Moderately hypofractionated radiotherapy (m-HRT) is a standard of care in the radical treatment of localized prostate cancer (PCa). Still, its role after radical prostatectomy (RP) is yet to be defined. We present long-term outcome and toxicity results of m-HRT in the post-prostatectomy setting.
Retrospective analysis of 172 PCa patients treated with daily volumetric image-guided Tomotherapy-based m-HRT between 2013 and 2020. For outcome and toxicity endpoints, we used Kaplan-Meier survival curves and the chi-square test for univariate analysis.
The median time from RP to m-HRT was 11 months (interquartile [IQR], 8.3-31.4). The median total dose to the prostate bed was 69.75 Gy (IQR, 65.25-72 Gy) (2.25 Gy per fraction). With a median follow-up of 8.25 years (IQR 7.06-9.17 years), 10-year overall survival (OS), metastasis-free survival (MFS), and biochemical relapse-free survival (b-RFS) were 98.8% (95% CI, 95.4-99.7), 85.9% (95% CI, 79.7-90.3), and 82.4% (95% CI, 75.8-87.3), respectively. Late genitourinary (GU) toxicity of grade ≥ 2 was observed in 14 (8.1%) patients. The 10-year freedom from late grade ≥ 2 GU toxicity was 89.8% (95% CI, 83.2-93.8%). Late gastrointestinal (GI) toxicity grade ≥ 2 was reported in 2 (1.1%) patients. The 10-year freedom from late grade ≥ 2 GI toxicity was 98.8% (95% CI, 95.3-99.7%). At univariate analysis, acute GU toxicity was associated with late GU toxicity (p = 0.016).
Our long-term results confirm the critical role of modern radiotherapy in curing PCa in the post-operative setting, reducing overall treatment time and the risk of toxicity.
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2026 Apr 06 [Epub ahead of print]
Federico Camilli, Saverio Caini, Chiara Doccioli, Simonetta Saldi, Eleonora Festa, Anna Giulia Becchetti, Sabrina Gravante, Riccardo Moretti, Rita Bellavita, Cynthia Aristei, Gianluca Ingrosso
Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Ospedale Santa Maria Della Misericordia, Piazzale Menghini 1, 06132, Perugia, Italy., Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy., Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy., Department of Diagnostic Imaging, Radiology II, Perugia General Hospital, Perugia, Italy., Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Ospedale Santa Maria Della Misericordia, Piazzale Menghini 1, 06132, Perugia, Italy. .