Outcome and patient-reported toxicity in localised prostate cancer treated with dose-escalated hypofractionated intensity-modulated radiotherapy

Abstract

Objective To report outcomes and late toxicity for a hypofractionated dose-escalated radiotherapy schedule in patients treated using intensity-modulated radiotherapy (IMRT) for localised prostate cancer. Materials and methods Eighty-eight men with localised prostate cancer were treated with 57 Gy in 19 daily fractions over 4 weeks. A total of 70 out of 88 had high-risk disease. Overall survival, cause-specific survival and biochemical progression-free survival (bPFS, Phoenix definition) were reported. Toxicity was measured retrospectively using Radiation Therapy Oncology Group (RTOG) criteria and assessed prospectively with a validated Late Effects in Normal Tissues Subjective, Objective, Management and Analytic (LENT/SOMA) patient questionnaire. Results At 5 years, overall survival was 84%, cause-specific survival 88% and bPFS 65%. In patients with high-risk disease, 5-year bPFS was 62%. There was no RTOG toxicity above grade III. LENT/SOMA questionnaires were returned by 74% patients. Median scores for bowel and urinary function were <1. Maximum bowel and urinary toxicity scores ≥2 were reported by 64% and 59% of patients, respectively. The median score for sexual function was 1·5, but nearly all (96%) patients recorded a toxicity score ≥2 for at least one question. Conclusions Dose-escalated hypofractionated radiotherapy delivered using IMRT has promising outcomes and acceptable late toxicity. This fractionation schedule is being compared with conventional treatment within an on-going multicentre phase III clinical trial. Copyright © Cambridge University Press 2013.