Disease control outcomes of stereotactic body radiation therapy or moderate hypo‐fractionation for prostate cancer: Real‐world experience at two Canadian centers

Abstract

BackgroundAdvantages of using stereotactic body radiation therapy to treat prostate cancer include short treatment times, decreased costs, and limited toxicity. Randomized trial outcomes comparing 5‐fraction stereotactic body radiation therapy to conventionally fractionated radiotherapy or hypo‐fractionated radiation therapy are pending.ObjectiveWe report the 10‐year experience with 5‐fraction stereotactic body radiation therapy and hypo‐fractionated radiation therapy at two Canadian centers.Material and MethodsPatients with low‐ or intermediate‐risk prostate cancer treated with stereotactic body radiation therapy alone (35–40 Gy in 5 fractions) or hypo‐fractionated radiation therapy alone (60–62 Gy in 20 fractions) in the period of July 2010 and June 2020. The biochemical relapse‐free survival, PSA nadir, interval time to PSA nadir, time to biochemical recurrence (2 ng/ml above PSA nadir) and overall survival were reviewed. Outcomes between treatment groups were compared after propensity‐matching by patient baseline characteristics. Kaplan‐Meier curves were used to assess biochemical relapse‐free survival and overall survival.ResultsWe identified 205 and 513 patients with low or intermediate‐risk prostate cancer who were treated with stereotactic body radiation therapy or hypo‐fractionation, respectively. Intermediate‐risk category composed 81% and 95% of the stereotactic body radiation therapy and hypo‐fractionated radiation therapy cohorts, respectively. After a median follow up of 58.6 months for the stereotactic body radiation therapy cohort and 45.0 months for the hypo‐fractionated cohort, biochemical relapse‐free survival and overall survival were not significantly different between treatment groups. The 5‐year biochemical relapse‐free survival rates were 92.1% and 93.6% and overall survival rates were 96.4% and 95.0% for the stereotactic body radiation therapy and hypo‐fractionated cohorts, respectively, after propensity‐matching. Stereotactic body radiation therapy resulted in a significantly lower PSA nadir (0.18 ng/ml) compared to hypo‐fractionated radiation therapy (0.48 ng/ml) in patients with low‐risk prostate cancer. Mean time to biochemical recurrence was not different between treatment groups.ConclusionsStereotactic body radiation therapy is an effective treatment option for low and intermediate‐risk prostate cancer with encouraging biochemical relapse‐free survival and overall survival rates comparable with hypo‐fractionated radiation therapy.