Hypofractionated Intensity-Modulated Radiotherapy (70 Gy at 2.5 Gy Per Fraction) for Localized Prostate Cancer: Cleveland Clinic Experience

• Published in: International journal of radiation oncology, biology, physics Vol. 68; no. 5; pp. 1424 - 1430
• Main Authors: Kupelian, Patrick A., M.D, Willoughby, Twyla R., M.S, Reddy, Chandana A., M.S, Klein, Eric A., M.D, Mahadevan, Arul, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2007
• Subjects: Adult; Aged; Aged, 80 and over; CARCINOMAS; Confidence Intervals; Disease-Free Survival; Dose Fractionation; FAILURES; Follow-Up Studies; Gastrointestinal Hemorrhage - etiology; HEALTH HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Hypofractionation; Intensity modulation; Local therapy; Male; Middle Aged; Multivariate Analysis; PATIENTS; PROSTATE; Prostatic neoplasms; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; RADIATION DOSES; Radiation Injuries - complications; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Rectal Diseases - etiology; RECTUM; Rectum - radiation effects; TOXICITY; Treatment Outcome; Urologic Diseases - etiology; Hypofractionation; Local therapy; Prostatic neoplasms; Radiotherapy; Intensity modulation
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2007.01.067

Purpose: To study the outcomes in patients treated for localized prostate cancer with 70 Gy delivered at 2.5-Gy/fraction within 5 weeks. Methods and Materials: The study sample included all 770 consecutive patients with localized prostate cancer treated with hypofractionated intensity-modulated radiotherapy at the Cleveland Clinic between 1998 and 2005. The median follow-up was 45 months (maximum, 86). Both the American Society for Therapeutic Radiology and Oncology (ASTRO) biochemical failure definition and the alternate nadir + 2 ng/mL definition were used. Results: The overall 5-year ASTRO biochemical relapse-free survival rate was 82% (95% confidence interval, 79–85%), and the 5-year nadir + 2 ng/mL rate was 83% (95% confidence interval, 79–86%). For patients with low-risk, intermediate-risk, and high-risk disease, the 5-year ASTRO rate was 95%, 85%, and 68%, respectively. The 5-year nadir + 2 ng/mL rate for patients with low-, intermediate-, and high-risk disease was 94%, 83%, and 72%, respectively. The Radiation Therapy Oncology Group acute rectal toxicity scores were 0 in 51%, 1 in 40%, and 2 in 9% of patients. The acute urinary toxicity scores were 0 in 33%, 1 in 48%, 2 in 18%, and 3 in 1% of patients. The late rectal toxicity scores were 0 in 89.6%, 1 in 5.9%, 2 in 3.1%, 3 in 1.3%, and 4 in 0.1% (1 patient). The late urinary toxicity scores were 0 in 90.5%, 1 in 4.3%, 2 in 5.1%, and 3 in 0.1% (1 patient). Conclusion: The outcomes after high-dose hypofractionation were acceptable in the entire cohort of patients treated with the schedule of 70 at 2.5 Gy/fraction.