Top

Published in:

01-02-2021 | Prostate Cancer | Original Article

Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity

Authors: Ciro Franzese, Marco Badalamenti, Davide Baldaccini, Giuseppe D’Agostino, Tiziana Comito, Davide Franceschini, Elena Clerici, Pierina Navarria, Giacomo Reggiori, Stefano Tomatis, Marta Scorsetti

Published in: Strahlentherapie und Onkologie | Issue 2/2021

Abstract

Objective

Postoperative radiotherapy (RT) is an established treatment for prostate cancer (PC). Though hypofractionation is commonly used for radical treatments, open issues still remain in the postoperative setting due to the lack of long-term data. Aim of this study was to evaluate long-term results of postoperative moderately hypofractionated RT (MHRT).

Methods

We conducted a retrospective analysis including PC patients treated with prostatectomy and postoperative MHRT delivered with volumetric modulated arc therapy (VMAT). Endpoints of the analysis included biochemical relapse-free survival (BRFS), distant metastases free-survival (DMFS), overall survival (OS), and pattern of acute and late toxicity.

Results

181 patients were included. Pathological stage was classified as pT3a in 33.6% and pT3b in 30%. Median PSA value before RT was 0.23 ng/ml and median RT total dose was 70 Gy (65–74.2 Gy) in 25/28 fractions. With a median follow-up of 54.5 months, rates of BRFS at 3 and 5 years were 80.7 and 72.3%. ISUP grade group (HR 1.44, p = 0.015), pathological T stage (HR 2.03; p = 0.009), and pre-RT PSA >0.2 ng/ml (HR 2.64; p = 0.015) were correlated with BRFS. Three and 5‑year DMFS were 87.4 and 80.8%. ISUP grade group (HR 1.50; p = 0.011) and pre-RT PSA (HR 5.34; p = 0.001) were correlated with DMFS. Five (2.7%) and 3 (1.6%) patients reported late grade 3 GU and GI toxicity, respectively.

Conclusion

Our results confirm the long-term safety and efficacy of postoperative MHRT for PC.

Advances in knowledge

The present paper demonstrates the long-term safety and efficacy of MHRT for postoperative prostate cancer. Reduction of treatment time in long-course radiotherapy has advantages in terms of both patients’ quality of life and departmental organization.

Schröder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360(13):1320–1328. https://doi.org/10.1056/NEJMoa0810084CrossRefPubMed

National Comprehensive Cancer Network (2019) NCCN clinical practice guidelines in oncology: prostate cancer 2019. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf

Thompson IM, Tangen CM, Paradelo J et al (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. J Am Med Assoc 296(19):2329–2335. https://doi.org/10.1001/jama.296.19.2329CrossRef

Wiegel T, Bottke D, Steiner U et al (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 27(18):2924–2930. https://doi.org/10.1200/JCO.2008.18.9563CrossRefPubMed

Bolla M, van Poppel H, Tombal B et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380(9858):2018–2027. https://doi.org/10.1016/S0140-6736(12)61253-7CrossRefPubMed

Brenner DJ, Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43(5):1095–1101. https://doi.org/10.1016/S0360-3016(98)00438-6CrossRefPubMed

Fowler J, Chappell R, Ritter M (2001) Is α/β for prostate tumors really low? Int J Radiat Oncol Biol Phys 50(4):1021–1031. https://doi.org/10.1016/S0360-3016(01)01607-8CrossRef

Dearnaley D, Syndikus I, Mossop H et al (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)30102-4CrossRefPubMedPubMedCentral

Lee WR, Dignam JJ, Amin MB et al (2016) Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol 34(20):2325–2332. https://doi.org/10.1200/JCO.2016.67.0448CrossRefPubMedPubMedCentral

10.

Michalski JM, Lawton C, El Naqa I et al (2010) Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 76(2):361–368. https://doi.org/10.1016/j.ijrobp.2009.02.006CrossRefPubMed

11.

Fossati N, Karnes RJ, Boorjian SA et al (2017) Long-term impact of adjuvant versus early salvage radiation therapy in pT3N0 prostate cancer patients treated with radical prostatectomy: results from a multi-institutional series. Eur Urol 71(6):886–893. https://doi.org/10.1016/j.eururo.2016.07.028CrossRefPubMed

12.

