Conventional Fractionated Versus Hypofractionated Radiation for Prostate Cancer: A 10-Year Update
Posted: Monday, May 18, 2020
A 10-year update of a randomized, prospective study, published in the Journal of Clinical Oncology, found that conventional fractionated intensity-modulated radiation therapy and moderate hypofractionated intensity-modulated radiation therapy appeared to be equally effective among men with localized prostate cancer. Using updated risk groups and definitions of biochemical failure, the study findings build on results from a previous single-institution trial published in 2013.
“What’s exciting is that we have 10-year randomized prospective data, which is the gold standard for studies, and the original results held up,” Eric M. Horwitz, MD, stated in a press release by the Fox Chase Cancer Center. “So, the short course of treatment isn’t better, it’s the same. But that’s good because patients get done in 5 weeks instead of 8 weeks. Essentially, what the study shows is that it’s effective, it’s safe, and it’s just more convenient.”
The researchers randomly assigned 303 men with intermediate- and high-risk prostate adenocarcinoma to receive conventional fractionated or hypofractionated radiotherapy. Patients with high-risk disease were prescribed 24 months of androgen-deprivation therapy and lymph node irradiation. Men with intermediate-risk disease were prescribed 4 months of androgen-deprivation therapy at their physician’s discretion. The median follow-up was 122.9 months.
Androgen-deprivation therapy use did not significantly differ between the two treatment groups (P = .56). There was no difference in the 10-year cumulative incidence of biochemical or clinical disease failure between the two radiation groups. The rate of disease failure was 25.9% among patients in the conventional-fractionation group and 30.6% in the hypofractionated-radiation group (P = .25). The 10-year rates of biochemical failure, prostate cancer–specific mortality, and overall mortality were also similar, although the incidence of distant metastases was significantly higher with the hypofractionated therapy (14.3% vs. 6.4%; P = .08).
Disclosure: For full disclosures of the study authors, visit ascopubs.org.