Assessing the Toxicity After Moderately Hypofractionated Prostate and Whole Pelvis Radiotherapy Compared to Conventional Fractionation

Overview

Journal Strahlenther Onkol

Specialties Oncology
Radiology

Date 2023 Jun 21

PMID 37341774

Authors

Matthias Moll

Gregor Goldner

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate acute and late gastrointestinal (GI) and genitourinary (GU) toxicities after moderately hypofractionated (HF) or conventionally fractionated (CF) primary whole-pelvis radiotherapy (WPRT).

Methods: Primary prostate-cancer patients treated between 2009 and 2021 with either 60 Gy at 3 Gy/fraction to the prostate and 46 Gy at 2.3 Gy/fraction to the whole pelvis (HF), or 78 Gy at 2 Gy/fraction to the prostate and 50/50.4 Gy at 1.8-2 Gy/fraction to the whole pelvis (CF). Acute and late GI and GU toxicities were retrospectively assessed.

Results: 106 patients received HF and 157 received CF, with a median follow-up of 12 and 57 months. Acute GI toxicity rates in the HF and CF groups were, respectively, grade 2: 46.7% vs. 37.6%, and grade 3: 0% vs. 1.3%, with no significant difference (p = 0.71). Acute GU toxicity rates were, respectively, grade 2: 20.0% vs. 31.8%, and grade 3: 2.9% vs. 0%, (p = 0.04). We compared prevalence of late GI and GU toxicities between groups after 3, 12, and 24 months and did not find any significant differences (respectively, p = 0.59, 0.22, and 0.71 for GI toxicity; p = 0.39, 0.58, and 0.90 for GU toxicity).

Conclusion: Moderate HF WPRT was well tolerated during the first 2 years. Randomized trials are needed to confirm these findings.

References

Faria S, Ruo R, Perna M, Cury F, Duclos M, Sarshoghi A . Long-Term Results of Moderate Hypofractionation to Prostate and Pelvic Nodes Plus Androgen Suppression in High-Risk Prostate Cancer. Pract Radiat Oncol. 2020; 10(6):e514-e520. DOI: 10.1016/j.prro.2020.06.012. View

Cox J, Stetz J, Pajak T . Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5):1341-6. DOI: 10.1016/0360-3016(95)00060-C. View

Dearnaley D, Syndikus I, Sumo G, Bidmead M, Bloomfield D, Clark C . Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial. Lancet Oncol. 2011; 13(1):43-54. DOI: 10.1016/S1470-2045(11)70293-5. View

Hall W, Paulson E, Davis B, Spratt D, Morgan T, Dearnaley D . NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer. Int J Radiat Oncol Biol Phys. 2020; 109(1):174-185. PMC: 7736505. DOI: 10.1016/j.ijrobp.2020.08.034. View

Pommier P, Chabaud S, Lagrange J, Richaud P, Le Prise E, Wagner J . Is There a Role for Pelvic Irradiation in Localized Prostate Adenocarcinoma? Update of the Long-Term Survival Results of the GETUG-01 Randomized Study. Int J Radiat Oncol Biol Phys. 2016; 96(4):759-769. DOI: 10.1016/j.ijrobp.2016.06.2455. View

Roach 3rd M, DeSilvio M, Valicenti R, Grignon D, Asbell S, Lawton C . Whole-pelvis, "mini-pelvis," or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial. Int J Radiat Oncol Biol Phys. 2006; 66(3):647-53. DOI: 10.1016/j.ijrobp.2006.05.074. View

Bolla M, de Reijke T, van Tienhoven G, van den Bergh A, Oddens J, Poortmans P . Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009; 360(24):2516-27. DOI: 10.1056/NEJMoa0810095. View

Kerkmeijer L, Groen V, Pos F, Haustermans K, Monninkhof E, Smeenk R . Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial. J Clin Oncol. 2021; 39(7):787-796. DOI: 10.1200/JCO.20.02873. View

Nabid A, Carrier N, Martin A, Bahary J, Lemaire C, Vass S . Duration of Androgen Deprivation Therapy in High-risk Prostate Cancer: A Randomized Phase III Trial. Eur Urol. 2018; 74(4):432-441. DOI: 10.1016/j.eururo.2018.06.018. View

10.

Dearnaley D, Sydes M, Graham J, Aird E, Bottomley D, Cowan R . Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007; 8(6):475-87. DOI: 10.1016/S1470-2045(07)70143-2. View

11.

Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D . 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. 2016; 17(8):1047-1060. PMC: 4961874. DOI: 10.1016/S1470-2045(16)30102-4. View

12.

Maulik S, Arunsingh M, Arun B, Prasath S, Mallick I . Moderately Hypofractionated Radiotherapy and Androgen Deprivation Therapy for High-risk Localised Prostate Cancer: Predictors of Long-term Biochemical Control and Toxicity. Clin Oncol (R Coll Radiol). 2021; 34(1):e52-e60. DOI: 10.1016/j.clon.2021.08.010. View

13.

Moll M, Weiss M, Stanisav V, Zaharie A, Goldner G . Effects of gold fiducial marker implantation on tumor control and toxicity in external beam radiotherapy of prostate cancer. Radiol Oncol. 2023; 57(1):95-102. PMC: 10039472. DOI: 10.2478/raon-2023-0004. View

14.

Yu J . Hypofractionated Radiotherapy for Prostate Cancer: Further Evidence to Tip the Scales. J Clin Oncol. 2017; 35(17):1867-1869. DOI: 10.1200/JCO.2017.72.7016. View

15.

Murthy V, Maitre P, Kannan S, Panigrahi G, Krishnatry R, Bakshi G . Prostate-Only Versus Whole-Pelvic Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer (POP-RT): Outcomes From Phase III Randomized Controlled Trial. J Clin Oncol. 2021; 39(11):1234-1242. DOI: 10.1200/JCO.20.03282. View

16.

Wachter S, Gerstner N, Dorner D, Goldner G, Colotto A, Wambersie A . The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2002; 52(1):91-100. DOI: 10.1016/s0360-3016(01)01821-1. View

17.

Peeters S, Heemsbergen W, Koper P, van Putten W, Slot A, Dielwart M . Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006; 24(13):1990-6. DOI: 10.1200/JCO.2005.05.2530. View

18.

Roach M, Moughan J, Lawton C, Dicker A, Zeitzer K, Gore E . Sequence of hormonal therapy and radiotherapy field size in unfavourable, localised prostate cancer (NRG/RTOG 9413): long-term results of a randomised, phase 3 trial. Lancet Oncol. 2018; 19(11):1504-1515. PMC: 6540797. DOI: 10.1016/S1470-2045(18)30528-X. View

19.

Phuong C, Chan J, Ni L, Wall P, Mohamad O, Wong A . Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost. Radiat Oncol. 2022; 17(1):12. PMC: 8772149. DOI: 10.1186/s13014-021-01976-2. View

20.

Viani G, Gouveia A, Moraes F, Cury F . Meta-analysis of Elective Pelvic Nodal Irradiation Using Moderate Hypofractionation for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys. 2022; 113(5):1044-1053. DOI: 10.1016/j.ijrobp.2022.04.008. View