Purpose: Moderate hypofractionation (MHF) offers logistical and financial advantages, and has become standard in Western countries but not yet in Africa. This study assessed GI and genitourinary (GU) acute toxicity in Rwandan men undergoing MHF (20 × 3 Gy) treatment.
Materials and methods: Since 2021, patients with prostate cancer at the Rwanda Cancer Centre have been informed about the study on MHF treatment and could participate by signing an informed consent. The study included patients with confirmed prostate adenocarcinoma (any T, any prostate-specific antigen any Gleason score, N0M0), excluding those with inflammatory bowel disease, previous pelvic irradiation, or previous prostatectomy. Participants received 20 fractions of 3 Gy over 4 weeks using the volumetric modulated arc radiotherapy (RT) technique with a 6 megavoltage linear accelerator. GI and GU acute toxicity was evaluated at week 2, at the end of RT, and 3 months after treatment using the Radiation Therapy Oncology Group (RTOG) acute toxicity grading system.
Results: Fifty consecutive patients with localized prostate cancer were included. The median patient age was 70 years. Most patients (86%) had high-risk disease and 94% received androgen-deprivation therapy. The cost and treatment time were reduced by 50%. The distribution of maximum acute RTOG toxicity scores were for GI 10% grade 0, 70% grade 1, 20% grade 2, 0% grade 3, and for GU scores were 0%, 40%, 54%, and 6%, respectively. By 3 months, RT symptoms had returned to baseline levels for most patients.
Conclusion: MHF (20 × 3 Gy) was well tolerated in men treated for prostate cancer in Rwanda, showing that MHF is feasible in an African setting. However, further research on acute and late toxicity for more patients is warranted.