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Radiation technique and outcomes following moderately hypofractionated treatment of low risk prostate cancer: a secondary analysis of RTOG 0415

Prostate Cancer and Prostatic Diseases volume 27, pages 95–102 (2024)Cite this article

Subjects

Abstract

Background

While moderately hypofractionated radiotherapy (MHRT) for prostate cancer (PC) is commonly delivered by intensity modulated radiation therapy, IMRT has not been prospectively compared to three-dimensional conformal radiotherapy (3D-CRT) in this context. We conducted a secondary analysis of the phase III RTOG 0415 trial comparing survival and toxicity outcomes for low-risk PC following MHRT with IMRT versus 3D-CRT.

Methods

RTOG 0415 was a phase III, non-inferiority trial randomizing low-risk PC patients to either MHRT or conventionally fractionated radiation with stratification by RT technique. A secondary analysis for differences in overall survival (OS), biochemical recurrence free survival (BRFS), or toxicity by EPIC scores and Common Terminology Criteria for Adverse Events (CTCAE) was performed.

Results

1079 patients received the allocated intervention with a median follow up of 5.8 years. 79.1% of patients were treated with IMRT and radiation technique was balanced between arms. Across all patients, RT technique was not associated with significant differences in BRFS, OS, or rates of acute and late toxicities. For patients completing MHRT, there was a difference in the late GU toxicity distribution between 3D-CRT and IMRT but no difference in late grade 2 or greater GU or GI toxicity. Stratifying patients by RT technique and fractionation, no significant differences were observed in the minimal clinically important difference (MCID) in EPIC urinary and bowel scores following RT.

Conclusions

RT technique did not impact clinical outcomes following MHRT for low-risk PC. Despite different late GU toxicity distributions in patients treated with MHRT by IMRT or 3D-CRT, there was no difference in late Grade 2 or greater GU or GI toxicity or patient reported toxicity. Increases in late GU and GI toxicity following MHRT compared to CFRT, as demonstrated in the initial publication of RTOG 0415, do not appear related to a 3D-CRT treatment technique.

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Fig. 1: Overall survival and biochemical recurrence-free survival across radiation therapy fractionation schemes.

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Data availability

This manuscript was prepared using data from the Datasets NCT00331773-D1, NCT00331773-D2 from the NCTN/NCORP Data Archive of the National Cancer Institute’s (NCI’s) National Clinical Trials Network (NCTN). Data were originally collected from clinical trial NCT number NCT00331773 A Phase III Randomized Study of Hypofractionated 3D-CRT/MRT Versus Conventionally Fractionated 3D-CRT/MRT in Patients With Favorable-Risk Prostate Cancer. All analyses and conclusions in this manuscript are the sole responsibility of the authors and do not necessarily reflect the opinions or views of the clinical trial investigators, the NCTN, the NCORP, or the NCI. Code is available at request from the senior author.

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Authors and Affiliations

  1. Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA

    David J. Carpenter, Joseph K. Salama, W. Robert Lee & Matthew J. Boyer

  2. Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC, USA

    Joseph K. Salama & Matthew J. Boyer

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  1. David J. Carpenter
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Contributions

DJC: formal analysis, writing-original draft, review and editing, investigation. JKS and WRL: investigation, supervision, writing—review and editing. MJB: conceptualization, investigation, formal analysis, writing—review and editing.

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Correspondence to Matthew J. Boyer.

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Carpenter, D.J., Salama, J.K., Lee, W.R. et al. Radiation technique and outcomes following moderately hypofractionated treatment of low risk prostate cancer: a secondary analysis of RTOG 0415. Prostate Cancer Prostatic Dis 27, 95–102 (2024). https://doi.org/10.1038/s41391-023-00653-7

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