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Abstract
Introductuion. Hypofractionated radiotherapy for prostate cancer (PCa) has garnered significant interest over the past two decades. To date, only a limited number of randomized studies have evaluated the efficacy and safety of moderately hypofractionated regimens radiotherapy in high-risk and very high-risk PCа. Consequently, the analysis of independent prospective studies investigating the potential of various dose fractionation schedules in the management of this complex patient population is of particular relevance.
Aim. To evaluate the long-term efficacy and safety of moderately hypofractionated radiotherapy with elective pelvic nodal irradiation and a prostate boost, combined with androgen deprivation therapy (ADT), in patients with high and very high-risk prostate adenocarcinoma (HVHR PCa).
Materials and Methods. From 2019 to 2020, 84 patients with HVHR PCa were treated with combined modality therapy, including moderately hypofractionated radiotherapy to the pelvic lymph nodes and prostate concurrent with ADT. External beam radiotherapy was delivered in 13 fractions of 3.0 Gy administered five times per week (EQD₂ α/β = 1.5: 50.1 Gy). A subsequent boost to the prostate and seminal vesicles was delivered using either high-dose-rate brachytherapy (HDR-BT) in a single fraction of 15.0 Gy (64 patients) or stereotactic body radiotherapy (SBRT) in three fractions of 7.0 Gy (20 patients). Radiation-induced toxicity was assessed according to the RTOG/EORTC grading system and the Common Terminology Criteria for Adverse Events (CTCAE v5.0).
Results. The 5-year biochemical recurrence-free survival was 83.4 % overall: 88.9 % in high-risk and 80.7 % in very high-risk PCа patients. Local and regional control rates reached 96.4 and 97.6 %, respectively. Early grade II and III genitourinary toxicity rates were 36.9 % and 0 %, while gastrointestinal toxicity rates were 45.2 and 2.4 %, respectively. Late grade II and III toxicities were observed in 8.3 and 2.4 % of patients for genitourinary effects, and 20.2 and 2.4 % for gastrointestinal effects.
Conclusion. Moderately hypofractionated radiotherapy to the pelvic lymph nodes and prostate (13 fractions of 3.0 Gy) followed by a boost to the prostate demonstrates high efficacy with a low risk of severe (grade III or higher) toxicity in patients with HVHR PCa.
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