Safety and Efficacy of Carbon-Ion Radiotherapy for Elderly Patients with High-Risk Prostate Cancer

SIMPLE SUMMARY: As the population ages, the number of elderly prostate cancer patients is increasing, and the choice of treatment options for elderly patients with poor general condition is becoming more difficult. The aim of our retrospective study is to assess the clinical outcomes after carbon-ion radiotherapy for elderly patients with high-risk prostate cancer. We compared 173 patients ≥75 years as the elderly group and 754 patients <75 years as the young group. Disease-specific and biochemical relapse-free survivals did not differ significantly between the young and elderly groups, and there were also no significant differences in adverse events between the two groups. Although this study is retrospective, carbon-ion radiotherapy may be a safe and effective treatment for elderly high-risk prostate cancer patients. ABSTRACT: Carbon-ion radiotherapy (CIRT) is a high-dose intensive treatment, whose safety and efficacy have been proven for prostate cancer. This study aims to evaluate the outcomes of CIRT in elderly patients with prostate cancer. Patients aged 75 years or above at the initiation of CIRT were designated as the elderly group, and younger than 75 years as the young group. The overall survival (OS), disease-specific survival (DSS), biochemical control rate (BCR), biochemical relapse-free survival (BRFS), and adverse events were compared between the elderly and young patients with high-risk prostate cancer treated with CIRT. The elderly group comprised 173 of 927 patients treated for high-risk prostate cancer between April 2000 and May 2018. The overall median age was 69 (range: 45–92) years. The median follow-up period was 91.9 (range: 12.6–232.3) months. The 10-year OS, DSS, BCR, and BRFS rates in the young and elderly groups were 86.9%/71.5%, 96.6%/96.8%, 76.8%/88.1%, and 68.6%/64.3%, respectively. The OS (p < 0.001) was longer in the younger group and the BCR was better in the elderly group (p = 0.008). The DSS and BRFS did not differ significantly between the two groups. The rates of adverse events between the two groups did not differ significantly and no patient had an adverse event of Grade 4 or higher during the study period. CIRT may be as effective and safe in elderly patients as the treatment for high-risk prostate cancer.