Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation

Barbara Alicja Jereczek-Fossa, Alessia Surgo, Patrick Maisonneuve, Andrea Maucieri, Marianna Alessandra Gerardi, Dario Zerini, Giulia Marvaso, Delia Ciardo, Stefania Volpe, Damaris Patricia Rojas, Giulia Riva, Ombretta Alessandro, Samantha Dicuonzo, Giuseppe Fanetti, Paola Romanelli, Anna Starzyńska, Federica Cattani, Raffaella Cambria, Cristiana Fodor, Cristina GaribaldiChiara Romanò, Ottavio De Cobelli, Roberto Orecchia

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the incidence and predictors for late toxicity and tumor outcome after hypofractionated radiotherapy using three different image-guided radiotherapy (IGRT) systems (hypo-IGRT) compared with conventional fractionation without image guidance (non-IGRT). Methods and materials: We compared the late rectal and urinary toxicity and outcome in 179 prostate cancer patients treated with hypo-IGRT (70.2 Gy/26 fractions) and 174 non-IGRT patients (80 Gy/40 fractions). Multivariate analysis was performed to define predictors for late toxicity. 5- and 8-year recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results: Mean follow-up was 81 months for hypo-IGRT and 90 months for non-IGRT group. Mainly mild late toxicity was observed: Hypo-IGRT group experienced 65 rectal (30.9% G1/G2; 6.3% G3/G4) and 105 urinary events (56% G1/G2; 4% G3/G4). 5- and 8-year RFS rates were 87.5% and 86.8% (hypo-IGRT) versus 80.4% and 66.8% (non-IGRT). 5- and 8-year OS rates were 91.3% and 82.7% in hypo-IGRT and 92.2% and 84% in non-IGRT group. Multivariate analysis showed that hypo-IGRT is a predictor for late genitourinary toxicity, whereas hypo-IGRT, acute urinary toxicity and androgen deprivation therapy are predictors for late rectal toxicity. Advanced T stage and higher Gleason score (GS) were correlated with worse RFS. Conclusions: A small increase in mild late toxicity, but not statistically significant increase in severe late toxicity in the hypo-IGRT group when compared with conventional non-IGRT group was observed. Our study confirmed that IGRT allows for safe moderate hypofractionation, offering a shorter overall treatment time, a good impact in terms of RFS and providing potentially more economic health care.

Original languageEnglish
Pages (from-to)65-78
Number of pages14
JournalRadiologia Medica
Issue number1
Publication statusPublished - Jan 24 2019


  • Conventional fractionation
  • Hypofractionation
  • Image-guided radiotherapy
  • Late toxicity
  • Prostate cancer

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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