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Nicosia L, Mazzola R, Vitale C, Cuccia F, Figlia V, Giaj-Levra N, Ricchetti F, Rigo M, Ruggeri R, Cavalleri S, Alongi F. Postoperative moderately hypofractionated radiotherapy in prostate cancer: a mono-institutional propensity-score-matching analysis between adjuvant and early-salvage radiotherapy. Radiol Med 2022; 127:560-570. [PMID: 35347581 DOI: 10.1007/s11547-022-01479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the impact of moderately hypofractionated postoperative radiotherapy (RT) in prostate cancer (PCa). MATERIALS AND METHODS The data of 304 surgically resected PCa patients were analyzed. One hundred and five patients underwent adjuvant RT (aRT), 77 early-savage RT (esRT), and 123 salvage RT (sRT). Biochemical relapse-free survival (BRFS), progression-free survival (PFS) and toxicity were analyzed. A propensity score matching (PSM) was performed to account for potential confounders between aRT and esRT groups. RESULTS The median follow-up was 33 months. Three-year BRFS and PFS were 82 and 85.2%, respectively, in the overall population. At the multivariate analysis, Gleason score and hormone therapy were factors independently correlated with BRFS and PFS. After PSM, there was no difference in BRFS and PFS between aRT and esRT patients. Severe toxicity was represented by grade 3 urinary incontinence (3.5%) and urgency (1%), and aRT correlated with increased any-grade acute toxicity. Severe grade 3 gastrointestinal late toxicity occurred in 1.3% of cases. CONCLUSION Postoperative moderately hypofractionated RT achieved acceptable disease control rate and demonstrated no increased or unexpected toxicity. Future prospective studies should evaluate the role of postoperative RT in patients with unfavorable disease characteristics.
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Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy.
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Ruggiero Ruggeri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
| | - Stefano Cavalleri
- Urology Division, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
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Mahase S, Nagar H. Hypofractionated Postoperative Radiotherapy for Prostate Cancer: Is the Field Ready Yet? EUR UROL SUPPL 2020; 22:9-16. [PMID: 34337473 PMCID: PMC8317782 DOI: 10.1016/j.euros.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/30/2022] Open
Abstract
Context Radiotherapy (RT) is a valid adjuvant treatment for men with high-risk pathological features after radical prostatectomy and a salvage treatment for biochemical recurrence. A major inconvenience is that RT takes course over 7–8 wk in these settings, which has been shown to limit its use. Retrospective and pilot prospective investigations suggest that hypofractionation may provide noninferior outcomes but report variable results regarding toxicities. Additionally, our evolving understanding of prostate cancer radiobiology suggests that hypofractionated regimens may not increase toxicity. Objective We examine and review the rationale and clinical evidence of hypofractionated RT in the adjuvant and salvage settings for prostate cancer. Evidence acquisition We reviewed relevant literature, with a particular focus on recent studies employing hypofractionated RT. Evidence synthesis Hypofractionated RT in the adjuvant or salvage setting is not a standard option for prostate cancer RT outside of an investigational trial. While smaller studies show conflicting data regarding toxicity, initial evidence from larger clinical trials appears to demonstrate that hypofractionated postoperative RT is as effective and safe as conventionally fractionated courses. Conclusions With the growing acceptance of hypofractionation across other cancer sites and the rise of extreme hypofractionation for definitive prostate cancer treatment, hypofractionated postoperative therapy for prostate cancer is poised to become an option, as it may reduce the burden on men and treatment centers while maintaining clinical efficacy and safety. Prospective trials are currently ongoing to address efficacy and safety concerns. Patient summary Postoperative radiotherapy is a potentially curative treatment for patients with high-risk disease or recurrence after surgery. Shortening of the treatment regimen with the availability of modern treatment delivery techniques in conjunction with the integration of molecular imaging information to refine treatment volumes may improve therapeutic benefit without increasing toxicity.
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Vilotte F, Antoine M, Bobin M, Latorzeff I, Supiot S, Richaud P, Thomas L, Leduc N, Guérif S, Iriondo-Alberdi J, de Crevoisier R, Sargos P. Post-Prostatectomy Image-Guided Radiotherapy: The Invisible Target Concept. Front Oncol 2017; 7:34. [PMID: 28337425 PMCID: PMC5343009 DOI: 10.3389/fonc.2017.00034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022] Open
Abstract
In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.
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Affiliation(s)
- Florent Vilotte
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Mickael Antoine
- Department of Medical Physics, Institut Bergonié , Bordeaux Cedex , France
| | - Maxime Bobin
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD, Clinique Pasteur , Toulouse , France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest René Gauducheau , Nantes , France
| | - Pierre Richaud
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Laurence Thomas
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Nicolas Leduc
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Stephane Guérif
- Department of Radiotherapy, CHU de Poitier , Poitiers , France
| | | | | | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
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