Five Year Results of a Randomized External Beam Radiotherapy Hypofractionation Trial for Prostate Cancer

Stereotactic body radiotherapy for prostate cancer: ready for prime time?

“…Combined, the toxicity and efficacy results for these studies of moderate hypofractionation [16][17][18]20] support the concept of a low α/β ratio and the use of increased hypofractionation (i.e., decreased fraction number with increased dose per fraction). Indeed, in comparison to the above studies, Zelefsky et al [21]delivered conventional fractionation of 81 Gy in 45 fractions with IMRT to 561 patients.…”

“…Toxicity was not statistically different between the two arms. Most recently, at ASTRO 2011, Pollack et al [18] reported on a randomized trial comparing 76 Gy delivered in 38 fractions to 70.2 Gy delivered in 26 fractions using IMRT. A total of 303 intermediate-and high-risk patients with a median follow-up of more than 60 months for the surviving patients were assessed.…”

“…As can be seen in Table 1, these results of hypofractionated treatment described above, which is consistent with an α/β The comparable freedom from biochemical failure (FFBF) rates and moderate toxicity of increasingly hypofractionated results support a low α/β ratio and the use of even higher doses per fraction fx Fractions, int intermediate, EQD equivalent dose at 1.8 Gy per fraction, assuming an α/β of 1.5 Gy, NS not specified, NSBD not specified by dose ratio of 1.5 Gy. That is, if the α/β ratio were significantly higher than 1.5 Gy, then hypofractionated studies [16][17][18]20] would have EQD1.8's below 70 Gy, which contradicts their comparable outcomes to conventional fractionation delivery at 81 Gy.…”

Treatment of prostate cancer by hypofractionated radiotherapy

“…No differences in maximal acute toxicity were seen, but a small increase in acute GI toxicity was noted during treatment. A 5-year update of this work showed no difference in biochemical outcomes [5]. The MD Anderson Cancer Center randomized 204 men to 75.6 Gy in 42 fractions versus 72 Gy in 30 fractions and found no significant difference in 5-year bRFS or toxicity [6].…”

Be it resolved that in the modern era, the best method for dose escalation is brachytherapy: The con position

“…A few large doses of radiation are called "hypofractionation;" delivering treatment in a shorter period of time is called "accelerated" treatment. Three RCTs have been published [10][11][12] and two RCTs presented in abstract 13,14 that confirm hypofractionated accelerated radiation is equally or more effective than standard fractionation radiation. Theoretically, one worries about hypofractionated accelerated radiation causing more toxicity.…”