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The Efficacy and Safety of Conventional and Hypofractionated High-Dose Radiation Therapy for Prostate Cancer in an Elderly Population: A Subgroup Analysis of the CHHiP Trial.
- Source :
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International Journal of Radiation Oncology, Biology, Physics . Apr2018, Vol. 100 Issue 5, p1179-1189. 11p. - Publication Year :
- 2018
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Abstract
- <bold>Purpose: </bold>Outcome data on radiation therapy for prostate cancer in an elderly population are sparse. The CHHiP (Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer) trial provides a large, prospectively collected, contemporary dataset in which to explore outcomes by age.<bold>Methods and Materials: </bold>CHHiP participants received 3 to 6 months of androgen deprivation therapy and were randomly assigned (1:1:1) to receive 74 Gy in 37 fractions (conventional fractionation), 60 Gy in 20 fractions, or 57 Gy in 19 fractions. Toxicity was assessed using clinician-reported outcome (CRO) and patient-reported outcome questionnaires. Participants were categorized as aged < 75 years or ≥ 75 years. Outcomes were compared by age group.<bold>Results: </bold>Of 3216 patients, 491 (15%) were aged ≥ 75 years. There was no difference in biochemical or clinical failure rates between the groups aged < 75 years and ≥ 75 years for any of the fractionation schedules. In the group aged ≥ 75 years, biochemical or clinical failure-free rates favored hypofractionation, and at 5 years, they were 84.7% for 74 Gy, 91% for 60 Gy, and 87.7% for 57 Gy. The incidence of CRO (grade 3) acute bowel toxicity was 2% in both age groups. The incidence of grade 3 acute bladder toxicity was 8% in patients aged < 75 years and 7% in those aged ≥ 75 years. The 5-year cumulative incidence of CRO grade ≥ 2 late bowel side effects was similar in both age groups. However, in the group aged ≥ 75 years, there was a suggestion of a higher cumulative incidence of bowel bother (small or greater) with 60 Gy compared with 74 Gy and 57 Gy. Patient-reported bladder bother was slightly higher in the group aged ≥ 75 years than the group aged < 75 years, and there was a suggestion of a lower cumulative incidence of bladder bother with 57 Gy compared with 74 Gy and 60 Gy in patients aged ≥ 75 years, which was not evident in those aged < 75 years.<bold>Conclusions: </bold>Hypofractionated radiation therapy appears to be well tolerated and effective in men aged ≥ 75 years. The 57-Gy schedule has potential advantages in that it may moderate long-term side effects without compromising treatment efficacy in this group. [ABSTRACT FROM AUTHOR]
- Subjects :
- *RADIOTHERAPY
*PROSTATE cancer patients
*PROSTATE cancer treatment
*ANDROGENS
*BLADDER cancer
*ANTIANDROGENS
*AGE distribution
*BLADDER
*COMPARATIVE studies
*INTESTINES
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*PROSTATE tumors
*RADIATION injuries
*RESEARCH
*RESEARCH funding
*STATISTICAL sampling
*EVALUATION research
*RANDOMIZED controlled trials
*DISEASE incidence
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 03603016
- Volume :
- 100
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- International Journal of Radiation Oncology, Biology, Physics
- Publication Type :
- Academic Journal
- Accession number :
- 128389876
- Full Text :
- https://doi.org/10.1016/j.ijrobp.2018.01.016