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Influence of the technique and comorbidities in hypofractionated radiotherapy for prostate cancer

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Abstract

Purpose

To analyze the differences in toxicity and biochemical relapse-free survival with hypofractionated radiotherapy with three-dimensional radiotherapy (3D-CRT) or volumetric arc therapy (VMAT) for prostate cancer taking into account comorbidity measured using the Charlson Comorbidity Index (CCI).

Methods

From January 2011 to June 2016, 451 patients with prostate cancer were treated with 60 Gy (20 daily fractions). VMAT or 3D-CRT was used. Distribution by stage: 17% low-risk, 27.2% intermediate-risk; 39.2% high-risk, 16.6% very high-risk. Mean CCI was 3.4.

Results

With a median follow up of 51 months, most patients did not experience any degree of acute GI toxicity (80.9%) compared to 19.1%, who experienced some degree, mainly G-I /II. In the multivariate analysis, only technique was associated with acute GI toxicity ≥ G2. Patients treated with VMAT had greater acute GI toxicity compared with those who received 3D-CRT (23.9% vs. 13.5%, p = 0.005). With respect to acute GU toxicity, 72.7% of patients experienced some degree, fundamentally G-I/II. Neither age, CCI, nor androgen deprivation therapy (ADT) were associated with greater toxicity. Overall survival at 2, 5 and 7 years was 97%, 88% and 83% respectively. The only factor with statistical significance was CCI, with a greater number of events in individuals with a CCI ≥ 4 (p < 0.03).

Conclusions

Hypofractionated radiotherapy for prostate cancer is an effective, well-tolerated treatment even for elderly patients with no associated comorbidity. Longer follow up is needed in order to report data on late toxicity.

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References

  1. REDECAN. Red Española de Registros de Cáncer. https://redecan.org/es/index.cfm. último acceso el 13 Jan 18.

  2. Dearnaley DP, Jovic G, Syndikus I, Khoo V, Cowan RA, Gram JD, et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2014;15(4):464–73.

    Article  Google Scholar 

  3. Hou Z, Li G, Bai S. High dose versus conventional dose in external beam radiotherapy of prostate cancer: a meta-analysis of long-term follow-up. J Cancer Res Clin Oncol. 2015;141:1063–71.

    Article  CAS  Google Scholar 

  4. Spratt DE, Pei X, Yamada J, Kollmeier MA, Cox B, Zelefsky MJ. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2013;85:686–92.

    Article  Google Scholar 

  5. Bentzen SM, Ritter MA. The alpha/beta ratio for prostate cancer: what is it, really? Radiother Oncol. 2005;76:1–3.

    Article  Google Scholar 

  6. Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50:1021–31.

    Article  CAS  Google Scholar 

  7. Brenner DJ, Martinez AA, Edmundson GK, Mitchell C, Thames HD, Armour EP. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys. 2002;52:6–13.

    Article  Google Scholar 

  8. Lukka H, Hayter C, Julian JA, Warde P, Morris WJ, Gospodarowicz M, et al. Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol. 2005;23:6132–8.

    Article  Google Scholar 

  9. Yeoh EE, Botten RJ, Butters J, Di Matteo AC, Holloway RH, Fowler J. Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys. 2011;81:1271–8.

    Article  Google Scholar 

  10. Arcangeli S, Strigari L, Gomellini S, Saracino B, Petrongari MG, Pinnarò P, et al. Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84:1172–8.

    Article  Google Scholar 

  11. Arcangeli G, Saracino B, Arcangeli S, Gomellini S, Petrongari MG, Sanguineti G, et al. Moderate Hypofractionation in high-risk, organ-confined prostate cancer: final results of a phase III randomized trial. J Clin Oncol. 2017;35:1891–7.

    Article  CAS  Google Scholar 

  12. Kuban DA, Nogueras-Gonzalez GM, Hamblin L, Lee AK, Choi S, Frank SJ, et al. Preliminary report of a randomized dose escalation trial for prostate cancer using hypofractionation. Int J Radiat Oncol Biol Phys. 2010;78(Suppl 3):S58.

