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Salvage radiotherapy after radical prostatectomy: analysis of toxicity by dose-fractionation in the RADICALS-RT trial

Petersen, Peter Meidahl; Cook, Adrian D; Sydes, Matthew R; Clarke, Noel; Cross, William; Kynaston, Howard; Logue, John; ... Catton, Charles; + view all (2023) Salvage radiotherapy after radical prostatectomy: analysis of toxicity by dose-fractionation in the RADICALS-RT trial. International Journal of Radiation: Oncology - Biology - Physics 10.1016/j.ijrobp.2023.04.032. (In press). Green open access

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Abstract

ABSTRACT: Emerging data indicate comparable disease control and toxicity of postoperative normo-fractionation and moderate hypofractionation radiotherapy (RT) in prostate cancer. In RADICALS-RT, patients were planned for treatment with either 66Gy in 33 fractions over 6.5 weeks or 52.5Gy in 20 fractions over 4 weeks. In this non-randomized, exploratory analysis, we explore the toxicity of these two schedules in patients who had adjuvant RT. METHODS: Information on RT dose was collected in all patients. Radiation Therapy Oncology Group toxicity score was recorded every 4 months for 2 years, 6-monthly until 5 years, then annually until 15 years. Patient-reported data were collected at baseline, 1, 5, and 10 years with use of standard questionnaires including Vaizey (bowel) and International Continence Society Male Short-Form (urinary incontinence). The highest grade of event was recorded within the first 2 years, and beyond 2 years, and compared between treatment groups using the χ² test. RESULTS: 217/634 (34%) patients were planned for 52.5Gy/20f and 417/634 (66%) for 66Gy/33f. In the first two years, grade 1 - 2 cystitis was reported more frequently among the 66Gy/33f group (52.5Gy/20f: 20% vs 66Gy/33f: 30%, p=0.04). After two years, grade 1-2 cystitis was reported in 16% in the 66Gy group, and 9% in the 52.5Gy group (p=0.08). Other toxicities were similar in the two groups and very few patients had any grade 3 - 4 toxicity. Patients reported slightly higher urinary and faecal incontinence scores at one year than at baseline, but no clinically meaningful differences were reported between 52.5Gy/20f and 66Gy/33f groups. Patient reported health was similar at baseline and at one year, and similar between 52.5Gy/20f and 66Gy/33f groups. CONCLUSION: Severe toxicity is rare after prostate bed radiotherapy with either 52.5Gy/20f or 66Gy/33f. Only modest differences were recorded in toxicity or in patient reported outcomes between these two schedules.

Type: Article
Title: Salvage radiotherapy after radical prostatectomy: analysis of toxicity by dose-fractionation in the RADICALS-RT trial
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijrobp.2023.04.032
Publisher version: https://doi.org/10.1016/j.ijrobp.2023.04.032
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. // This research was funded in whole, or in part, by the UKRI grant number MC_UU_12023/28. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Keywords: Late effects, moderate hypofractionation, Prostate cancer, Salvage radiotherapy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10169601
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