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Comparative Study
. 2019 Jan;124(1):65-78.
doi: 10.1007/s11547-018-0937-9. Epub 2018 Sep 15.

Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation

Barbara Alicja Jereczek-Fossa  1   2 , Alessia Surgo  3 , Patrick Maisonneuve  4 , Andrea Maucieri  2 , Marianna Alessandra Gerardi  2 , Dario Zerini  2 , Giulia Marvaso  2 , Delia Ciardo  2 , Stefania Volpe  1   2 , Damaris Patricia Rojas  1   2 , Giulia Riva  1   2 , Ombretta Alessandro  1   2 , Samantha Dicuonzo  2 , Giuseppe Fanetti  1   2 , Paola Romanelli  2 , Anna Starzyńska  5 , Federica Cattani  6 , Raffaella Cambria  6 , Cristiana Fodor  2 , Cristina Garibaldi  6 , Chiara Romanò  6   7 , Ottavio De Cobelli  1   8 , Roberto Orecchia  9
Affiliations
Comparative Study

Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation

Barbara Alicja Jereczek-Fossa et al. Radiol Med. 2019 Jan.

Erratum in

Abstract

Purpose: To evaluate the incidence and predictors for late toxicity and tumor outcome after hypofractionated radiotherapy using three different image-guided radiotherapy (IGRT) systems (hypo-IGRT) compared with conventional fractionation without image guidance (non-IGRT).

Methods and materials: We compared the late rectal and urinary toxicity and outcome in 179 prostate cancer patients treated with hypo-IGRT (70.2 Gy/26 fractions) and 174 non-IGRT patients (80 Gy/40 fractions). Multivariate analysis was performed to define predictors for late toxicity. 5- and 8-year recurrence-free survival (RFS) and overall survival (OS) were analyzed.

Results: Mean follow-up was 81 months for hypo-IGRT and 90 months for non-IGRT group. Mainly mild late toxicity was observed: Hypo-IGRT group experienced 65 rectal (30.9% G1/G2; 6.3% G3/G4) and 105 urinary events (56% G1/G2; 4% G3/G4). 5- and 8-year RFS rates were 87.5% and 86.8% (hypo-IGRT) versus 80.4% and 66.8% (non-IGRT). 5- and 8-year OS rates were 91.3% and 82.7% in hypo-IGRT and 92.2% and 84% in non-IGRT group. Multivariate analysis showed that hypo-IGRT is a predictor for late genitourinary toxicity, whereas hypo-IGRT, acute urinary toxicity and androgen deprivation therapy are predictors for late rectal toxicity. Advanced T stage and higher Gleason score (GS) were correlated with worse RFS.

Conclusions: A small increase in mild late toxicity, but not statistically significant increase in severe late toxicity in the hypo-IGRT group when compared with conventional non-IGRT group was observed. Our study confirmed that IGRT allows for safe moderate hypofractionation, offering a shorter overall treatment time, a good impact in terms of RFS and providing potentially more economic health care.

Keywords: Conventional fractionation; Hypofractionation; Image-guided radiotherapy; Late toxicity; Prostate cancer.

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