Research & Innovation
Publications
Ultrahypofractionated linac-based radiotherapy of primary prostate cancer - early results of an Austrian nationwide registry study
PMU Authors
Johannes Berchtold, Falk Roder, Frank Wolf
All Authors
Natalee Annon-Eberharter, Johannes Berchtold, Angela Ginestet, Georg Gruber, Lukas Kocik, Oxana Komina, Tanja Langsenlehner, Elisabeth Nechvile, Christoph Resl, Falk Roder, Samuel M. Vorbach, Ludmila Zahlbruckner, Frank Wolf
Journal association
CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY
Abstract
Background and purpose: Ultrahypofractionated radiotherapy (UHFX) has emerged as an attractive alternative to normo-and moderately hypofractionated regimens for localized prostate cancer. However, its broader adoption remains limited by technical challenges and concerns regarding genitourinary toxicity. We established a nationwide Austrian registry of low and intermediate risk localized prostate cancer patients treated with linacbased stereotactic body radiation therapy (SBRT) to provide real-world data about UHFX treatment conventions, toxicity, oncologic outcomes, and patient-reported quality of life (QoL). Methods: This is a multicenter, registry-based prospective study. Eligibility was restricted to patients with low-and intermediate-risk prostate cancer. Patient characteristics, toxicity (CTCAE v5.1), urinary function (IPSS), and QoL (EPIC-26) were prospectively reported in a web-based database. Results: Between September 2022 and April 2026, 191 patients were enrolled, of whom 169 were included in the final analysis. Median follow-up was 14 months (IQR 7-24). NCCN risk distribution consisted of 23.7% low-risk, 48.5% favorable intermediate-risk, and 27.8% unfavorable intermediate-risk disease. All patients received 40 Gy in five fractions. Treatment was delivered on alternating weekdays in 61.5% and on consecutive weekdays in 38.5% of patients. Median PSA declined from 7.74 ng/mL at baseline to 0.63 ng/mL at 12 months. No biochemical recurrence was observed during the first year of follow-up. Grade 1-2 genitourinary toxicity peaked at treatment completion and declined thereafter, while grade > 3 toxicity remained uncommon (<1%). Gastrointestinal toxicity remained low throughout follow-up, with no grade > 3 gastrointestinal toxicity observed. Conclusion: In this nationwide real-world cohort, UHFX delivered in five fractions was well tolerated and showed favorable early oncological outcomes with low rates of severe toxicity across academic and non-academic institutions, consistent with results from randomized phase III trials.
Keywords
REGISTRY, Austria, Hypofractionation, Prostate SBRT, Sabr, Uhfx