comparison of survival between hypofractionated and conventional radiotherapy in clinically localized prostate cancer: a single-center retrospective cohort

Background: prostate cancer (pca) is the most frequently diagnosed visceral cancer among men. the main role of radical prostatectomy and external-beam radiation therapy (ebrt) in the management of patients with localized pca has been established. objectives: this study aims at comparing the clinical outcomes of hypofractionated versus conventional ebrt in the definitive management of patients with localized pca. methods: from 2013 to 2019, a consecutive series of patients with localized pca was treated with conventional (74 gy at 2 gy fractions) or hypofractionated (70.2 gy at 2.7 gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3d-crt) and intensity-modulated radiation therapy (imrt), respectively. the impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-rfs) and overall survival (os) was assessed. results: the median follow-up was 42 months (range: 8 - 81 months). among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. the patient characteristics between groups were comparable. the mean bc-rfs of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (ci) 95%: 34.5 - 35.7, p = 0.25). accordingly, the mean os of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (ci 95%: 37.3 - 38.6, p = 0.04). the sub-analysis showed that the os benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (ci 95%: 0.02 - 1.46, p = 0.054). conclusions: hypofractionation had os benefit over the conventional schedule for definitive radiotherapy of localized pca. this benefit was limited to patients with intermediate- and high-risk pca.