    Article  Google Scholar 

  13. Hoffman KE, Ranh Voong K, Pugh TJ, Skinner H, Levy LB, Takiar V, et al. Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial. Int J Radiat Oncol Biol Phys. 2014;88:1074–84.

    Article  Google Scholar 

  14. Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomized, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17:1047–60.

    Article  Google Scholar 

  15. Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn PP, de Jager H, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomized, non-inferiority, phase 3 trial. Lancet Oncol. 2016;17:464–74.

    Article  Google Scholar 

  16. Incrocci L, Wortel RC, Alemayehu WG, Aluwini S, Schimmel E, Krol S, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2016;17:1061–9.

    Article  Google Scholar 

  17. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, et al. Randomized trial of hypofractionated external- beam radiotherapy for prostate cancer. J Clin Oncol. 2013;31:3860–8.

    Article  Google Scholar 

  18. Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, et al. Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol. 2016;34:2325–32.

    Article  Google Scholar 

  19. Catton CN, Lukka H, Gu C-S, Martin JM, Supiot S, Chung PWM, et al. Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol. 2017;35:1884–900.

    Article  CAS  Google Scholar 

  20. Arcangeli G, Arcangeli S, Pinzi V, Benassi M, Benassi M, Strigari L. Optimal scheduling of hypofractionated radiotherapy for localized prostate cancer: a systematic review and metanalysis of randomized clinical trials. Cancer Treat Rev. 2018;70:22–9.

    Article  Google Scholar 

  21. Koontz BF, Bossi A, Cozzarini C, Wiegel T, D’Amico A. A systematic review of hypofractionation for primary management of prostate cancer. Eur Urol. 2015;68:683–91.

    Article  Google Scholar 

  22. Zaorsky NG, Ohri N, Showalter TN, Dicker AP, Den RB. Systematic review of hypofractionated radiation therapy for prostate cancer. Cancer Treat Rev. 2013;39:728–36.

    Article  Google Scholar 

  23. Matthes KL, Limam M, Pestoni G, Held L, Korol D, Rohrmann S. Impact of comorbidities at diagnosis on prostate cancer treatment and survival. J Cancer Res Clin Oncol. 2018;144:707–15.

    Article  Google Scholar 

  24. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  Google Scholar 

  25. Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61:1234–40.

    Article  Google Scholar 

  26. Timmerman RD. An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol. 2008;18:215–22.

    Article  Google Scholar 

  27. Roach M III, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer, recommendation of RTOG ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65:965–74.

    Article  Google Scholar 

  28. National Comprehensive Cancer Network. Prostate cancer (versión 4.2018). 2018.

  29. Wilson JM, Dearnaley DP, Syndikus I, Khoo V, Birtle A, Bloomfield D, et al. The efficacy and safety of conventional and hypofractionated high-dose radiation therapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial. Int J Radiation Oncol Biol Phys. 2018;100:1179–89.

    Article  Google Scholar 

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Funding

None declared.

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Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga University, Campus Universitario de Teatinos S/N, 29013, Malaga, Spain

    R. Correa, I. Navarro, M. Lobato, A. Otero, I. Jerez, I. Zapata, Y. Lupiañez, J. A. Medina & J. Gómez-Millán

  2. Department of Radiation Oncology, Juan Ramón Jimenez Hospital, Huelva, Spain

    J. M. Rico

  3. Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain

    D. Olmos

  4. CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Malaga, Spain

    D. Olmos

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  1. R. Correa
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  2. I. Navarro
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  3. M. Lobato
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  5. I. Jerez
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Correspondence to R. Correa.

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All procedures performed in the study were in accordance with the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent for the treatment proposed was obtained from all individual participants included in the study.

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Correa, R., Navarro, I., Lobato, M. et al. Influence of the technique and comorbidities in hypofractionated radiotherapy for prostate cancer. Clin Transl Oncol 22, 311–318 (2020). https://doi.org/10.1007/s12094-019-02224-6

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  • DOI: https://doi.org/10.1007/s12094-019-02224-6

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