Editorial Comment: Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial

Anders Widmark ¹, Adalsteinn Gunnlaugsson ², Lars Beckman ³, Camilla Thellenberg-Karlsson ⁴, Morten Hoyer ⁵, Magnus Lagerlund ⁶, et al.

¹ Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; ² Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden; ³ Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden; ⁴ Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; 5 Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; 6 Department of Oncology, Kalmar Hospital, Kalmar, Sweden

Lancet. 2019 Aug 3;394(10196):385-395.

DOI: 10.1016/S0140-6736(19)31131-6 | ACCESS: 10.1016/S0140-6736(19)31131-6

COMMENT

Due the low alpha/beta ratio, the hypofractionation of the external radiotherapy treatment of prostate cancer can increase the therapeutic ratio and reduce the health-care cost and improve the patient comfort. It can be done by moderate hypofractionation (using 2.4 – 3.4 Gy) or by ultra-hypofractionation (at least 5 Gy per fraction) ( ¹ - ³ ).

This phase 3 non-inferiority randomized trial is the first to report on the efficacy and side-effects on ultra-fractionation compared with conventional and has the PSA relapse and clinical failure as primary endpoint. The most relevant secondary endpoints were the overall survival and prostate cancer-specific survival and the median follow-up time was 5yr.

The ultra-hypofractionation was non-inferior to the conventional fractionation (HR 1.002) and no significant differences were found in terms of relevant urinary or gastrointestinal toxicity.

REFERENCES

• ¹
  Dasu A, Toma-Dasu I. Prostate alpha/beta revisited -- an analysis of clinical results from 14 168 patients. Acta Oncol. 2012;51:963-74.
• ²
  Zietman AL. Making Radiation Therapy for Prostate Cancer More Economical and More Convenient. J Clin Oncol. 2016;34:2323-4.
• ³
  Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, et al. Hypofractionated Radiation Therapy for Localized Prostate Cancer: Executive Summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline. Pract Radiat Oncol. 2018;8:354-60.

Publication Dates

• Publication in this collection
  11 Sept 2020
• Date of issue
  Nov-Dec 2020