10-Year Update of a Randomized Prospective Trial of Conventional Versus Hypofractionated Radiation Therapy for Localized Prostate Cancer

Abstract

NACRT vs NACT, 75.4% vs 70.1%, PZ0.455) and in patients with R0 resection (NACRT vs NACT, 91.3% vs 80.3%, PZ0.113). However, patients with R0 resection treated with NACRT were associated with significantly higher disease-free survival (DFS, 87.1% vs 63.9%, pZ0.050) and locoregional recurrence free survival (LRFS, 100% vs 79.3%, pZ0.014) as compared with NACT. Conclusion: The design of preoperative concurrent SIB-IMRT with oral S-1 showed better DFS and LRFS with an acceptable toxicity profile, which encouraged future randomized phase III trials comparing NACRT with NACT for resectable or unresectable gastric adenocarcinoma.

Moderately Hypofractionated Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost for Prostate Cancer: Five-Year Toxicity Results from a Prospective Phase I/II Trial

“…The largest phase III trial to include pelvic nodal treatment in testing moderate hypofractionation was the Fox Chase Cancer Center (FCCC) study, which treated 31.7% of its patients with pelvic nodal elds. 9,19 151 patients were enrolled on the hypofractionation arm with a higher proportion of high risk patients and thus ADT use than the MDACC trial (14.6% LR, 57% IR, 28.5% HR, 45% ADT), but still less use than the current trial (80%). The pelvis was treated to 50-52Gy in 26 fractions at 1.92 Gy per fraction and 70.2 Gy in 26 fractions of 2.7 Gy to the prostate.…”

“…Updated results show no signi cant difference in any QOL measures using EPIC, IPSS, and EQD5 scores, but interestingly a trend towards a worse rate of distant metastases at 10 years in the hypofractionation arm. 9,23 Di Muzio et al also reported 5 year results of a large phase I/II trial involving pelvic lymph node coverage in intermediate and high risk patients. 18 Fifty-three intermediate risk and 80 high risk patients received 74.2 Gy in 28 fractions of 2.65 Gy and 51.8 Gy at 1.85 Gy per fraction to the pelvic lymph nodes.…”

“…These trials demonstrated equivalent BF, PCSM, overall survival (OS). [3][4][5][6][7][8][9][10][11][12][13] In 2018, this led to a joint ASTRO, ASCO, and AUA guideline recommending moderate hypofractionation be offered across low, intermediate, and high risk groups regardless of age, comorbidity, and urinary function. 14 Consensus opinion is that moderate hypofractionation has a similar risk of acute GU and late GU/GI toxicity compared to conventional EBRT with higher rates of acute GI toxicity.…”

Moderately Hypofractionated Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost for Prostate Cancer: Five-Year Toxicity Results From a Prospective Phase I/II Trial

“…The largest phase III trial to include pelvic nodal treatment in testing moderate hypofractionation was the Fox Chase Cancer Center (FCCC) study, which treated 31.7% of its patients with pelvic nodal fields ( 9 , 25 ). 151 patients were enrolled on the hypofractionation arm with a higher proportion of HR patients and thus ADT use than the MDACC trial (14.6% LR, 57% IR, 28.5% HR, and 45% ADT), but still less use than the current trial (80%).…”

“…These advances occurred during the same time period that radiobiologic models suggested prostate cancer's would be more sensitive to hypofractionation than conventional fractionation which in turn led to the successful completion of multiple randomized controlled trials comparing standard to moderate hypofractionation. These trials demonstrated equivalent BF, PCSM, overall survival (OS) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In 2018, this led to a joint ASTRO, ASCO, and AUA guideline recommending moderate hypofractionation be offered across low, intermediate, and HR groups regardless of age, comorbidity, and urinary function (14).…”