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Hypofractionated radiotherapy superior to conventional in high-risk prostate cancer
51st ASTRO Annual Meeting
Patients with high-risk prostate cancer treated with hypofractionated radiation therapy had longer freedom from biochemical failure and longer freedom from distant metastases than patients treated with standard radiation therapy, according to the results of a study presented at the 51st ASTRO Annual Meeting.
Giorgio Arcangeli, MD, radiation oncologist at the Regina Elena National Cancer Institute, in Rome presented findings from the phase-3 study.
“The study not only shows that hypofractionated radiation improves the control of prostate cancer, but it also cuts the number of treatment visits in half for patients, Arcangeli said in a press release.
“This is an important benefit for these high-risk patients, who are typically an older, less mobile population. It’s also especially helpful for those living at long distance from radiation treatment centers,” he said.
Between January 2003 and December 2007, men with high risk prostate cancer (n=168) were randomly assigned to hypofractionated therapy (62 Gy/20 fractions/ five weeks) or conventional therapy (80 Gy/40 fractions/ eight weeks) of 3D conformal radiation therapy (3D-CRT).
3D-CRT uses computers and imaging techniques to view the size, shape and location of the main tumor and surrounding organs and precisely tailors radiation beams. Hence, nearby normal tissue receives less radiation and can heal more quickly.
At three years, 87% of patients treated with hypofractionated radiation had freedom from biochemical failure vs. 79% of patients treated with standard radiation therapy.
The three-year freedom from distant metastases was also higher in patients treated with hypofractionated radiotherapy (88% vs. 82%).
Finally, those in the hypofractionated radiation group had only 20 sessions of radiation (four weeks of radiation treatments daily) compared with 40 to 45 sessions (eight to nine weeks of treatments daily).
No differences were observed between groups for late side effects of genitourinary and gastrointestinal function.
Further studies are currently being conducted to examine the benefits of even shorter treatment schedules, according to Arcangeli. – by Christen Haigh
This study provides preliminary results that a shorter course of radiation using higher doses per day along with nine-months of hormone therapy is effective and perhaps superior to standard fractionation. Although the results are encouraging, the median follow-up was only three years and therefore, adopting this treatment regimen for standard clinical practice may be premature.
Hypofractionated radiation therapy with combined hormone therapy seems to be an effective treatment for prostate cancer. The follow-up interval is brief. Long-term follow-up will be needed to fully assess the efficacy and toxicity of this treatment regimen, especially given that the genitourinary toxicity rates appear to be increasing with time.
– Andrew Lee, MD, MPH
Associate Professor, Department of Radiation Oncology, M.D. Anderson Cancer Center
For more information:
- Arcangeli G. #168. Presented at: 51st ASTRO Annual Meeting; Nov. 1-5, 2009, Chicago.
