Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial

Incrocci, Luca; Wortel, Ruud C.; Alemayehu, Wendimagegn; Aluwini, S.; Schimmel, Erik C.; Krol, Augustinus D.G.; Toorn, Peter-Paul van der; Jager, Hanja de; Heemsbergen, Wilma D.; Heijmen, B.; Pos, Floris J.

doi:10.1016/s1470-2045(16)30070-5

Cited by 420 publications

(325 citation statements)

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“…The largest study by far, the CHHiP trial with more than 3200 patients included was first partially published as a subset of 457 patients [17] and just recently 5‑year follow-up data became available [16]. Two other large studies, the RTOG 0415 and the HYPRO trial have also just been published in detail [11, 15]. The studies from Yeoh et al.…”

Section: Moderate Hypofractionationmentioning

confidence: 99%

“…[13, 14]Incrocci et al. [15]3974076027 % intermediate73 % high95 % IMRT/IGRT78 Gy/39 fx/ 2.0 Gy 64.6 Gy/19 fx/ 3.4 Gy 66 % ADT5 years RFS 77.1 % (NS)5 years RFS 80.5 %3 years G2+ GU 39 %3 years G3+ GU12.9 %3 years G2+ GI 17.7 %(3 years G3+ GU p = 0.02)3 years G2+ GU 41.3 %3 years G3+ GU 19.0 %3 years G2+ GI 21.9 % CHHiP Dearnaley et al. [16, 17]1065/37 fx1074/20 fx1077/19 fx6215 % low73 % intermediate12 % highIMRTIGRT not mandatory74 Gy/37 fx/ 2.0 Gy 60 Gy/20 fx/ 3.0 Gy 57 Gy/19 fx/ 3.0 Gy 97 % ADT5 years PFS (NS)88.3 % (37 fx)vs.90.6 % (20 fx)vs.85.9 % (19 fx) Acute G2 + GI (p < 0.0001) 25 % (37 fx)38 % (20 fx)38 % (19 fx) 5 years G 2+ GI (RTOG, NS) 13.7 % (37 fx)11.9 % (20 fx)11.3 % (19 fx) 5 years G 2 + GU (RTOG, NS) 9.1 % (37 fx)11.7 % (20 fx)6.6 % (19 fx) Fox Chase Pollack et al.…”

Section: Moderate Hypofractionationmentioning

confidence: 99%

“…Thus, the authors again had to state that with respect to late toxicity non-inferiority could not be shown. As there was no significant difference, neither in 5‑year relapse-free survival nor in treatment failure, the authors concluded that their hypofractionated radiotherapy regimen could not be regarded as the new standard of care [15]. …”

Section: Moderate Hypofractionationmentioning

confidence: 99%

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Hypofractionated radiotherapy for localized prostate cancer

Höcht¹,

Aebersold

Albrecht

et al. 2016

Strahlenther Onkol

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AimThis article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.MethodsBased on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.ResultsSeveral large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.ConclusionUntil the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.

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Section: Moderate Hypofractionationmentioning

confidence: 99%

Section: Moderate Hypofractionationmentioning

confidence: 99%

Section: Moderate Hypofractionationmentioning

confidence: 99%

See 1 more Smart Citation

Hypofractionated radiotherapy for localized prostate cancer

Höcht¹,

Aebersold

Albrecht

et al. 2016

Strahlenther Onkol

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“…The merits of a hypofractionated radiation therapy have been the subject of many studies. Hypofractionated schedules are currently used in many cancers such as breast, rectum, and prostate cancer or soft tissue sarcoma [1,2,3,4]. Stereotactic body radiotherapy (SBRT) represents another form of extremely hypofractionated radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

Spałek

2018

Oncol Res Treat

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Hypofractionated radiotherapy is commonly used to treat many cancers. The number of indications for this fractionation schedule is increasing. Knowledge of the potential hematological toxicity arising from hypofractionated irradiation is vital since many patients receive further systemic treatment. This review analyzes the available evidence on the effect of hypofractionated radiotherapy on hematological toxicity. However, radiobiological data on bone marrow responses to high doses of radiation per fraction are sparse. Additional biological effects may also play an significant role in bone marrow function and recovery after hypofractionated radiotherapy. Clinical data show a good early hematological tolerance of hypofractionated radiotherapy (both large field and for stereotactic body radiotherapy). There are, however, no data available that assess late hematological toxicity. Evidence on acute hematological toxicity after hypofractionated radiotherapy does not suggest any significant impact of altered fractionation on early treatment tolerance, although further research to assess this problem is needed. The effect of hypofractionation on late hematological tolerance is unknown because the data are still lacking.

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“…However in the same Lancet Oncology issue in June 2016 Incrocci (3) publish the final results of the HYPRO protocol comparing 78 Gy (2 Gy/Fr/5 days per week) with a hypofractionated schedule delivering 64.6 Gy with 16 fractions of 3.4 Gy 3 fractions per week: with only 3 fractions per week the biological dose could be equivalent to 3 Gy per Fr/5 Fr a week. Finally 820 patients with intermediate or high-risk prostate cancer were enrolled.…”

mentioning

confidence: 99%