Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline

Morgan, Scott C.; Hoffman, Karen E.; Loblaw, D.A.; Buyyounouski, Mark K.; Patton, Caroline; Barocas, Daniel A.; Bentzen, Søren M.; Chang, Michael; Efstathiou, Jason A.; Greany, Patrick; Halvorsen, Per H.; Koontz, Bridget F.; Lawton, Colleen A.; Leyrer, C.M.; Lin, Daniel W.; Ray, Michael E.; Sandler, Howard M.

doi:10.1016/j.juro.2018.10.001

Cited by 63 publications

(92 citation statements)

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“…Although no dosimetric parameters were associated with differences in overall GU toxicities, multivariate models identified associations between late grade ≥2 urinary incontinence/retention and high‐range bladder dose (V60‐V70). Patients treated with either modality received conventionally fractionated RT (maximum dose, 70.2 Gy [RBE]); however, these dosimetric associations may carry greater importance in the context of growing interest in hypofractionation based on data extrapolated from the intact setting . Although official recommendations regarding postoperative hypofractionation are pending, small retrospective studies have reported low rates of acute and late GU and GI toxicities with early follow‐up .…”

Section: Discussionmentioning

confidence: 99%

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Santos

Barsky

Hwang

et al. 2019

Cancer

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Background Despite increasing utilization of proton‐beam therapy (PBT) in the postprostatectomy setting, no data exist regarding toxicity outcomes relative to intensity‐modulated radiotherapy (IMRT). The authors compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicity outcomes in patients with prostate cancer (PC) who received treatment with postprostatectomy IMRT versus PBT. Methods With institutional review board approval, patients with PC who received adjuvant or salvage IMRT or PBT (70.2 gray with an endorectal balloon) after prostatectomy from 2009 through 2017 were reviewed. Factors including combined IMRT and PBT and/or concurrent malignancies prompted exclusion. A case‐matched cohort analysis was performed using nearest‐neighbor 3‐to‐1 matching by age and GU/GI disorder history. Logistic and Cox regressions were used to identify univariate and multivariate associations between toxicities and cohort/dosimetric characteristics. Toxicity‐free survival (TFS) was assessed using the Kaplan‐Meier method. Results Three hundred seven men (mean ± SD age, 59.7 ± 6.3 years; IMRT, n = 237; PBT, n = 70) were identified, generating 70 matched pairs. The median follow‐up was 48.6 and 46.1 months for the IMRT and PBT groups, respectively. Although PBT was superior at reducing low‐range (volumes receiving 10% to 40% of the dose, respectively) bladder and rectal doses (all P ≤ .01), treatment modality was not associated with differences in clinician‐reported acute or late GU/GI toxicities (all P ≥ .05). Five‐year grade ≥2 GU and grade ≥1 GI TFS was 61.1% and 73.7% for IMRT, respectively, and 70.7% and 75.3% for PBT, respectively; and 5‐year grade ≥3 GU and GI TFS was >95% for both groups (all P ≥ .05). Conclusions Postprostatectomy PBT minimized low‐range bladder and rectal doses relative to IMRT; however, treatment modality was not associated with clinician‐reported GU/GI toxicities. Future prospective investigation and ongoing follow‐up will determine whether dosimetric differences between IMRT and PBT confer clinically meaningful differences in long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Santos

Barsky

Hwang

et al. 2019

Cancer

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“…As our objective was to improve BDFS without increasing toxicity, our treatment schedule was designed to be equieffective for late normal tissue toxicity probability with our standard radiotherapy treatment ( [18] for avoiding excessive short overall times, fractions were planned to be administered two (Monday and Thursday) or three times (every other day) per week over 2.5-3 weeks instead of daily fractions over 1.5 weeks. ASTRO-ASCO-AUA evidence-based UHRT guidelines suggest that avoiding consecutive daily treatments could decrease toxicity [19]. The HYPO-RT-PC phase III trial has also found that, probably due to the shorter overall treatment time, early side effects were more pronounced with ultra-hypofractionation than with conventional fractionation [8].…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic a-blockers (tamsulosin 0.4 mg/day) or antiinflammatory medications (hydrocortisone enema, given a few millilitres once a day) were routinely administered during radiotherapy. Treatment was completed over a period of [13][14][15][16][17][18][19][20][21][22][23]…”

Section: Treatmentmentioning

confidence: 99%

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Macías

Barrera-Mellado

2019

BJU International

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ObjectivesTo report toxicity (primary endpoint) and biochemical disease-free survival (BDFS) outcomes of a phase II trial evaluating ultra-hypofractionated radiation therapy (UHRT), focusing on patients with unfavourable intermediate-risk and high-risk prostate cancer (PCa). Patients and MethodsFrom 2012 to 2017, 154 patients (92 with unfavourable intermediate-risk or high-risk PCa) were treated with helical TomoTherapy delivering 43.8-45.2 Gy in eight fractions over 3 weeks. Of these, 73% received hormonotherapy (51% neoadjuvant). ResultsThe median (range) follow-up was 48 (19-84) months. For the whole series, crude BDFS and 5-year BDFS rates were 97.4% and 94.3%, respectively. The corresponding figures for unfavourable intermediate-risk and high-risk PCa were 96.7% and 90%, respectively. The crude metastasis-free survival rate was 98% for the unfavourable intermediate-risk and high-risk group. For the whole series, the 5-year cumulative urinary/ intestinal grade 2+ late toxicity was 17.8/7.4%. No grade 4-5 toxicity was observed. One patient experienced late grade 3 toxicity (urinary). ConclusionThis eight-fraction UHRT regimen can be safely delivered to patients with unfavourable intermediate-risk/high-risk PCa. Its relapse rates are similar to those reported for the combination of external beam radiotherapy plus brachytherapy, however, the observed toxicity profile is milder. The disease survival rates compare favourably with historical controls in some other forms of radiotherapy, with similar side effects. Since the low rate of biochemical/ metastasis relapse is encouraging, further research to confirm these results is justified.Keywords stereotactic body radiotherapy, brachytherapy, high risk, hypofractionated radiotherapy, quality of life, #ProstateCancer, #PCSM

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“…All of these patients (n ¼ 40) had low-risk prostate cancer [9]. The ASTRO/ASCO/AUA guideline identified six prospective studies with a median follow-up of at least 48 months [1]. There were 532 patients in total, but 80% of those had low-risk disease.…”

Section: Brachytherapy Versus Ultrahypofractionated Radiationmentioning

confidence: 99%

“…The American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO) and American Urological Association (AUA) hypofractionation guideline defines moderate hypofractionation as 2.4e3.4 Gy/day and ultrahypofractionated (UHF) radiotherapy as doses per treatment of 5.0 Gy/day or higher [1]. According to that guideline, in men with low-risk prostate cancer who decline active surveillance and choose active treatment with external beam radiotherapy (EBRT), UHF may be offered as an alternative to conventional fractionation (Key Question 3A) [1]. In men with intermediate-risk prostate cancer receiving EBRT, UHF may be offered as an alternative to conventional fractionation (Key Question 3B).…”

Section: Introductionmentioning

confidence: 99%

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Loblaw

2020

Clinical Oncology

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Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline

Cited by 63 publications

References 0 publications

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

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