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.

Late toxicity of image-guided hypofractionated radiotherapy for prostate : non-randomized comparison with conventional fractionation / B.A. Jereczek-Fossa, A. Surgo, P. Maisonneuve, A. Maucieri, M.A. Gerardi, D. Zerini, G. Marvaso, D. Ciardo, S. Volpe, D.P. Rojas, G. Riva, O. Alessandro, S. Dicuonzo, G. Fanetti, P. Romanelli, A. Starzyńska, F. Cattani, R. Cambria, C. Fodor, C. Garibaldi, C. Romanò, O. De Cobelli, R. Orecchia. - In: LA RADIOLOGIA MEDICA. - ISSN 0033-8362. - 124:1(2019 Jan 24), pp. 65-78. [10.1007/s11547-018-0937-9]

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

B.A. Jereczek-Fossa
Primo
;
A. Surgo
Secondo
;
A. Maucieri;M.A. Gerardi;G. Marvaso;S. Volpe;D.P. Rojas;G. Riva;O. Alessandro;S. Dicuonzo;G. Fanetti;C. Romanò;O. De Cobelli
Penultimo
;
R. Orecchia
Ultimo
2019

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.
Conventional fractionation; Hypofractionation; Image-guided radiotherapy; Late toxicity; Prostate cancer; Radiology, Nuclear Medicine and Imaging
Settore MED/24 - Urologia
Settore MED/36 - Diagnostica per Immagini e Radioterapia
24-gen-2019
15-set-2018
http://hdl.handle.net/2434/822668
Article (author)
File in questo prodotto:
File Dimensione Formato  
10.1007_s11547-018-0937-9.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 1.4 MB
Formato Adobe PDF
1.4 MB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/603193
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 17
  • ???jsp.display-item.citation.isi??? 16
social impact