Long-term analysis of the efficacy and safety of moderate hypofractionation regimens in salvage radiotherapy after radical prostatectomy

Background. Biochemical recurrence following radical prostatectomy remains a key clinical challenge in prostate cancer management. Salvage radiotherapy is the standard therapeutic approach in this setting, but long-term outcomes of moderately hypofractionated dose regimens are still insufficiently explored, making the optimal fractionation scheme a subject of debate. Moreover, the use of moderate dose hypofractionation regimens allows for a significant reduction in the overall duration of treatment. the purpose of the study: to evaluate the long-term efficacy and safety of moderately hypofractionated salvage radiotherapy to the prostate bed.

Material and Methods. This retrospective study included 42 patients who underwent SRT at a total dose of 57 Gy in 19 3 Gy daily fractions. The median follow-up time was 94.6 months. Outcomes assessed included biochemical control, radiation-induced toxicity (RTOG criteria), and the dynamics of quality of life using validated questionnaires.

Results. Moderate dose hypofractionation provided stable oncological control in the majority of patients, with satisfactory survival outcomes and quality of life. Grade I–II early toxicity was noted in 57.2 % and 59.6 % of patients for the urinary bladder and rectum, respectively. Severe toxicity (Grade III) was reported in only one case (2.4 %), whereas most radiation-induced complications were mild to moderate and did not require intensive medical management. Quality of life, as assessed by the IPSS, QoL, and ICIQ-SF scales, remained stable during and after treatment.

Conclusions. Long-term data confirm that the use of moderate hypofractionation during salvage radiotherapy to the prostate bed demonstrates a high level of efficacy and a favorable safety profile. The obtained results allow this regimen to be considered a justified and patient-convenient alternative to traditional dose fractionation in clinical practice.

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