Hypofractionated Volumetric Modulated Arc Radiotherapy with simultaneous Elective Nodal Irradiation is feasible in prostate cancer patients: A single institution experience

PurposeTo assess feasibility, toxicity and biochemical relapse-free survival (b-RFS) for a group of organ confined (OC) Saudi prostate cancer patients treated by hypo-fractionated Volumetric Modulated Arc Radiation Therapy (VMAT) Simultaneous Integrated Boost (SIB) Elective Nodal Irradiation (ENI) whole pelvic radiotherapy (WPRT).Patients and methodsBetween March 2009 and January 2014, 29 OC prostate cancer patients; median age 64 years, PS 0–1 were treated in King Faisal Specialist Hospital – Riyadh, Kingdom of Saudi Arabia using VMAT–SIB–ENI–WPRT, to a total dose of 70 Gy in 28 fractions. Twenty Four patients (83%) were treated with neo-adjuvant; concurrent androgen deprivation therapy (ADT). Median follow-up (FU) was 42 months (range: 18–72 months).ResultsThe 3-year actuarial b-RFS for low/intermediate and high risk groups were 100%, and 48%, respectively (p = 0.09) with a median FU period of 34 months (range: 14–53 months). Gleason Score (p = 0.02), and pretreatment PSA (p = 0.01) were predictive for biochemical failure on univariate analysis; with no observed prostate cancer-related deaths. Grade 2 acute/late GI and GU toxicities were 28%/0% and 17%/10% respectively with no reported grade 3/4 toxicities. Four (50%) out of the 8 patients with baseline partial potency, retained sexual function on long term follow-up.ConclusionsHypo-fractionation dose escalation VMAT–SIB–ENI–WPRT using 2 arcs is a feasible technique for intermediate/high risk OC prostate cancer patients, with acceptable rates of acute/late toxicities, much favorable planning target volume (PTV) coverage, and shorter overall treatment time. Prospective randomized controlled trials are encouraged to confirm its equivalence to other fractionation schemes.