Vol 27, No 1 (2022)
Research paper
Published online: 2022-01-27

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Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis

Maria Valentina Tenti1, Gianluca Ingrosso1, Vittorio Bini2, Cristina Mariucci3, Simonetta Saldi4, Emanuele Alì1, Claudio Zucchetti5, Rita Bellavita4, Cynthia Aristei1
Rep Pract Oncol Radiother 2022;27(1):142-151.

Abstract

Background: To date, few studies have been published on image-guided helical tomotherapy (HT) in a moderate hypofractionation of localized PCa. We report outcome and toxicity of localized PCa patients treated with HT-based moderate hypofractionated radiotherapy.

Materials and methods: 76 patients were retrospectively analyzed. A total dose of 60 Gy (20 x 3 Gy) or 67.5 Gy (25 x 2.7 Gy) was prescribed. The Chi2 test was used to analyze associations between toxicity and dosimetric and clinical parameters. The Cox proportional hazard regression model was used for multivariate analysis. Kaplan-Meier method was used for survival analysis.

Results: median follow-up was 42.26 months [interquartile (IQR), 23–76). At 4-year, overall survival (OS) and metastasis-free survival (MFS) were 91% and 89%, respectively. At multivariate analysis, smoking habitude was associated with MFS [hazard ratio (HR) 7.32, 95% CI: 1.57–34.16, p = 0.011]. Acute and late grade ≥ 2 gastro-intestinal (GI) toxicity was observed in 6.5% and 2.6% of patients, respectively. Acute and late grade ≥ 2 genito-urinary (GU) toxicity were 31.5% and 3.9%. Four-year late GI and GU grade ≥ 2 toxicity were 3% and 7%, respectively. Acute GI toxicity was associated with statins medication (p = 0.04) and androgen deprivation therapy (p = 0.013). Acute GU toxicity was associated with the use of anticoagulants (p = 0.029) and antiaggregants (p = 0.013).

Conclusions: HT-based moderate hypofractionation shows very low rates of toxicity. Smoking habitude is associated with the risk of developing metastases after radical treatment for localized PCa.

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