Vol 9, No 1 (2024)
Original article
Published online: 2023-12-27

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New possibilities for dose fractionation in radiotherapy for prostate cancer

Zofia Durczyńska1, Mieszko Białas2, Patrycja Erdmańska1, Krzysztof Roszkowski1
Medical Research Journal 2024;9(1):23-28.

Abstract

Introduction: Optimizing radiotherapy fractionation schedules is crucial for improving outcomes in prostate cancer treatment. This study compared a hypofractionated radiotherapy regimen to conventional fractionation schedules. Material and methods: 198 patients with localized prostate cancer were treated with radical radiotherapy and hormonal therapy. Patients were divided into 3 groups: Group I received 60 Gy in 3 Gy fractions over 4 weeks; Group II received 70.2 Gy in 2.6 Gy fractions over 6 weeks; Group III received 76 Gy in 2 Gy fractions over 8 weeks. Acute and late toxicities, biochemical control and overall survival were analysed. Results: With a median of 60 months follow-up, 5-year overall survival was 84.5%, 84.8% and 88.5% in Groups I, II and III respectively (p = 0.7). Two patients (4.4%) in Group I developed local recurrence, compared to none in Group II and 1 patient (1.6%) in Group III. Ten patients developed distant metastases. Acute grade 2 gastrointestinal toxicity occurred in 31–38% of patients, most resolving by 6 months. Acute genitourinary toxicity was more common with hypofractionation. Late toxicity was minimal across all groups. Conclusions: Hypofractionated radiotherapy allowed safe dose escalation without increased toxicity. Local control and survival outcomes were excellent, and comparable to conventional fractionation. Hypofractionation enables treatment acceleration and optimization of resource utilization. Further dose escalation may improve tumour control. Hypofractionation should be considered for routine clinical practice.

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References

  1. Pollack A, Walker G, Horwitz E, et al. Randomized Trial of Hypofractionated External-Beam Radiotherapy for Prostate Cancer. Journal of Clinical Oncology. 2013; 31(31): 3860–3868.
  2. Dearnaley D, Syndikus I, Mossop H, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. The Lancet Oncology. 2016; 17(8): 1047–1060.
  3. Incrocci L, Wortel R, Alemayehu W, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. The Lancet Oncology. 2016; 17(8): 1061–1069.
  4. Lee W, Dignam J, Amin M, et al. Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. Journal of Clinical Oncology. 2016; 34(20): 2325–2332.
  5. Catton C, Lukka H, Gu CS, et al. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. Journal of Clinical Oncology. 2017; 35(17): 1884–1890.
  6. Bekelman J, Lee W. Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics. 2017; 97(4): 718–721.
  7. Pryor D, Turner S, Tai K, et al. Moderate hypofractionation for prostate cancer: A user's guide. Journal of Medical Imaging and Radiation Oncology. 2018; 62(2): 232–239.
  8. Koontz B, Bossi A, Cozzarini C, et al. A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer. European Urology. 2015; 68(4): 683–691.
  9. D’Amico A, Chen MH, Renshaw A, et al. Androgen Suppression and Radiation vs Radiation Alone for Prostate Cancer. JAMA. 2008; 299(3).
  10. Arcangeli S, Greco C. Hypofractionated radiotherapy for organ-confined prostate cancer: is less more? Nature Reviews Urology. 2016; 13(7): 400–408.
  11. Hodges J, Lotan Y, Boike T, et al. Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy: An Emerging Initial Radiation Treatment Option for Organ-Confined Prostate Cancer. Journal of Oncology Practice. 2012; 8(3S).
  12. Catton C, Lukka H, Gu CS, et al. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. Journal of Clinical Oncology. 2017; 35(17): 1884–1890.
  13. Vogelius I, Bentzen S. Meta-analysis of the Alpha/Beta Ratio for Prostate Cancer in the Presence of an Overall Time Factor: Bad News, Good News, or No News? International Journal of Radiation Oncology*Biology*Physics. 2013; 85(1): 89–94.
  14. Proust-Lima C, Taylor J, Williams S, et al. Determinants of Change in Prostate-Specific Antigen Over Time and Its Association With Recurrence After External Beam Radiation Therapy for Prostate Cancer in Five Large Cohorts. International Journal of Radiation Oncology*Biology*Physics. 2008; 72(3): 782–791.
  15. Zietman AL, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol . 2010; 28(7): 1106–1111.