Acute toxicity profile in prostate cancer with conventional and hypofractionated treatment

Abstract

PurposeTo compare the acute toxicities in radical treatment of prostate cancer between conventional schedule (C-ARM) with 78 Gy/39 fractions and hypofractionation conformal treatment (H-ARM) with 69 Gy/23 fractions.Methods and materialThis prospective double arm study consisted of 217 patients with prostate cancer, 112 in H-ARM and 105 in C-ARM arm. C-ARM received conventional six- field conformal radiotherapy with 78 Gy in 39 fractions while H-ARM received hypofractionation with 69 Gy in 23 fractions. Weekly assessment of acute reactions was done during treatment and with one, and 3 months using RTOG scale. Univariated analysis was performed to evaluate differences between the incidences of acute reaction in the treatment arms. Variables with p value less than 0.1 were included in the multivariated logistic regression.ResultsThere was no difference between H-ARM versus C-ARM for severity and incidence in genitourinary (GU) and gastrointestinal (GI) acute toxicity. During the treatment comparing H-ARM with C-ARM no differences was observed for GI toxicity (grade 0–3; H-ARM = 45.5%, 34%, 18.7% and 1.8% versus C-ARM = 47.6%, 35.2%, 17.2% and 0). For acute GU toxicity no difference was detected between H-ARM (grade 0–3; 22.3%, 54.5%, 18.7% and 4.5%) and C-ARM (grade 0–3; 25.8%, 53.3%, 17.1% and 3.8%).At the 3- months follow-up, persistent Grade > =2 acute GU and GI toxicity were 2.5% and 1.8% in H-ARM versus 5.7% and 3% in C-ARM (p > 0.05). In univariated and multivariated analyses, there was not any dosimetric predictor for GI and GU toxicity.ConclusionsOur data demonstrate that hypofractionated radiotherapy achieving high biological effective dose using conformal radiotherapy is feasible for prostate cancer, being well tolerated with minimal severe acute toxicity.

Treatment of prostate cancer with intensity modulated radiation therapy (IMRT)

“…The hypofractioning scheme using conformal radiotherapy with high biologically effective dose is feasible in prostate cancer and is well tolerated with minimal severe acute toxicity (B). 39 The dosage regimen, with consecutive fractions at doses of 3Gy/day was also compared to other regimens reported in the literature using daily fractions between 2.7 and 6.5Gy, which showed similar results (B). 39 Recommendation Hypofractioning, with higher daily fractions of 2.5Gy, can maintain higher bioequivalent tumor doses without causing increased acute and delayed side effects.…”

“…39 The dosage regimen, with consecutive fractions at doses of 3Gy/day was also compared to other regimens reported in the literature using daily fractions between 2.7 and 6.5Gy, which showed similar results (B). 39 Recommendation Hypofractioning, with higher daily fractions of 2.5Gy, can maintain higher bioequivalent tumor doses without causing increased acute and delayed side effects. Hypofractionated radiation therapy was not superior to conventional radiation therapy in these patients, and led to slightly higher acute gastrointestinal toxicity.…”

Radical prostatectomy versus high-dose irradiation in localized/locally advanced prostate cancer: A Swedish multicenter randomized trial with patient-reported outcomes

“…Dose escalation did not result in significant deterioration of quality of life (Al-Mamgani et al, 2011). Hypofractionated RT, with high biologic effective dose using CRT, found to be well tolerated with minimal severe acute toxicity, compared with conventional RT (Viani et al, 2013).…”

Hypofractionated radiation therapy versus conventional radiation therapy in prostate cancer: A systematic review of its safety and efficacy

“…3,4 PCa can be classified in different ways: according to tumor extent (TNM), histopathological grade (Gleason), clinical or histopathological stage and according to risk. 17,18 Hypofractionated RT could be more advantageous than conventional RT, since it would enable us to improve tumor control and to reduce radio-induced toxicity. Any clinical-practice guideline on treatment of PCa includes information on the different treatment options depending on the clinical or pathological stage, with grades of evidence and recommendations in compliance with the criteria of the SIGN group.…”