Subjective and objective measures of late genitourinary morbidity following hypofractionated radiotherapy in men with prostate cancer

Abstract

To value the late genitourinary (GU) morbidity in men treated with a hypofractionated radiotherapy regimen for prostate cancer. Patients with intermediate risk factors according to D'Amico's criteria were selected. The hypofractionated schedule consisted of 15 fractions of 3.63 Gy delivered three times per week for a total dose of 54.3 Gy. Significant changes in storage-symptoms were not found. A significant transient worsening in the score of late effects of normal tissue late effects normal tissue task force (LENT)-subjective, objective, management, analytic (SOMA) urinary-function domain was observed at 12 months with subsequent improvement at 28 months. The assessment of voiding-symptoms and maximum urinary flow rate (Qmax) showed that no significant difference was measurable at 12 and 28 months. For PVR, a transient increase at 12 months with a subsequent decrease at 28 months was measured. No significant increase in alphablockers usage and in the percentage of men with pathological nonintubated uroflowmetry (NIF) was observed at 12 and 28 months. Finally, patients did not perceive any clinical worsening in their quality of life (QoL) as attested by the International Prostate Symptom Score (IPSS)-QoL. Our study seems to suggest that our hypofractionated radiotherapy schedule for the treatment of prostate cancer is safe in terms of late urinary morbidity. Further study will be required to confirm our results.

Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer

“…Therefore, although there is no doubt that HF offers major potential advantages to patients and to the economy of health systems, their development should not be at the expense of a lower likelihood of tumour control as well as of an unacceptable late toxicity. Published data shows that HF protocols seem not to be associated with an unacceptable late toxicity as documented by our [12] and other groups [7][8][9][10][11][13][14][15]. The analysis carried out in the present study provides some clinical evidence to further justify trends already emerging toward HF conformal technology in clinically localized prostate cancer.…”

“…All the men presented a risk of seminal vesicle involvement of > 15%. In the 3D-HFRT the CTV1 received a dose of 43.4 Gy standard equivalent to 63.5 Gy (assuming a α / β ratio of 1.5 Gy) or 57.5 Gy (assuming a α / β ratio of 3 Gy) [12]. To estimate the risk of lymph node involvement the following equation: (2/ 3)initial PSA level + [(Gleason score-6) × 10] was applied for each patient.…”

“…However, at the present the main concern is the uncertainty about normal tissue toxicity of such HF protocols. Although clinical reports [7][8][9][10][11][12][13][14][15] have found acceptable levels of morbidity and reasonable PSA control rates using doses of 2.5-3 Gy, clinical data are sparse and, although promising, require further validation. If the hypothesis that the prostate cancer α / β ratio is lower than normal tissue is correct, then the optimal fractional dose is likely to be even higher than the doses tested thus far, but if incorrect, the result may be increased normal tissue toxicity.…”

Advances in Prostate Cancer Research and Treatment

“…Prostate cancer (Pca) is one of the most commonly diagnosed cancers in men and surgery [3] and radiotherapy (RT) [3–5] remain the gold standard for the treatment of localized or locally advanced Pca. Radiotherapy is configured as a powerful treatment approach with outstanding oncological results and with impressive technical improvements over the last two decades [6].…”