Ten years results from a phase II study on image guided Intensity–Modulated Radiation Therapy with simultaneous integrated boost in high-risk prostate cancer

Abstract Purpose There is no consensus how to treat high-risk prostate cancer, and long-term results from hypofractionated radiotherapy are lacking. We report 10 year results after image guided intensity-modulated radiotherapy (IMRT) with hypofractionated simultaneous integrated boost (SIB) and elective pelvic field. Methods and Materials Between 2007 and 2009, 97 consecutive patients with high-risk prostate cancer were included, treated with 2.7-2.0 Gy x 25 Gy to the prostate, seminal vesicles and elective pelvic field. Toxicity was scored according to RTOG criteria and biochemical disease free survival (BFS) defined by the Phoenix definition. Patients were subsequently divided into three groups: high-risk (HR) (n=32), very high-risk (VHR) (n=50), and N+/s-PSA ≥100 (n=15). Differences in outcomes were examined using Kaplan Meier analyses. Results BFS in the HR+VHR patients was 64%, metastasis free survival (MFS) 80%, prostate-cancer-specific-survival (PCSS) 90%, and overall survival (OS) 72%.VHR vs. HR subgroups demonstrated significantly different BFS, 54% vs 79% (p = 0.01). MFS and PCSS in the VHR group vs HR group were 76% vs 87% (p = 0.108) and 74% vs 100% (p = 0.157). Patients reaching nadir PSA Conclusions High-risk prostate cancer patients obtained favourable 10 year outcomes with low toxicity. There were significantly better results in the HR versus the VHR group, both better than the N+/PSA ≥ 100 group. A nadir PSA value