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Outcome and patient-reported toxicity in localised prostate cancer treated with dose-escalated hypofractionated intensity-modulated radiotherapy

J Radiother Pract 2013 Dec;12(4):326-333.

J Radiother Pract 2013 Dec;12(4):326-333.

Objective:

To report outcomes and late toxicity for a hypofractionated dose-escalated radiotherapy schedule in patients treated using intensity-modulated radiotherapy (IMRT) for localised prostate cancer.

Materials and methods:

Eighty-eight men with localised prostate cancer were treated with 57 Gy in 19 daily fractions over 4 weeks. A total of 70 out of 88 had high-risk disease. Overall survival, cause-specific survival and biochemical progression-free survival (bPFS, Phoenix definition) were reported. Toxicity was measured retrospectively using Radiation Therapy Oncology Group (RTOG) criteria and assessed prospectively with a validated Late Effects in Normal Tissues Subjective, Objective, Management and Analytic (LENT/SOMA) patient questionnaire.

Results:

At 5 years, overall survival was 84%, cause-specific survival 88% and bPFS 65%. In patients with high-risk disease, 5-year bPFS was 62%. There was no RTOG toxicity above grade III. LENT/SOMA questionnaires were returned by 74% patients. Median scores for bowel and urinary function were <1. Maximum bowel and urinary toxicity scores ≥2 were reported by 64% and 59% of patients, respectively. The median score for sexual function was 1·5, but nearly all (96%) patients recorded a toxicity score ≥2 for at least one question.

Conclusions:

Dose-escalated hypofractionated radiotherapy delivered using IMRT has promising outcomes and acceptable late toxicity. This fractionation schedule is being compared with conventional treatment within an on-going multicentre phase III clinical trial.

Copyright © Cambridge University Press 2013.

Comment from Henk van der Poel: Hypofractionation is currently studied to improve efficacy, reduce toxicity and provide a more practical approach to external beam radiotherapy of the prostate. Although GU and GI toxicity was never over grade III, the incidence of 59% and 64% maximal toxicity >=2 compares unfavorably to data reported in earlier comparative hypofractionation studies (Hegemann et al., Radiat Oncol. 2014 Dec 6;9(1):275) and may better reflect outcomes when hypofractionation will be introduced more widely.