Briganti A, Wiegel T, Joniau S et al (2012) Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: results of a match-controlled multi-institutional analysis. Eur Urol 62(3):472–487. https://doi.org/10.1016/j.eururo.2012.04.056CrossRefPubMed

13.

Ost P, De Troyer B, Fonteyne V, Oosterlinck W, De Meerleer G (2011) A matched control analysis of adjuvant and salvage high-dose postoperative intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 80(5):1316–1322. https://doi.org/10.1016/j.ijrobp.2010.04.039CrossRefPubMed

14.

Hwang WL, Tendulkar RD, Niemierko A et al (2018) Comparison between adjuvant and early-salvage postprostatectomy radiotherapy for prostate cancer with adverse pathological features. JAMA Oncol 4(5):e175230. https://doi.org/10.1001/jamaoncol.2017.5230CrossRefPubMedPubMedCentral

15.

Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25(15):2035–2041. https://doi.org/10.1200/JCO.2006.08.9607CrossRefPubMedPubMedCentral

16.

Tendulkar RD, Agrawal S, Gao T et al (2016) Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. j Clin Oncol 34(30):3648–3654. https://doi.org/10.1200/JCO.2016.67.9647CrossRefPubMed

17.

Lee LW, McBain CA, Swindell R, Wylie JP, Cowan RA, Logue JP (2004) Hypofractionated radiotherapy as salvage for rising prostate-specific antigen after radical prostatectomy. Clin Oncol 16(8):517–522. https://doi.org/10.1016/j.clon.2004.07.006CrossRef

18.

Koukourakis MI, Papadopoulou A, Abatzoglou I, Panteliadou M, Sismanidou K, Touloupidis S (2012) Postoperative pelvic hypofractionated accelerated radiotherapy with cytoprotection (HypoARC) for high-risk or recurrent prostate cancer. Anticancer Res 32(10):4561–4568PubMed

19.

Kruser TJ, Jarrard DF, Graf AK et al (2011) Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence. Cancer 117(12):2629–2636. https://doi.org/10.1002/cncr.25824CrossRefPubMed

20.

Fersino S, Tebano U, Mazzola R et al (2017) Moderate hypofractionated postprostatectomy volumetric modulated arc therapy with daily image guidance (VMAT-IGRT): a mono-institutional report on feasibility and acute toxicity. Clin Genitourin Cancer 15(4):e667–e673. https://doi.org/10.1016/j.clgc.2017.01.025CrossRefPubMed

21.

Syndikus I, Pickles TKE et al (1996) Postoperative radiotherapy for stage pT3 carcinoma of the prostate: improved local control. J Urol 155:1983–1986CrossRef

22.

Cozzarini C, Fiorino C, Deantoni C et al (2014) Higher-than-expected severe (grade 3–4) late urinary toxicity after postprostatectomy hypofractionated radiotherapy: a single-institution analysis of 1176 patients. Eur Urol 66(6):1024–1030. https://doi.org/10.1016/j.eururo.2014.06.012CrossRefPubMed

Title: Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity
Authors: Ciro Franzese
Marco Badalamenti
Davide Baldaccini
Giuseppe D’Agostino
Tiziana Comito
Davide Franceschini
Elena Clerici
Pierina Navarria
Giacomo Reggiori
Stefano Tomatis
Marta Scorsetti
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 2/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01691-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity

Abstract

Objective

Methods

Results

Conclusion

Advances in knowledge

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Advances in knowledge

Please log in to get access to this content

Other articles of this Issue 2/2021

Ultrahypofractionation of localized prostate cancer

Treatment of low-risk prostate cancer: a retrospective study with 477 patients comparing external beam radiotherapy and I-125 seeds brachytherapy in terms of biochemical control and late side effects

Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis

Performance assessment of two motion management systems for frameless stereotactic radiosurgery

Correction to: Managing patient flows in radiation oncology during the COVID-19 pandemic

Sichere Schwangerschaft nach Brustkrebstherapie von BRCA-Mutations-Trägerinnen?