Hypofractionated radiotherapy for localized prostate cancer

Abstract

AimThis article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.MethodsBased on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.ResultsSeveral large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.ConclusionUntil the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

“…Our results indicate low sensitivity of prostate cancer to fractionation with high doses per fraction, much lower than that indicated by the small α/β mentioned above. This has been claimed by other authors, highlighting that the design of hypofractionated schemes for prostate cancer radiotherapy need to be proceed with caution [8].…”

“…This sensitivity appears in a low value of the α/β parameter of the linear-quadratic (LQ) model, where to calculate the equivalence between different fractionation schemes used in clinical practice, a value of α/β between 1.5 and 3.0 Gy is usually considered [6]. All of this has led to the proliferation of clinical studies and applications of hypofractionation in HDR-BT for prostate cancer, as in case of EBRT [7,8].…”

How will the CHHiP trial affect the future of prostate radiotherapy?

“…NHS England will audit RT practice and expect 70% of patients treated with EBRT to receive HFRT. The German Society of Radiation Oncology commissioned an expert review of hypofractionation [16] which concluded that hypofractionation was appropriate provided strict quality control using IMRT/IGRT was employed as in U.K. guidance. These recommendations are endorsed by the European Association of Urology Guidelines 2017 Edition [17].…”

Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study

“…Hypofractionation regimen employs a large dose per fraction of 2.2 to 4.0Gy daily, with a shorter overall treatment period which is usually less than 4 weeks [36]. In this study, 62% of patients were treated with various hypofractionation regimens; the most common regimen being 45Gy in 18 fractions over 3.5 weeks.…”