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Open Access 01-10-2019 | Prostate Cancer | Original Article

Risk-adapted moderate hypofractionation of prostate cancer

A prospective analysis of acute toxicity, QOL and outcome in 221 patients

Authors: Andreas Schörghofer, Michael Groher, Josef Karner, Andrea Kopp, Gerhard Kametriser, Thomas Kunit, Josef Holzinger, Felix Sedlmayer, Dr. Frank Wolf, MD-PhD

Published in: Strahlentherapie und Onkologie | Issue 10/2019

Abstract

Purpose

Prostate cancer (PCA) is highly heterogeneous in terms of its oncologic outcome. We therefore aimed to tailor radiation treatment to the risk status by using three different hypofractionated radiation regimen differing in applied dose, use of rectum spacer, inclusion of pelvic lymph nodes (pLN) and use of androgen deprivation therapy (ADT). Here we report on acute toxicity, quality of life (QOL) and oncologic outcome at a median follow-up of 12 months.

Methods

A total of 221 consecutive PCA patients received hypofractionated intensity-modulated radiotherapy (IMRT). Low-risk (LR) patients were planned to receive 60 Gy in 20 fractions (EQD2^α/β1.5 = 77.1 Gy), intermediate-risk (IR) patients 63 Gy in 21 fractions (EQD2^α/β1.5 = 81 Gy), and high-risk (HR) patients 67.5 Gy in 25 fractions (EQD2^α/β1.5 = 81 Gy) to the prostate and 50 Gy in 25 fractions to the pLN. Acute rectal toxicity was assessed by endoscopy. In addition, toxicity was scored using CTC-AE 4.0 and IPSS score, while QOL was assessed using QLQ-PR25 questionnaires.

Results

Acute CTC reactions were slightly higher in the HR regimen but reverted to baseline at 3 months. GI G2 toxicity was 4%, 0% and 12% for the LR, IR and HR regimen. Compared to IR patients, the increase in toxicity in HR patients was statistically significant (p = 0.002) and mainly caused by a higher incidence of diarrhea presumably due to pelvic EBRT. QOL scores of all domains were worse for the HR regimen (not significant).

Conclusion

Risk-adapted moderate hypofractionation is associated with low GI/GU toxicity. Given the higher rate of pelvic metastases in HR patients, slightly higher transient acute reactions should be outweighed by possible oncological benefits.

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Title: Risk-adapted moderate hypofractionation of prostate cancer
A prospective analysis of acute toxicity, QOL and outcome in 221 patients
Authors: Andreas Schörghofer
Michael Groher
Josef Karner
Andrea Kopp
Gerhard Kametriser
Thomas Kunit
Josef Holzinger
Felix Sedlmayer
Dr. Frank Wolf, MD-PhD
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 10/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01477-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk-adapted moderate hypofractionation of prostate cancer

A prospective analysis of acute toxicity, QOL and outcome in 221 patients

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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