279P - Hypofractionated radiotherapy protocol implementation and early outcomes for prostate cancer patients: A single institution retrospective review

Background

The moderated hypofractionation (MoHF) radiotherapy (RT) protocols offer an alternative treatment (Tx) that solves both the workload issue as well as the duration of Tx for prostate cancer (PC) patients while delivering a more adapted dose to the tumor cells. Therefore, the MoHF protocol has been implemented in our department using the Volumetric Arc Modulated Therapy (VMAT) with Image Guided Radiation Therapy (IGRT) for our PC patients.

Methods

From May 24^th 2021 to June 30^th 2023, there were totally 23 patients who were applied the MoHF protocols. Initially, we implemented protocol of 60Gy in 20 fractions (60Gy/20fx) for intermediate-risk PC patients. Since December 2022, the protocol of 68Gy in 25 fractions (68Gy/25fx) was implemented for high-risk PC patients based on the new data of PCS5 trial. All patients were treated accordingly to institutional protocol for Tx of PC. A weekly consultation during RT course was also held for each patient to follow up with the possible acute side effects.

Results

The average duration to complete Tx planning was 7 days. For dose constraint achievement, 100% of planning had D2% < 107% of dose prescription while 21/23 plans (91.30%) achieved the criteria of planning target volum (PTV) coverage as well as organs at risk (OARs) protection. 2/23 plans (8.70%) were validated with a minor deviation in either target coverage or OARs constraints. The most common acute toxicity was dysuria which happened on 21/23 cases (91.30%) with grade 1 or 2. This side effect was resolutive in 100% of patients within 1 month after completion of Tx. No grade 3 or higher acute or late toxicity was reported. The cost-effectiveness of the MoHF protocols, was compared to a normo-fractionated protocol in 8 weeks (80Gy/40fx). The cost of RT was reduced by 25% going from more than 7000USD for the 8-weeks protocol to 5800USD for the 68Gy/25fx protocol and to 4900USD for the 60Gy/20fx protocol. The entire treatment costs were further reduced due to lower accommodation and transportation fees in the shorter protocols.

Conclusions

For PC patients indicated with definitive RT, the MoHF is a more convenient and safer alternative with manageable side effects and a reduction of treatment direct and indirect cost.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.