Hypofractionated versus conventional IMRT in unfavorable intermediate- and high-risk prostate cancer: A phase II comparative study of PSA kinetics, dosimetric and toxicity outcomes - 28/04/26
, Mohamed A Alm El-Din , Asmaa Mohamed Alkady , Rabab Mahmoud Moussa , Mohamed Mohamed Elshebeny Abstract |
Background |
Prostate cancer (PCa) is a leading global malignancy, with unfavorable intermediate-risk (UIR) and high-risk (HR) disease requiring optimized treatment strategies. Hypofractionated intensity-modulated radiotherapy (HF IMRT) has gained attention due to the low α/β ratio of prostate cancer, suggesting enhanced sensitivity to larger fraction sizes. This study compares PSA kinetics, dosimetric and toxicity outcomes between HF IMRT and conventional fractionated IMRT (CF IMRT).
Methods |
In this prospective phase II study, 60 patients with UIR or HR localized PCa were enrolled. Thirty patients received HF IMRT (60 Gy in 20 fractions over 4 weeks) while 30 underwent CF IMRT (74–80 Gy in 37–40 fractions over 7.4–8 weeks). All patients received androgen deprivation therapy. PSA levels were monitored regularly, and biochemical relapse-free survival (BRFS) was defined by the Phoenix criterion. Dosimetric parameters for bladder, rectum, femoral heads, bowel, and penile bulb were analyzed.
Results |
After a median follow-up of 17 months, 2.5-year BRFS was 96.7% in the HF IMRT group versus 90% in the CF IMRT group ( P = 0.612). PSA nadir values were comparable, but time to nadir was significantly shorter with HF IMRT (12.8 vs. 17.1 months, P = 0.019), indicating a more rapid biochemical response. Dosimetric analysis revealed significantly lower bladder and rectal dose-volume exposures ( P < 0.001) and reduced femoral head maximum dose with HF IMRT. Target coverage metrics (D95, CI, HI) were similar between groups, confirming oncologic equivalence.
Conclusion |
Hypofractionated IMRT demonstrates durable PSA control with greater treatment efficiency and improved dosimetric safety compared to CF IMRT. As a phase II study, these findings are preliminary and subject to inherent limitations; therefore, definitive conclusions cannot be drawn. Nonetheless, they provide a strong rationale for appropriately designed phase III trials to validate the benefits of hypofractionation in unfavorable intermediate- and high-risk prostate cancer.
Level of evidence |
Evidence from multiple phase III randomized controlled trials and meta-analyses (Level 1) supports the non-inferiority of HF IMRT compared to CF IMRT, confirming equivalent biochemical control and toxicity outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : Prostate cancer, Radiotherapy, Hypofractionation, Treatment outcomes, Toxicity
Plan
Vol 36 - N° 5
Article 103104- juin 2026 Retour au numéro
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