Hypofractionated versus conventionally fractionated radiation therapy for prostate carcinoma: Updated results of a phase III randomized trial

Acute Toxicity of Hypofractionated Intensity-Modulated Radiotherapy for Prostate Cancer

“…Since the early 2000s, to further improve local disease control in prostate cancer, multiple studies [6][7][8][9][10] have explored the feasibility and efficacy of hfrt based on the concept that prostate cancer cells have a low α:aab ratio (0.8-1.5). A low ratio theoretically demonstrates a therapeutic gain with the use of hfrt 5 .…”

“…A progressive movement toward dose escalation has since occurred, with dose per fraction increasing to 3.5 Gy from 2.2 Gy in hfrt (Table iv). Dose escalation has been achieved with advances in conformal technology, allowing for increasing conformality of rt with a safe reduction in margins 8,9,13,21,31 .…”

“…Hypofractionation for prostate cancer is a radiobiologic concept of theoretical advantage demonstrated with an equivalent biologic effective dose delivered using more than 2.2 Gy per fraction 5 . Hypofractionated rt (hfrt) in the treatment of prostate cancer has demonstrated promising biochemical control and acceptable acute and late toxicity [6][7][8][9] . Clarity concerning the optimal dose and fractionation of hfrt and evidence of equivalent or…”

Recent advances in the management of radiation colitis

“…Modern radiation treatment techniques, such as three-dimensional treatment planning, also optimize the treatment technique by developing more accurate dose distributions. Notably, three-dimensional conformal radiotherapy techniques, including intensity-modulated radiotherapy, may not reduce late intestinal toxicity because margins around the cancer may not be able to be safely reduced and because of the prescription of higher radiation doses [97,98] . Brachytherapy, alone or as a supplement to external beam radiotherapy, is now increasingly being utilized to decrease normal tissue toxicity, without compromising treatment efficacy, in the management of prostate carcinoma [99,100] .…”

What do we know about the α/β for prostate cancer?

“…8 Several recent studies have reported low a/b values for prostate cancer. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] If this a/b is proven to be lower than values estimated for late complications, then hypofractionated regimens are expected to improve the therapeutic ratio, 8,[29][30][31][32][33][34][35][36] beyond the advantages on cost saving and patient convenience.…”