Moderate hypofractionated post-prostatectomy radiation therapy is feasible and well tolerated: experience from a single tertiary cancer centre

Hypofractionated Post-Prostatectomy Radiotherapy in 16 Fractions: A Single-Institution Outcome

BACKGROUND

The optimal hypofractionated schedule of post-prostatectomy radiotherapy remains to be established. We evaluated treatment outcomes and toxicity of moderately hypofractionated post-prostatectomy radiotherapy in 16 daily fractions delivered with intensity-modulated radiotherapy. The treatment schedule selection was motivated by limited technology resources and was radiobiologically dose-escalated.

METHODS

One hundred consecutive M0 patients with post-prostatectomy radiotherapy were evaluated. Radiotherapy indication was adjuvant (ART) in 19%, early-salvage (eSRT) in 46% and salvage (SRT) in 35%. The dose prescription for prostate bed planning target volume was 52.8 Gy in 16 fractions of 3.3 Gy. The Common Terminology Criteria v. 4 for Adverse Events scale was used for toxicity grading.

RESULTS

The median follow-up was 61 months. Five-year biochemical recurrence-free survival (bRFS) was 78.6%, distant metastases-free survival (DMFS) was 95.7% and overall survival was 98.8%. Treatment indication (ART or eSRT vs. SRT) was the only significant factor for bRFS (HR 0.15, 95% CI 0.05-0.47, p = 0.001) and DMFS (HR 0.16, 95% CI 0.03-0.90; p = 0.038). Acute gastrointestinal (GI) toxicity grade 2 was recorded in 24%, grade 3 in 2%, acute genitourinary (GU) toxicity grade 2 in 10% of patients, and no grade 3. A cumulative rate of late GI toxicity grade ≥ 2 was observed in 9% and late GU toxicity grade ≥ 2 in 16% of patients.

CONCLUSIONS

The observed results confirmed efficacy and showed a higher than anticipated rate of early GI, late GI, and GU toxicity of post-prostatectomy radiobiologically dose-escalated hypofractionated radiotherapy in 16 daily fractions.

The Latest Data Specifically Focused on Long-Term Oncologic Prognostication for Very Old Adults with Acute Vulnerable Localized Prostate Cancer: A Nationwide Cohort Study

Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV-LPC). Clinicians have been deeply troubled by this near end-of-life medical choice for a very specific group of patients. We compared the oncological prognostication of very old patients with AV-LPC after they underwent either radical prostatectomy (RP) or massive-dose intensity-modulated radiotherapy (IMRT) coupled with long-term androgen deprivation therapy (ADT) over a long-term investigation. Methods: In this nationwide cohort study, we used the Taiwan Cancer Registry Database and retrieved information related to patients (aged ≥ 80 years) with AV-LPC who underwent standard RP (the RP group) or massive-dose IMRT + long-term ADT (at least 72 Gy and ADT use ≥18 months; the IMRT + ADT group). After potential confounders were controlled for using propensity score matching (PSM), we utilized the Cox proportional hazards regression to evaluate the oncologic prognostication. Results: The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all-cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41−2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36−2.11, p < 0.0001), 1.12 (95% CI: 1.04−1.33, p < 0.0001), and 1.15 (95% CI: 1.06−1.71, p = 0.0311), respectively. Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with AV-LPC.