The efficacy and safety of conventional and hypofractionated high-dose radiotherapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): James M. Wilson, David Dearnaley, Isabel Syndikus, Vincent Khoo, Alison Birtle, David Bloomfield, Ananya Choudhury, John Graham, Catherine Ferguson, Zafar Malik, Julian Money-Kyrle, Joe M. O'Sullivan, Miguel Panades, Chris Parker, Yvonne Rimmer, Christopher Scrase, John Staffurth, Andrew Stockdale, Clare Cruickshank, Clare Griffin, Emma Hall
IntroductionOutcome data on radiotherapy for prostate cancer in an elderly population are sparse. The CHHiP trial provides a large, prospectively collected, contemporary dataset in which to explore outcomes by age.Methods and MaterialsCHHiP participants received 3-6 months of androgen deprivation therapy and were randomly assigned (1:1:1) to receive 74Gy in 37 fractions (conventional fractionation), 60Gy in 20 fractions or 57Gy in 19 fractions. Toxicity was assessed using clinician-reported and patient-reported outcome (CRO/PRO) questionnaires. Participants were categorised as aged less than 75 (<75) or 75 years and older (75+).Outcomes were compared by age-group.Results491/3216 (15%) were 75+. There was no difference in biochemical or clinical failure (BCF) rates between the <75 and the 75+ group for any of the fractionation schedules. In the 75+ group BCF-free rates favoured hypofractionation and at 5 years were 74Gy: 84.7%, 60Gy: 91%, 57Gy: 87.7%. The incidence of CRO (G3) acute bowel toxicity was 2% in both age-groups. Grade 3 acute bladder toxicity was 8% and 7%. Five year cumulative incidence of CRO grade 2+ late bowel side effects was similar in both age groups. However, in the 75+ group, there was a suggestion of a higher cumulative incidence of bowel bother (≥small) with 60Gy compared to 74Gy and 57Gy. Patient-reported bladder bother was slightly higher in the 75+ group than the <75 group and there was a suggestion of a lower cumulative incidence of bladder bother with 57Gy compared to 74Gy and 60Gy in the 75+ group which was not evident in those <75.ConclusionHypofractionated radiotherapy appears to be well tolerated and effective in men over 75. The 57 Gy schedule has potential advantages in that it may moderate long term side effects without compromising treatment efficacy in this group.

Teaser

The efficacy and toxicity of radiotherapy for localised prostate cancer in CHHiP trial participants aged 75 and over was compared with patients younger than 75. There was no evidence of a difference in biochemical or clinical recurrence free survival or clinically significant toxicity between the older and younger patient groups. Hypofractionated radiotherapy is an effective and well tolerated treatment for localised prostate cancer in an elderly population with good performance status.


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