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Open Access 01-07-2020 | Prostate Cancer | Original Article

Moderately HRT vs. CRT for localized prostate cancer using image-guided VMAT with SIB: evaluation of acute and late toxicities

Authors: Stratos Vassis, Beatrice Nöldeke, M.Sc., Prof. Dr. med. Hans Christiansen, PD Dr. med. Christoph A. von Klot, Dr. med. Roland Merten

Published in: Strahlentherapie und Onkologie | Issue 7/2020

Abstract

Purpose

This retrospective study aims at investigating the effects of moderately hypofractionated radiation therapy (HRT) on acute and late toxicities as well as on early biochemical control and therapeutic efficiency compared to conventional radiation therapy (CRT) in prostate cancer.

Patients and methods

We analyzed 55 HRT patients irradiated with the total dose of 60 Gy in 20 fractions delivered over 4 weeks. These patients were compared to a control group of 55 patients who received CRT with a total of <78 Gy in 37–39 fractions delivered over circa 8 weeks. External beam radiation therapy (EBRT) was conducted using daily image-guided (cone beam CT) volumetric modulated arc therapy (VMAT) and a simultaneously integrated boost (SIB) for both groups to protect the rectum. Acute toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE) v5, whereas chronic toxicities were assessed in accordance with LENT-SOMA. Patient traits were compared by implementing t‑tests and Wilcoxon–Whitney tests for continuous variables, whereas discrete characteristics were evaluated by applying two-tailed Fisher’s exact tests. In addition, we calculated average treatment effects (ATE). Thereby, propensity score matching (PSM) based on nearest-neighbor matching considering age, comorbidities, and risk stratification as covariates was applied. The statistical analysis was conducted using Stata 14.2 (StataCorp LLC, TX, USA).

Results

As confirmed by the descriptive tests, the ATE revealed that the intensity and occurrence of urinary frequency (p = 0.034) and proctitis (p = 0.027) significantly decreased for the HRT group, whereas all other acute toxicities did not differ significantly between the HRT and CRT groups. For late toxicities, neither statistical tests nor ATE estimation showed significant differences. Also, no significant difference was found regarding the decrease in prostate specific antigen (PSA) after a median follow-up of 13 months (range 2–28 months), which indicates biochemical freedom from progression.

Conclusion

HRT offers several medical and economic advantages and should therefore be considered as a useful alternative to CRT.

Parts of the results have been orally presented at the DEGRO Annual Meeting 2019 in Münster.

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Title: Moderately HRT vs. CRT for localized prostate cancer using image-guided VMAT with SIB: evaluation of acute and late toxicities
Authors: Stratos Vassis
Beatrice Nöldeke, M.Sc.
Prof. Dr. med. Hans Christiansen
PD Dr. med. Christoph A. von Klot
Dr. med. Roland Merten
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Proctitis
Prostate Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 7/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01589-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Moderately HRT vs. CRT for localized prostate cancer using image-guided VMAT with SIB: evaluation of acute and late toxicities

Abstract

Purpose

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

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