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.
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.
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.
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.
International journal of radiation oncology, biology, physics. 2018 Jan 09 [Epub]
James M Wilson, David P 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, CHHiP Investigators
Guy's and St. Thomas' NHS Foundation Trust/Kings College, London, UK., The Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, London, UK. Electronic address: ., Clatterbridge Cancer Centre, Wirral, UK., The Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, London, UK., Rosemere Cancer Centre, Royal Preston Hospital/University of Manchester, Preston, UK., Brighton and Sussex University Hospitals, Brighton, UK., Christie Hospital, Manchester, UK., Beacon Centre, Musgrove Park Hospital, Taunton, UK., Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK., Royal Surrey County Hospital, Guildford, UK., Queen's University Belfast, Belfast, UK., Lincoln County Hospital, Lincoln, UK., Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Ipswich Hospital, Ipswich, UK., Cardiff University/Velindre Cancer Centre, Cardiff, UK., University Hospital Coventry, Coventry, UK., The Institute of Cancer Research, London, UK.