Prostate Cancer (PCa) is the second leading cause of cancer death in the elderly (≥75 years). There is currently little data on hypofractionated radiotherapy in older patients affected by localized PCa. We present the long-term results of hypofractionated radiotherapy in elderly patients with localized PCa from the IPOPROMISE database.
retrospective analysis of 719 PCa elderly (≥75 years) patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020. For survival endpoints, we used Kaplan-Meier survival curves and univariate and multivariable Cox's proportional hazards regression models.
Median age at PCa diagnosis was 78.4 years (interquartile [IQR], 76.8-80.3 years), 74% of patients had a modified Charlson co-morbidity index (elderly-PCa-CCI, (e-PCCI)) of 0. Based on NCCN risk grouping, 399 patients (55.5%) were affected by unfavorable to very high-risk disease. Median follow-up was 4.2 years (IQR 2.4-6.4 years). 31/719 (4.3%) patients died from any cause. At 5 years, overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival were 95.6% (95% CI 93.4-97.1%), 99.2% (95%CI 97.9-99.7%), and 97.3% (95% CI 95.1-98.5%), respectively. In multivariate analysis, baseline PSA, and Gleason score were associated with MFS. On univariate analysis, e-PCCI ≥ 2 was associated with OS (p = 0.02). The 5-year freedom from late grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity were 95.1% (95% CI 93.0-96.5%) and 96.7% (95% CI 93.7-97.1%), respectively.
Our results represent a valuable add-on to the current literature, confirming the prominent role of radiotherapy in the cure of elderly fit patients affected by localized disease.
Prostate cancer and prostatic diseases. 2025 Mar 17 [Epub ahead of print]
Gianluca Ingrosso, Eleonora Festa, Saverio Caini, Elisabetta Ponti, Giulio Francolini, Chiara Doccioli, Andrea Lancia, Simona Fondelli, Roberto Santini, Maurizio Valeriani, Luciana Rago, Alessio Bruni, Antonietta Augurio, Fabio Trippa, Donatella Russo, Maria Tamburo, Silvana Parisi, Simona Borghesi, Sara Gomellini, Silvia Scoccianti, Daniela Musio, Marco Stefanacci, Giuseppe Facondo, Teodora Statuto, Giulia Miranda, Bianca Santo, Alessandro Di Marzo, Rita Bellavita, Annamaria Vinciguerra, Lorenzo Livi, Cynthia Aristei, Beatrice Detti
Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy. ., Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy., Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy., Radiation Oncology Department, San Giovanni Addolorata Hospital, Rome, Italy., Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy., Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy., Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy., Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy., Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy., Radiation Oncology Unit, IRCCS-CROB, Rionero in Vulture, Potenza, Italy., Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy., Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy., Department of Radiotherapy, Saint Maria Hospital, Terni, Italy., Radiotherapy Unit, Ospedale "Vito Fazzi", Lecce, Italy., Radiotherapy Unit, Cannizzaro Hospital, Catania, Italy., Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy., Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy., Radiation Oncology Unit of Prato, Azienda USL Centro Toscana, Prato, Italy.