HYPOFRACTIONATED RADIOTHERAPY IN INTERMEDIATE PROSTATE CANCER.

M. Valeriani, P Bonome, S. Bracci, V. De Sanctis, MF Osti, L. Agolli, T. Falco, R. Maurizi Enrici

Cattedra di Radioterapia, Facolt di Medicina e Psicologia, Universit Sapienza, Roma
Correspondence to: Maurizio Valeriani, Radiation Oncology Department. SantAndrea Hospital, Via di Grottarossa 1035-1039,
00189 Rome (Italy). Tel.: +39 0633776160; Fax: +39 0633776608; e-mail: mauval1@libero.it

Introduction: To evaluate the tolerance and the clinical efficacy of hypofractionated radiotherapy in patients
affected by intermediate risk prostate cancer.
Materials and Methods: Between March 2007 and January 2015, 146 patients with intermediate risk
prostate cancer were treated with 3-dimension conformal hypofractionated radiotherapy. Intermediate risk
was defined as clinical stage T1T2 and pre-radiotherapy PSA between 10 and 20 ng/mL, and Gleason Score
equal to <7 or clinical stage T1T2 and pre-radiotherapy PSA between 20 ng/mL, and Gleason Score equal
to 7. A total dose of 43,8 Gy was delivered to seminal vesicles and 54,75 Gy to the prostate, 3,65 Gy per
fraction, three times a week for a total of 5 weeks. All patients underwent neoadjuvant, concomitant and
adjuvant hormonal therapy (OT) for a total duration of 9 months. Acute and late toxicities were evaluated
according to RTOG scale. The nadir PSA after radiotherapy plus 2 ng/mL was used for defining biochemical
relapse (Phoenix criteria).
Results: Median follow-up was 45 months (range 4-84 months). Seven patients (4.7%) developed
biochemical failure. Six patients (4%) died from causes different from prostate cancer without biochemical
failure, while 2 patients (1.3%) died due to disease progression. Acute toxicities (within 3 months from the
end of RT) were as follow: Grade 1 Genitourinary (GU) toxicities were 41,2%, while 12% presented Grade 2
toxicities; Grade 1 Gastrointestinal (GI) toxicities were 11,6 %, Grade 2 GI toxicities were 13.8%. Late GU
and GI toxicities Grade 2 recorded at the last follow-up were 3,8% and 5,6% respectively. No patient
developed grade 4 toxicity. 3-year BFS and 5-year BFS were 95,4% and 93%, respectively.
Discussion and Conclusions: The hypofractionated schedule used is well tolerated with a low rate of acute
and late grade 2 gastrointestinal and genitourinary toxicities. Hypofractionation is useful to obtain high rate
of tumor control also if longer follow-up is needed.