Comparison of Survival Between Hypofractionated and Conventional Radiotherapy in Clinically Localized Prostate Cancer: A Single-Center Retrospective Cohort

Prostate cancer (pCa) is the most frequently diagnosed visceral cancer among men. The main role of radical prostatectomy and external-beam radiation therapy (EBRT) in the management of patients with localized pCa has been established.

This study aims at comparing the clinical outcomes of hypofractionated versus conventional EBRT in the definitive management of patients with localized pCa.

From 2013 to 2019, a consecutive series of patients with localized pCa was treated with conventional (74 Gy at 2 Gy fractions) or hypofractionated (70.2 Gy at 2.7 Gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), respectively. The impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-RFS) and overall survival (OS) was assessed.

The median follow-up was 42 months (range: 8 - 81 months). Among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. The patient characteristics between groups were comparable. The mean bc-RFS of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (CI) 95%: 34.5 - 35.7, P = 0.25). Accordingly, the mean OS of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (CI 95%: 37.3 - 38.6, P = 0.04). The sub-analysis showed that the OS benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (CI 95%: 0.02 - 1.46, P = 0.054).

Hypofractionation had OS benefit over the conventional schedule for definitive radiotherapy of localized pCa. This benefit was limited to patients with intermediate- and high-risk pCa.