10-yr Results of Moderately Hypofractionated Postoperative Radiotherapy for Prostate Cancer Focused on Treatment Related Toxicity

Introduction To retrospectively report long term outcomes following postoperative hypofractionated radiotherapy (RT) for prostate cancer, emphasizing treatment related toxicity. Material and Methods Patients for whom adjuvant or salvage RT was indicated after prostatectomy were treated with a course of moderate hypofractionation consisting in the delivery of 62.5 Gy in 25 fractions (2.5 Gy per fraction) on the prostate bed in five consecutive weeks (EQD21.5 = 70 Gy) by means of 3D-CRT in most of them. Androgen deprivation therapy (ADT) was allowed at physician's discretion. Patients were evaluated for urinary and rectal complications according to the Common Terminology Criteria for Adverse Events v4 (CTCAE v.4). Overall survival (OS), biochemical recurrence free survival (bRFS), and metastasis-free survival (MFS) were estimated using the Kaplan–Meier method. Results One hundred and ten patients with a median age of 67 years (range 51-78) were enrolled. The majority of them (82%) had adverse pathologic features only, while 31 (28%) had early biochemical relapse. Median PSA level before RT was 0.12 ng/ml (range 0-9 ng/ml). Median time from surgery was 4 months (range 1-136 months). Twenty-eight patients (25.4%) also received ADT. At a median follow up of 103 months (range 19-138 months), late Grade 3 and Grade 4 rectal toxicity were 0.9% (one case of hematochezia) and 0.9% (one case of fistula), respectively, while late Grade 3 GU side effects (urethral stenosis) occurred in 9 cases (8%). No late Grade 4 events were observed, respectively. Ten-year OS, b-RFS and MFS were 77.3% (95% C.I.: 82.1% - 72.5%), 53.3% (95% C.I.: 59.9% - 47.6%), and 76.7% (95% C.I.: 81.2% - 72.2%), respectively. Conclusion Our study provides long term data that a shortened course of postoperative RT is as safe and effective as a long course of conventionally fractionated RT and would improve patients’ convenience and significantly reduce RT department workloads. Micro-Abstract This retrospective study on postoperative hypofractionated RT for prostate cancer (110 patients, 103-month follow-up) reveals low rates of severe toxicities. Ten-year survival rates are encouraging (77.3% overall, 53.3% biochemical recurrence-free, 76.7% metastasis-free). These results suggest that hypofractionated RT is a safe and effective alternative, offering convenience and reduced workload compared to conventional RT.