Ten Year Results of Extensive Nodal Radiotherapy and Moderately Hypofractionated Simultaneous Integrated Boost in Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer

Aims: To report 10-year outcomes of WPRT and HD moderately hypofractionated SIB to the prostate in UIR, HR, and VHR PCa. Methods: From 11/2005 to 12/2015, 224 UIR, HR, and VHR PCa patients underwent WPRT at 51.8 Gy/28 fractions and SIB at 74.2 Gy (EQD2 88 Gy) to the prostate. Androgen deprivation th...

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Main Authors: Nadia Gisella Di Muzio, Chiara Lucrezia Deantoni, Chiara Brombin, Claudio Fiorino, Cesare Cozzarini, Flavia Zerbetto, Paola Mangili, Roberta Tummineri, Italo Dell’Oca, Sara Broggi, Marcella Pasetti, Anna Chiara, Paola Maria Vittoria Rancoita, Antonella Del Vecchio, Mariaclelia Stefania Di Serio, Andrei Fodor
Format: Article
Language:English
Published: MDPI AG 2021-10-01
Series:Cancers
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Online Access:https://www.mdpi.com/2072-6694/13/19/4970
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Summary:Aims: To report 10-year outcomes of WPRT and HD moderately hypofractionated SIB to the prostate in UIR, HR, and VHR PCa. Methods: From 11/2005 to 12/2015, 224 UIR, HR, and VHR PCa patients underwent WPRT at 51.8 Gy/28 fractions and SIB at 74.2 Gy (EQD2 88 Gy) to the prostate. Androgen deprivation therapy (ADT) was prescribed in up to 86.2% of patients. Results: Median follow-up was 96.3 months (IQR: 71–124.7). Median age was 75 years (IQR: 71.3–78.1). At last follow up, G3 GI–GU toxicity was 3.1% and 8%, respectively. Ten-year biochemical relapse-free survival (bRFS) was 79.8% (95% CI: 72.3–88.1%), disease-free survival (DFS) 87.8% (95% CI: 81.7–94.3%), overall survival (OS) 65.7% (95% CI: 58.2–74.1%), and prostate cancer-specific survival (PCSS) 94.9% (95% CI: 91.0–99.0%). Only two patients presented local relapse. At univariate analysis, VHR vs. UIR was found to be a significant risk factor for biochemical relapse (HR: 2.8, 95% CI: 1.17–6.67, <i>p</i> = 0.021). After model selection, only Gleason Score ≥ 8 emerged as a significant factor for biochemical relapse (HR = 2.3, 95% CI: 1.12–4.9, <i>p</i> = 0.023). Previous TURP (HR = 3.5, 95% CI: 1.62–7.54, <i>p</i> = 0.001) and acute toxicity ≥ G2 (HR = 3.1, 95% CI = 1.45–6.52, <i>p</i> = 0.003) were significant risk factors for GU toxicity ≥ G3. Hypertension was a significant factor for GI toxicity ≥ G3 (HR = 3.63, 95% CI: 1.06–12.46, <i>p</i> = 0.041). ADT (HR = 0.31, 95% CI: 0.12–0.8, <i>p</i> = 0.015) and iPsa (HR = 0.37, 95% CI: 0.16–0.83, <i>p</i> = 0.0164) played a protective role. Conclusions: WPRT and HD SIB to the prostate combined with long-term ADT, in HR PCa, determine good outcomes with acceptable toxicity.
ISSN:2072-6694