Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis
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ORIGINAL ARTICLE
Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis Jörg Tamihardja1 · Max Schortmann1 · Ingulf Lawrenz1 · Stefan Weick1 · Klaus Bratengeier1 · Michael Flentje1 · Matthias Guckenberger2 · Bülent Polat1 Received: 27 May 2020 / Accepted: 3 August 2020 © The Author(s) 2020
Abstract Purpose Evaluation of long-term outcome and toxicity of moderately hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost treatment planning and cone beam CT-based image guidance for localized prostate cancer. Methods Between 2005 and 2015, 346 consecutive patients with localized prostate cancer received primary radiotherapy using cone beam CT-based image-guided intensity-modulated radiotherapy (IG-IMRT) and volumetric modulated arc therapy (IG-VMAT) with a simultaneous integrated boost (SIB). Total doses of 73.9 Gy (n = 44) and 76.2 Gy (n = 302) to the high-dose PTV were delivered in 32 and 33 fractions, respectively. The low-dose PTV received a dose (D95) of 60.06 Gy in single doses of 1.82 Gy. The pelvic lymph nodes were treated in 91 high-risk patients to 45.5 Gy (D95). Results Median follow-up was 61.8 months. The 5-year biochemical relapse-free survival (bRFS) was 85.4% for all patients and 93.3, 87.4, and 79.4% for low-, intermediate-, and high-risk disease, respectively. The 5-year prostate cancer-specific survival (PSS) was 94.8% for all patients and 98.7, 98.9, 89.3% for low-, intermediate-, and high-risk disease, respectively. The 5-year and 10-year overall survival rates were 83.8 and 66.3% and the 5-year and 10-year freedom from distant metastasis rates were 92.2 and 88.0%, respectively. Cumulative 5-year late GU toxicity and late GI toxicity grade ≥2 was observed in 26.3 and 12.1% of the patients, respectively. Cumulative 5-year late grade 3 GU/GI toxicity occurred in 4.0/1.2%. Conclusion Moderately hypofractionated radiotherapy using SIB treatment planning and cone beam CT image guidance resulted in high biochemical control and survival with low rates of late toxicity.
Keywords Simultaneous integrated boost · Cone beam CT · Hypofractionation · Intensity-modulated radiation therapy · Image-guided radiation therapy
Introduction Primary radiotherapy as an established curative treatment option for localized prostate cancer, one of the most common cancer types [1], has undergone substantial changes in clinical practice. Lately, hypofractionated [2–7] and doseescalated [8–10] approaches are on the advance to improve the therapeutic ratio, reduce cost, and shorten the duration of prostate radiation therapy. Jörg Tamihardja
[email protected] 1
Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
2
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
When on-board cone beam CT (CBCT) became available in 2004, highly conformal image-guided intensity-modulated radiation therapy (I
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