Moderate Hypofractionated Helical Tomotherapy for Localized Prostate Cancer in Older Patients: A Single-Institution Study of Toxicity and Outcomes

Introduction The optimal management of localized prostate cancer (PCa) in the “oldest-old” demographic presents a unique clinical challenge, requiring a careful balance between oncological control and the preservation of quality of life. This study aims to evaluate the safety, toxicity profile, and clinical outcomes of moderately hypofractionated helical tomotherapy (HT) in a cohort of patients aged 75 years and older with localized PCa. Materials and Methods In this retrospective cohort study, we analyzed 51 consecutive patients with a median age of 79 years treated between 2016 and 2022. All patients received 69 Gy in 25 fractions (2.76 Gy/fraction) via the HT platform. Risk stratification was performed using the D’Amico classification, revealing that the majority were high-risk (52.9%) or intermediate-risk (43.1%). Clinical outcomes included biochemical relapse-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Toxicity grading followed CTCAE v4.0 criteria, and Quality of Life (QoL) was evaluated through the International Prostate Symptom Score (IPSS) and a single-item index. Results At a median follow-up of 38 months, the 5-year BRFS, CSS, and OS rates were 83.3%, 80.1%, and 68.8%, respectively. Acute Grade 2 genitourinary and gastrointestinal toxicities occurred in 25.5% and 27.5% of the subjects. Late Grade 3 complications were rare (1 GU, 4 GI). Significant longitudinal improvements in IPSS and QoL were observed within 3 months post-treatment ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" overflow="scroll"> <mml:mrow> <mml:mi>p</mml:mi> <mml:mo>&lt;</mml:mo> <mml:mn>0.001</mml:mn> </mml:mrow> </mml:math> ). Conclusion Moderately hypofractionated HT may be a safe and effective treatment for elderly PCa patients, suggesting potential for excellent oncological control and symptomatic relief.