Optimising Radiotherapy for Prostate Cancer: Comparison of Treatment Schedules and Toxicities

Area of Science:

• Radiation Oncology
• Medical Physics
• Urologic Oncology

Background:

• Prostate cancer is a leading malignancy globally, often managed with radiotherapy.
• Radiobiological evidence supports hypofractionated radiotherapy (hypo-RT) due to prostate cancer's low α/β ratio.
• Hypo-RT aims to improve treatment efficacy without increasing toxicity to normal tissues.

Purpose of the Study:

• To compare biochemical recurrence-free survival (bRFS) between moderate hypo-RT and conventional fractionated radiotherapy (C-RT).
• To evaluate and compare toxicity profiles and quality of life (QoL) between the two radiotherapy regimens.

Main Methods:

• Retrospective analysis of 20 patients treated between January 2022 and January 2024.
• Patients received either moderate hypo-RT (70 Gy/28 fractions) or C-RT (80 Gy/40 fractions).
• Treatment involved daily cone beam CT (CBCT)-based image guidance; toxicities assessed via RTOG criteria; QoL via IPSS.

Main Results:

• At a median 24-month follow-up, bRFS was comparable between hypo-RT and C-RT groups.
• No significant differences in Grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicities were observed (p>0.05).
• Urinary symptom outcomes and overall QoL were similar across both treatment arms.

Conclusions:

• Moderate hypo-RT is a viable alternative to C-RT for intermediate and high-risk prostate cancer.
• It leverages prostate cancer's radiobiological characteristics for comparable oncologic outcomes.
• Hypo-RT achieves this with minimal early and late toxicities, preserving patient quality of life.