Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE)

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2024年2月19日

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Gianluca Ingrosso,
Elisabetta Ponti,
Giulio Francolini,
Saverio Caini,
Simona Fondelli,
Roberto Santini,
Maurizio Valeriani,
Luciana Rago,
Giacomo Duroni,
Alessio Bruni,
Antonietta Augurio,
Francesco Tramacere,
Fabio Trippa,
Donatella Russo,
Marta Bottero,
Maria Tamburo,
Silvana Parisi,
Simona Borghesi,
Andrea Lancia,
Sara Gomellini,
Silvia Scoccianti,
Marco Stefanacci,
Gianluca Vullo,
Teodora Statuto,
Giulia Miranda,
Bianca Santo,
Alessandro Di Marzo,
Rita Bellavita,
Annamaria Vinciguerra,
Lorenzo Livi,
Cynthia Aristei,
Niccolò Bertini,
Carolina Orsatti,
Beatrice Detti

摘要

Background

Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series.

Materials and methods

We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan–Meier survival curves and fitted univariate and multivariable Cox’s proportional hazards regression models to study the association between the clinical variables and each survival type.

Results

At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3–99.6%) and 85.5% (95%CI 81.9–89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4–6%) and 6% (95%CI 4–8%), respectively.

Conclusion

Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials.