Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer

Area of Science:

• Radiation Oncology
• Urologic Oncology
• Prostate Cancer Treatment

Background:

• Hypofractionated radiation therapy (RT) offers potential for long-term biochemical relapse-free survival (bRFS) in prostate cancer.
• Data on adjuvant and salvage postprostatectomy hypofractionated RT outcomes are limited.
• This study investigates toxicity and clinical outcomes of postprostatectomy hypofractionated RT.

Purpose of the Study:

• To evaluate the toxicity and clinical outcomes of hypofractionated intensity modulated radiation therapy (HIMRT) in the postprostatectomy setting.
• To assess biochemical recurrence rates and late toxicity profiles.

Main Methods:

• Retrospective analysis of 56 men receiving postprostatectomy HIMRT (2.5-Gy fractions) from a prospectively maintained database.
• Image-guided HIMRT with a median dose of 65 Gy; androgen deprivation therapy used at discretion.
• Assessment of acute and late toxicities using CTCAE v4.0 and RTOG/EORTC scales; Kaplan-Meier for time-to-event outcomes.

Main Results:

• Median follow-up was 48 months. 4-year actuarial bPFS rate was 75%.
• Limited acute toxicity observed; no acute grade 3 toxicity.
• 52% experienced late genitourinary (GU) toxicity, with 28% experiencing grade 3 (gross hematuria). Most grade 3 GU toxicity resolved.

Conclusions:

• Postprostatectomy hypofractionated RT demonstrates promising biochemical control.
• Higher-than-anticipated late grade 3 GU toxicity was observed, primarily gross hematuria, though most cases resolved.
• Further follow-up is needed to confirm long-term efficacy and toxicity.