Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 10, pp 2547–2554 | Cite as

Moderate versus extreme hypofractionated radiotherapy: a toxicity comparative analysis in low- and favorable intermediate-risk prostate cancer patients

  • Luca NicosiaEmail author
  • Rosario Mazzola
  • Michele Rigo
  • Vanessa Figlia
  • Niccolò Giaj-Levra
  • Giuseppe Napoli
  • Francesco Ricchetti
  • Stefanie Corradini
  • Ruggero Ruggieri
  • Filippo Alongi
Original Article – Clinical Oncology



External beam radiotherapy (EBRT) is an effective treatment option for low- and favorable intermediate-risk prostate cancer (PCa) and it is usually delivered in conventional fractionation or with moderate hypofractionation (hRT), with comparable results. In the last years, a new treatment approach with stereotactic body radiotherapy (SBRT) has shown promising results. The aim of the present study was to directly compare the toxicity and outcome between hRT and SBRT in low and favorable intermediate PCa patients.

Materials and methods

The hRT schedules were: 71.4 Gy or 74.2 Gy in 28 fractions for low- or favorable intermediate-risk PCa, respectively, while the SBRT schedules were: 35 Gy or 37.5 Gy in five fractions, for low or favorable intermediate risk, respectively. Toxicity assessment was performed according to CTCAE v5.0 grading. The International Prostatic Symptoms Score (IPSS) was also recorded.


One hundred forty-nine patients were analyzed, overall 81 (54.36%) patients were low risk and 68 (45.64%) were favorable intermediate risk. Sixty-nine (46.3%) patients were treated with hypo-RT and 80 (53.7%) with SBRT. Median follow-up was 33 months (range 11–58 months). The actuarial survival rate was 98.66%. The 3-years BFS rates were 95.5% and 100% for hRT and SBRT, respectively (p = 0.051). One case (0.6%) of acute grade 3 urinary toxicity occurred in a patient with favorable intermediate risk treated with hRT. He initially suffered gross hematuria and acute urinary retention not treatable with urinary catheter, therefore a suprapubic catheter was placed and steroids were administered. No differences in acute, late or severe toxicity were detected.


Stereotactic body radiotherapy reported a good clinical outcome and safe toxicity profile. Results are comparable to hRT, but a longer follow-up is needed to assess the late effectiveness and toxicity.


Prostate cancer Low risk Favorable intermediate risk Hypofractionated radiotherapy SBRT Stereotactic body radiotherapy 



The authors would like to thank Prof. Brian Hawkins for his help in the final revision of the manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Luca Nicosia
    • 1
    Email author
  • Rosario Mazzola
    • 1
  • Michele Rigo
    • 1
  • Vanessa Figlia
    • 1
  • Niccolò Giaj-Levra
    • 1
  • Giuseppe Napoli
    • 1
  • Francesco Ricchetti
    • 1
  • Stefanie Corradini
    • 2
  • Ruggero Ruggieri
    • 1
  • Filippo Alongi
    • 1
  1. 1.Advanced Radiation Oncology DepartmentIRCCS Sacro Cuore Don Calabria Hospital, Cancer Care CenterVeronaItaly
  2. 2.Radiation Oncology Department, University HospitalLMU MunichMunichGermany

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