Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer

B. A. Jereczek-Fossa, A. Maucieri, G. Marvaso, S. Gandini, C. Fodor, D. Zerini, G. Riva, O. Alessandro, A. Surgo, S. Volpe, G. Fanetti, S. Arculeo, M. A. Zerella, S. Parisi, P. Maisonneuve, A. Vavassori, F. Cattani, R. Cambria, C. Garibaldi, A. StarzyńskaG. Musi, O. De Cobelli, M. Ferro, F. Nolè, D. Ciardo, R. Orecchia

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Abstract

To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69–77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.

Original languageEnglish
Article number9
JournalMedical Oncology
Volume36
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Intensity-Modulated Radiotherapy
Prostatic Neoplasms
Radiotherapy
Neoplasms
Disease-Free Survival
Proportional Hazards Models
Conformal Radiotherapy
Radiation Oncology
Survival

Keywords

  • Dose escalation
  • Hypofractionation
  • Image-guided radiotherapy
  • Prostate cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{39cc821aded0485fabc8eb65c403dbea,
title = "Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer",
abstract = "To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60{\%}) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40{\%}) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69–77). Compared with 3D-CRT, in IMRT group more high-risk patients (29{\%} vs 18{\%}; P = 0.002) and more high-volume target (75{\%} vs 60{\%}; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8{\%} and in 11{\%} IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2{\%} and 16{\%} IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26{\%} and 40{\%} IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5{\%} IMRT and 15{\%} 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91{\%}, 92{\%} and 91{\%}, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.",
keywords = "Dose escalation, Hypofractionation, Image-guided radiotherapy, Prostate cancer",
author = "Jereczek-Fossa, {B. A.} and A. Maucieri and G. Marvaso and S. Gandini and C. Fodor and D. Zerini and G. Riva and O. Alessandro and A. Surgo and S. Volpe and G. Fanetti and S. Arculeo and Zerella, {M. A.} and S. Parisi and P. Maisonneuve and A. Vavassori and F. Cattani and R. Cambria and C. Garibaldi and A. Starzyńska and G. Musi and {De Cobelli}, O. and M. Ferro and F. Nol{\`e} and D. Ciardo and R. Orecchia",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s12032-018-1233-1",
language = "English",
volume = "36",
journal = "Medical Oncology",
issn = "1357-0560",
publisher = "Humana Press Inc.",
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TY - JOUR

T1 - Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer

AU - Jereczek-Fossa, B. A.

AU - Maucieri, A.

AU - Marvaso, G.

AU - Gandini, S.

AU - Fodor, C.

AU - Zerini, D.

AU - Riva, G.

AU - Alessandro, O.

AU - Surgo, A.

AU - Volpe, S.

AU - Fanetti, G.

AU - Arculeo, S.

AU - Zerella, M. A.

AU - Parisi, S.

AU - Maisonneuve, P.

AU - Vavassori, A.

AU - Cattani, F.

AU - Cambria, R.

AU - Garibaldi, C.

AU - Starzyńska, A.

AU - Musi, G.

AU - De Cobelli, O.

AU - Ferro, M.

AU - Nolè, F.

AU - Ciardo, D.

AU - Orecchia, R.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69–77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.

AB - To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69–77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.

KW - Dose escalation

KW - Hypofractionation

KW - Image-guided radiotherapy

KW - Prostate cancer

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DO - 10.1007/s12032-018-1233-1

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