1031 - Hypofractionated Radiotherapy for Prostate Cancer: Preliminary Results from the HypoAfrica Study
Presenter(s)
S. Kibudde1, A. O. Joseph2, A. Mallum3, T. A. Ngoma4, A. Ajose5, E. Lugina6, J. Dachi Kisukari7, S. Adeneye8, T. Mkhize9, A. Alabi5, I. El Hamamsi8, M. A. Mseti6, P. Akowe8, A. Studen10, H. Li11, J. Lehmann12, S. Huq13, S. M. Avery14, W. Ngwa15, and L. Incrocci16; 1Uganda Cancer Institute, Uganda, Uganda, 2NSIA-LUTH Cancer Centre, Lagos, Nigeria, Lagos, Nigeria, 3Department of Radiotherapy and Oncology, College of Health Sciences University of KwaZulu Natal, Durban, South Africa, 4Ocean Road Cancer Institute, Dar Es Salaam, Tanzania, United Republic of, 5Lagos University Teaching Hospital, Lagos, Nigeria, 6Ocean Road Cancer Institute, Dar Es Salam, Tanzania, United Republic of, 7Ocean Road Cancer Institute, Dar es Salam, Tanzania, United Republic of, 8NSIA-LUTH Cancer Center, Lagos, Nigeria, 9Inkosi Albert Luthuli Central Hospital, Durban, South Africa, 10University of Ljubljana, Ljubljana, Slovenia, 11Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 12The University of Sydney, Newcastle, Australia, 13UPMC Hillman Cancer Center, Pittsburgh, PA, 14University of Pennsylvania, Philadelphia, PA, 15John Hopkins University, Baltimore, MD, 16Department of Radiotherapy, Erasmus Medical Center, Rotterdam, Netherlands
Purpose/Objective(s):
Prostate cancer (PCa) is the most common malignancy among men in sub-Saharan Africa (SSA). Given the high burden of PCa in these resource-limited settings, adopting evidence-based strategies to enhance treatment accessibility is crucial. Hypofractionated radiotherapy (HFRT) has the potential to increase radiotherapy access by reducing overall treatment duration and costs, while optimizing personnel, equipment and infrastructural resource utilization. Multiple randomized trials in Europe and North America have demonstrated the non-inferiority of HFRT compared to conventional radiotherapy in terms of toxicity and treatment outcomes. This study evaluates the feasibility, and safety of moderate HFRT for the treatment of localized PCa in SSA.Materials/Methods:
The HypoAfrica study is a multi-center, prospective, non-randomized, phase II non-inferiority trial conducted across three centers in Nigeria, South Africa and Tanzania. Eligible patients were men with histologically confirmed localized PCa. Patients were treated with HFRT using IMRT or VMAT to a total dose of either 60Gy in 20 fractions for low- and intermediate-risk PCa or 62Gy in 20 fractions for high-risk PCa. Androgen deprivation therapy was administered as physicians’ discretion according to institutional protocols. The primary endpoints were gastrointestinal (GI) and genitourinary (GU) toxicities, assessed using Common Terminology Criteria for Adverse Events (CTCAE) at baseline, upon completion of radiotherapy and at 3-, 12-, and 24-months post treatment.Results:
A total of 182 men were enrolled. The median age was 70 years (range: 51-81 years). All patients completed HFRT, and follow-up assessment were available for 169 patients at 3-month, and 134 patients at 12-month. In this cohort, 49%(n=90) received 60Gy and 49% (n=90) received 62Gy. At radiotherapy completion, grade =2 GI toxicity was reported by 2% (n=4) of patients and grade =2 GU toxicity in 4% (n=8). At three months post-radiotherapy, the rates of grade =2 GI and GU toxicity were 2% (n=4) and 5% (n=8), respectively. At 12 months post-radiotherapy, grade =2 GI and GU toxicity were each reported in 5% (n=7) participants.Conclusion:
Preliminary data suggests that HFRT for localized PCa is feasible and well-tolerated in SSA, with acute GI and GU toxicities profiles comparable to or lower to those reported in Western HFRT trials. On-going follow-up will provide further insight into long-term toxicities and treatment outcomes. Future efforts will focus on validating these findings in additional African centers to facilitate wider HFRT adoption and improve access to curative radiotherapy for PCa in SSA.