Moderate-Hypofractionated Radical Radiotherapy for Early-Stage Prostate Cancer: A Propensity Score Matching Analysis Comparing Dose Fractionation Patterns

IntroductionThis study evaluates the clinical outcomes, survival benefits, and toxicities of two moderate-hypofractionated radiotherapy (MHRT) patterns, 60 Gy in 20 fractions (60 Gy/20f) and 70 Gy in 28 fractions (70 Gy/28f), in early-stage prostate cancer patients.MethodsThis retrospective study analyzed data from 187 patients diagnosed between 2014 and 2023, using propensity score matching to ensure efficacy assessment accuracy. The primary endpoints reported were overall survival (OS) and disease-free survival (DFS), calculated using Kaplan-Meier analysis. Toxicity and side effects were evaluated using Criteria for Adverse Events v5.0, focusing on the urinary and gastrointestinal (GI) systems.ResultsAfter matching, each of the 60 Gy and 70 Gy groups included 73 patients. The median follow-up duration for all patients was 36.0 months. The OS rates for the 60 Gy and 70 Gy groups were 86.3% and 89.0%, respectively, with 3-year OS rates of 92.4% and 89.0% (<i>P</i> = 0.375). The 3-year DFS rates were 91.0% in the 60 Gy group and 81.0% in the 70 Gy group (<i>P</i> = 0.096), indicating no significant differences between the groups. The incidence of acute Grade 2 or higher urinary toxicities was comparable between the two groups (60 Gy group vs 70 Gy group: 9.6% vs 9.6%, <i>P</i> = 1.0), while the 70 Gy group demonstrated an advantage for late Grade 2 or higher toxicities (60 Gy group vs 70 Gy group: 12.3% vs 2.8%, <i>P</i> = .028). For the GI system, the incidence of acute toxicities was higher in the 60 Gy group, albeit not statistically significant (60 Gy group vs 70 Gy group: 11.0% vs 6.8%, <i>P</i> = .383), while late toxicities were equivalent between the groups (60 Gy group vs 70 Gy group: 1.4% vs 1.4%, <i>P</i> = 1.0).ConclusionBoth MHRT fractionation patterns demonstrate comparable survival outcomes and toxicities in early-stage prostate cancer, suggesting MHRT's viability as a primary treatment. The 60 Gy/20f pattern marginally favored survival, albeit not with statistical significance.