(2):269–276. https://doi.org/10.1038/s41391-018-0034-0

    Article  CAS  PubMed  Google Scholar 

  15. Chang MG, Mukhopadhyay N, Holdford D, Skinner V, Saraiya S, Moghanaki D, Anscher MS (2018) Phase 1/2 study of hypofractionated intensity-modulated radiation therapy for prostate cancer including simultaneously integrated boost. Pract Radiat Oncol 8(3):e149–e157. https://doi.org/10.1016/j.prro.2017.09.007

    Article  PubMed  Google Scholar 

  16. Alongi F, Fogliata A, Navarria P, Tozzi A, Mancosu P, Lobefalo F, Reggiori G, Clivio A, Cozzi L, Scorsetti M (2012) Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Report of feasibility and acute toxicity. Strahlenther Onkol 188(11):990–996. https://doi.org/10.1007/s00066-012-0171-7

    Article  CAS  PubMed  Google Scholar 

  17. Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn PP, de Jager H et al (2016) Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol 17(4):464–474

    Article  Google Scholar 

  18. Franzese C, Fogliata A, D’Agostino GR, Di Brina L, Comito T, Navarria P, Cozzi L, Scorsetti M (2017) Moderate hypofractionated radiotherapy with volumetric modulated arc therapy and simultaneous integrated boost for pelvic irradiation in prostate cancer. J Cancer Res Clin Oncol 143(7):1301–1309. https://doi.org/10.1007/s00432-017-2375-9

    Article  CAS  PubMed  Google Scholar 

  19. Ferrera G, Mortellaro G, Mannino M, Caminiti G, Spera A, Figlia V, Iacoviello G, Di Paola G, Mazzola R, Lo Casto A, Alongi F, Pappalardo MP, Lagalla R (2015) Moderate hypofractionation and simultaneous integrated boost by helical tomotherapy in prostate cancer: monoinstitutional report of acute tolerability assessment with different toxicity scales. Radiol Med 120(12):1170–1176. https://doi.org/10.1007/s11547-015-0555-8

    Article  PubMed  Google Scholar 

  20. Longobardi B, Berardi G, Fiorino C, Alongi F, Cozzarini C, Deli A, La Macchia M, Perna L, Di Muzio NG, Calandrino R (2011) Anatomical and clinical predictors of acute bowel toxicity in whole pelvis irradiation for prostate cancer with tomotherapy. Radiother Oncol 101(3):460–464. https://doi.org/10.1016/j.radonc.2011.07.014

    Article  PubMed  Google Scholar 

  21. Jorgo K, Polgar C, Major T, Stelczer G, Herein A, Pocza T, Gesztesi L, Agoston P (2019) Acute and late toxicity after moderate hypofractionation with simultaneous integrated boost (SIB) radiation therapy for prostate cancer. A single institution, prospective study. Pathol Oncol Res. https://doi.org/10.1007/s12253-019-00623-2

    Article  PubMed  Google Scholar 

  22. Shaikh T, Li T, Handorf EA, Johnson ME, Wang LS, Hallman MA, Greenberg RE, Price RA Jr, Uzzo RG, Ma C, Chen D, Geynisman DM, Pollack A, Horwitz EM (2017) Long-term patient-reported outcomes from a phase 3 randomized prospective trial of conventional versus hypofractionated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 97(4):722–731. https://doi.org/10.1016/j.ijrobp.2016.12.034

    Article  PubMed  Google Scholar 

  23. Leibel SA, Fuks Z, Zelefsky MJ, Whitmore WF Jr (1994) The effects of local and regional treatment on the metastatic outcome in prostatic carcinoma with pelvic lymph node involvement. Int J Radiat Oncol Biol Phys 28(1):7–16

    Article  CAS  Google Scholar 

  24. Asbell SO, Krall JM, Pilepich MV, Baerwald H, Sause WT, Hanks GE, Perez CA (1988) Elective pelvic irradiation in stage A2, B carcinoma of the prostate: analysis of RTOG 77-06. Int J Radiat Oncol Biol Phys 15(6):1307–1316

    Article  CAS  Google Scholar 

  25. Pommier P, Chabaud S, Lagrange JL, Richaud P, Lesaunier F, Le Prise E, Wagner JP, Hay MH, Beckendorf V, Suchaud JP, Pabot du Chatelard PM, Bernier V, Voirin N, Perol D, Carrie C (2007) Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 25(34):5366–5373

    Article  Google Scholar 

  26. Lawton CA, DeSilvio M, Roach M 3rd et al (2007) An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 69:646–655

    Article  Google Scholar 

  27. Dearnaley D, Griffin CL, Lewis R, Mayles P, Mayles H, Naismith OF, Harris V, Scrase CD, Staffurth J, Syndikus I, Zarkar A, Ford DR, Rimmer YL, Horan G, Khoo V, Frew J, Venkitaraman R, Hall E (2019) Toxicity and patient-reported outcomes of a phase 2 randomized trial of prostate and pelvic lymph node versus prostate only radiotherapy in advanced localised prostate cancer (PIVOTAL). Int J Radiat Oncol Biol Phys 103(3):605–617. https://doi.org/10.1016/j.ijrobp.2018.10.003

    Article  PubMed  PubMed Central  Google Scholar 

  28. Carvalho ÍT, Baccaglini W, Claros OR, Chen FK, Kayano PP, Lemos GC, Weltman E, Kuban DA, Carneiro A (2018) Genitourinary and gastrointestinal toxicity among patients with localized prostate cancer treated with conventional versus moderately hypofractionated radiation therapy: systematic review and meta-analysis. Acta Oncol 57(8):1003–1010. https://doi.org/10.1080/0284186X.2018.1478126

    Article  PubMed  Google Scholar 

  29. Jereczek-Fossa BA, Surgo A, Maisonneuve P, Maucieri A, Gerardi MA, Zerini D, Marvaso G, Ciardo D, Volpe S, Rojas DP, Riva G, Alessandro O, Dicuonzo S, Fanetti G, Romanelli P, Starzyńska A, Cattani F, Cambria R, Fodor C, Garibaldi C, Romanò C, De Cobelli O, Orecchia R (2019) Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation. Radiol Med 124(1):65–78. https://doi.org/10.1007/s11547-018-0937-9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, ARNAS Civico Hospital, Radiation Oncology School, University of Palermo, Palermo, Italy

    Francesco Cuccia, Giovanna Trapani, Vito Valenti, Giorgia De Gregorio, Emanuele Quartuccio, Nicoletta Luca & Antonella Tripoli

  2. Department of Radiation Oncology, ARNAS Civico Hospital, Palermo, Italy

    Gianluca Mortellaro & Giuseppe Ferrera

  3. Department of Radiation Oncology, San Gaetano Radiotherapy and Nuclear Medicine Center, Bagheria, Palermo, Italy

    Lucia Ognibene

  4. Department of Surgical Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy

    Vincenzo Serretta

  5. Radiation Oncology School, Section of Radiology - Di.Bi.Med, University of Palermo, Palermo, Italy

    Antonio Lo Casto

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  1. Francesco Cuccia
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Correspondence to Giovanna Trapani.

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Cuccia, F., Mortellaro, G., Trapani, G. et al. Acute and late toxicity and preliminary outcomes report of moderately hypofractionated helical tomotherapy for localized prostate cancer: a mono-institutional analysis. Radiol med 125, 220–227 (2020). https://doi.org/10.1007/s11547-019-01095-9

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