Moderately Hypofractionated Prostate Radiotherapy Using VMAT: A Prospective Observational Study

Karrar Mahdi Badi; Marwah Ali Khalaf; Haider Kazem; Biplab Sarkar; Pallab Sarkar

doi:10.31557/APJCC.2026.11.6.857

Authors

Karrar Mahdi Badi Department of Medical Physics, College of Science, Al-Qadisiyah University, Al-Qadisiyah, Iraq.
Marwah Ali Khalaf Department of Community Health of Nursing, College of Nursing, University of Kirkuk, Iraq.
Haider Kazem Department of Environmental Research and Pollution Prevention, College of Science, University of Al-Qadisiyah, Iraq.
Biplab Sarkar Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata- 700054, India.
Pallab Sarkar City College, Department of Life Science, 102/1, Raja Ram Mohan Sarani Rd, Machuabazar, Kolkata, West Bengal 700009, India.

DOI:

https://doi.org/10.31557/APJCC.2026.11.6.857

Keywords:

Prostate cancer, radiotherapy, RapidArc, VMAT, biochemical control, toxicity.

Abstract

Introduction: The primary objective was to evaluate 3-year biochemical control in prostate cancer patients treated with moderately hypofractionated volumetric modulated arc radiotherapy (VMAT/RapidArc: RA) based prostate treatment. Secondary objectives included disease-free survival (DFS), acute and late genitourinary (GU) and gastrointestinal (GI) toxicity scored using RTOG criteria, treatment efficiency in terms of treatment time, and dosimetric parameters.

Materials and Methods: This prospective observational study included 70 patients with histologically confirmed adenocarcinoma of the prostate treated with VMAT between 01.01.2020 and 31.12.2021. Patients were stratified into risk categories based on NCCN criteria. Treatment was definitive or post-prostatectomy adjuvant, with or without androgen deprivation therapy (ADT). Simulation and planning were performed according to RTOG/ESTRO guidelines, with dose constraints based on QUANTEC recommendations. Treatment efficiency parameters included monitor units (MU) and treatment time.

Results: Median age was 61 years; 12.8% were in the low-risk group, 40% had intermediate-risk, and 47.1% high-risk disease. All patients completed treatment with a mean delivery time of less than 3 minutes per fraction. VMAT provided excellent PTV coverage (PTV V95% = 97.2% of the prescribed dose) and maintained organ-at-risk (OAR) constraints. At 3 years, actuarial biochemical control and DFS were 81.4% (95% CI: 70.5%–89.3%) and 78.6% (95% CI: 67.3%–87.1%), respectively. Acute Grade ≥2 GU and GI toxicities were 22% and 17.2%; late Grade ≥2 toxicities were 8% and 11%. No Grade 4 events were observed.

Conclusion: RapidArc (RA) radiotherapy for prostate cancer achieved high biochemical control, acceptable toxicity, and superior treatment efficiency. These findings support RA as a safe and effective technique with potential for broader clinical adoption in prostate radiotherapy.