Journal ArticleDOI
Dose-Fractionation Sensitivity of Prostate Cancer Deduced From Radiotherapy Outcomes of 5,969 Patients in Seven International Institutional Datasets: α/β = 1.4 (0.9–2.2) Gy
TLDR
The overall α/β value was consistently low, unaffected by AD deprivation, and lower than the appropriate values for late normal-tissue morbidity, which favors the use of hypofractionated radiotherapy schedules for all risk groups, which is also very beneficial logistically in limited-resource settings.Abstract:
Purpose There are reports of a high sensitivity of prostate cancer to radiotherapy dose fractionation, and this has prompted several trials of hypofractionation schedules. It remains unclear whether hypofractionation will provide a significant therapeutic benefit in the treatment of prostate cancer, and whether there are different fractionation sensitivities for different stages of disease. In order to address this, multiple primary datasets have been collected for analysis. Methods and Materials Seven datasets were assembled from institutions worldwide. A total of 5969 patients were treated using external beams with or without androgen deprivation (AD). Standard fractionation (1.8–2.0 Gy per fraction) was used for 40% of the patients, and hypofractionation (2.5–6.7 Gy per fraction) for the remainder. The overall treatment time ranged from 1 to 8 weeks. Low-risk patients comprised 23% of the total, intermediate-risk 44%, and high-risk 33%. Direct analysis of the primary data for tumor control at 5 years was undertaken, using the Phoenix criterion of biochemical relapse–free survival, in order to calculate values in the linear-quadratic equation of k (natural log of the effective target cell number), α (dose-response slope using very low doses per fraction), and the ratio α/β that characterizes dose-fractionation sensitivity. Results There was no significant difference between the α/β value for the three risk groups, and the value of α/β for the pooled data was 1.4 (95% CI=0.9–2.2) Gy. Androgen deprivation improved the bNED outcome index by about 5% for all risk groups, but did not affect the α/β value. Conclusions The overall α/β value was consistently low, unaffected by AD deprivation, and lower than the appropriate values for late normal-tissue morbidity. Hence the fractionation sensitivity differential (tumor/normal tissue) favors the use of hypofractionated radiotherapy schedules for all risk groups, which is also very beneficial logistically in limited-resource settings.read more
Citations
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Journal ArticleDOI
Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial
David P. Dearnaley,Isabel Syndikus,Helen Mossop,Vincent Khoo,Alison Birtle,D. Bloomfield,John Graham,Peter Kirkbride,John P Logue,Zafar Malik,Julian Money-Kyrle,Joe M. O'Sullivan,Miguel Panades,Chris Parker,Helen Patterson,Christopher D Scrase,John Staffurth,Andrew Stockdale,Jean Tremlett,M. Bidmead,Helen Mayles,O. Naismith,C. South,Annie Gao,Clare Cruickshank,Shama Hassan,Julia Pugh,Clare Griffin,Emma Hall +28 more
TL;DR: Hypofractionated radiotherapy using 60 Gy in 20 fractions is non-inferior to conventional fractionation using 74 Gy in 37 fractions and is recommended as a new standard of care for external-beam radiotherapy of localised prostate cancer after 5 years follow-up.
Journal ArticleDOI
Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer
Charles Catton,Himu Lukka,Chu-Shu Gu,Jarad Martin,Stéphane Supiot,Peter Chung,Glenn Bauman,Jean-Paul Bahary,Shahida Ahmed,Patrick Cheung,Keen Hun Tai,Jackson S.Y. Wu,Matthew Parliament,Theodoros Tsakiridis,Tom Corbett,Colin Tang,Ian S. Dayes,Padraig Warde,Tim Craig,Jim A. Julian,Mark Levine +20 more
TL;DR: The hypofractionated RT regimen used in this trial was not inferior to conventional RT and was not associated with increased late toxicity, and should be considered for intermediate-risk prostate cancer.
Journal ArticleDOI
Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer.
Alan Pollack,Gail Walker,Eric M. Horwitz,Robert Price,Steven J. Feigenberg,Andre Konski,Radka Stoyanova,Benjamin Movsas,Richard E. Greenberg,Robert G. Uzzo,Charlie Ma,Mark K. Buyyounouski +11 more
TL;DR: The hypofractionation regimen did not result in a significant reduction in BCDF; however, it is delivered in 2.5 fewer weeks; men with compromised urinary function before treatment may not be ideal candidates for this approach.
Journal ArticleDOI
Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial
Luca Incrocci,Ruud C. Wortel,Wendimagegn Ghidey Alemayehu,Shafak Aluwini,E. Schimmel,Stijn Krol,Peter-Paul van der Toorn,Hanja de Jager,Wilma D. Heemsbergen,Ben J.M. Heijmen,Floris J. Pos +10 more
TL;DR: Hypofractionated radiotherapy was not superior to conventional radiotherapy with respect to 5-year relapse-free survival and cannot be regarded as the new standard of care for patients with intermediate-risk or high-risk prostate cancer.
Journal ArticleDOI
Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial.
Douglas Brand,Douglas Brand,Alison Tree,Alison Tree,Peter Ostler,Hans van der Voet,Andrew Loblaw,William Chu,Daniel Ford,Shaun Tolan,Suneil Jain,Alexander G.R. Martin,John Staffurth,Philip Camilleri,Kiran Kancherla,John Frew,Andrew K Chan,Ian S. Dayes,Daniel Henderson,Stephanie Brown,Clare Cruickshank,Stephanie Burnett,A. Duffton,Clare Griffin,Victoria Hinder,Kirsty Morrison,Kirsty Morrison,O. Naismith,Emma Hall,Nicholas van As,Nicholas van As,D Dodds,E Lartigau,S Patton,Alan J. Thompson,Mathias Winkler,P Wells,T Lymberiou,Daniel Saunders,M Vilarino-Varela,P Vavassis,Theodoros Tsakiridis,R Carlson,George Rodrigues,Jacob Tanguay,S Iqbal,Scott C. Morgan,A Mihai,A Li,O Din,Miguel Panades,R Wade,Yvonne Rimmer,J Armstrong,N Oommen +54 more
TL;DR: The results suggest that substantially shortening treatment courses with stereotactic body radiotherapy does not increase either gastrointestinal or genitourinary acute toxicity.
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