Clinical Practice Guideline on Hypofractionated Radiation Therapy for Localized Prostate Cancer
Posted: Thursday, December 13, 2018
A panel of experts from the American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO), and American Urological Association (AUA) recently developed an evidence-based clinical guideline for physicians treating men with early-stage prostate cancer using external-beam radiation therapy (EBRT). The report was published in their respective journals (Practical Radiation Oncology, the Journal of Clinical Oncology, and the Journal of Urology).
“Conclusive evidence from several large, well-designed randomized trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation,” stated Howard Sandler, MD, FASTRO, FASCO, of Cedars-Sinai Medical Center and co-chair of the guideline panel, in an ASCO press release.
Based on 4 large randomized controlled trials with more than 6,000 patients, the panel recommends that moderate hypofractionation (fraction size of 240–340 cGy) should be offered as an alternative to conventional fractionation (180–200 cGy) regardless of cancer risk group, patient age, comorbidity, anatomy, or baseline urinary function. They also noted that patients should be informed about a small increased risk of short-term gastrointestinal toxicity.
For ultrahypofractionation (≥ 500 cGy), guidance varies by risk of prostate cancer and is considered a “conditional” recommendation, reflecting the limited base of current evidence on this approach. It may be offered as an alternative to conventional fractionation for low-risk patients. For intermediate-risk disease, the expert panel strongly encourages treating these patients as part of a clinical trial or multi-institutional registry. For those with high-risk disease, ultrahypofractionation is not recommended outside of a trial or registry.
The panel excluded treatment for locally advanced or metastatic disease, postoperative radiation, salvage therapy, and reirradiation from the current guideline. Additionally, fraction sizes between 340 and 500 cGy have been examined in few studies and therefore are outside the scope of the guideline.
“Men who opt to receive hypofractionated radiation therapy will be able to receive a shorter course of treatment,” noted panel co-chair, Scott C. Morgan MD, FRCPC, of the University of Ottawa, Ontario, Canada, because “clinicians can reduce overall treatment time while maintaining outcomes.”