The American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA) have issued a new guideline for treating men with early-stage prostate cancer. According to the three medical societies, hypofractionated external beam radiation therapy (EBRT) can shorten cancer treatments and provide more convenience to patients.
EBRT is a standard method of treatment for patients with localized prostate cancer; however, hypofractionated ERBT allows for patients to obtain larger amounts of radiation with fewer treatment sessions. Traditional radiation treatments typically last eight to nine weeks, compared to hypofractionated EBRT, which lasts only four to five weeks.
“Conclusive evidence from several large, well-designed randomized trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation,” Howard Sandler, MD, co-chair of the guideline panel, said in a prepared statement issued by ASTRO. “Significant advances in treatment planning and delivery have enabled oncologists to deliver more powerful, life-saving doses of radiation in fewer visits and without compromising quality of life.”
The guideline was developed by an expert-panel of physicians, researchers and a patient advocate. They reviewed 61 studies published from December 2001 to March 2017, including four large randomized clinical trials consisting of more than 6,000 patients.
These specific recommendations apply to male patients who need or prefer treatment instead of monitoring and have opted for EBRT instead of other treatment options specific to localized prostate cancer. Key recommendations include:
- EBRT patients should be provided with the option of moderate hypofractionation as an alternative to traditional fractionation—regardless of their risk, age, anatomy or urinary function.
- Physicians must counsel patients about the increased risk of short-term gastrointestinal toxicity and also communicate the limited amounts of data related to oncologic outcomes five years post treatment.
- Per the results of randomized trials, suggested treatment protocols for “moderate hypofractionation” include: 6,000 cGy dispensed in 20 fractions of 300 cGy throughout 4-weeks; or 7,000 cGy dispensed in 28 fractions of 250 cGy throughout five and a half weeks.
- Ultrahypofractionation guidance will depend upon prostate-cancer risk. Low-risk patients can use hypofractionation as an alternative to traditional fractionation. Intermediate-risk patients should be treated as part of a clinical trial or multi-national registry. High-risk patients should not be offered ultrahypofractionation outside of a trial or registry.
- Per the results of randomized trials, suggested treatment protocols for “ultrahypofractionantion” include: 3,500 cGy in five fractions of 700 cGy, or 3,625 cGy in five fractions of 725 cGy. Radiation doses larger than 3,625 cGy and consecutive daily treatments are not recommended for five-fraction regimens.
“Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer,” the guideline panel wrote in their guideline article. “The limits in the current evidentiary base—especially for ultrahypofractionation—highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients.”
“Men who opt to receive hypofractionated radiation therapy will be able to receive a shorter course of treatment, which is a welcomed benefit to many men. When clinicians can reduce overall treatment time while maintaining outcomes, it’s to our patients’ benefit, as they can spend less time away from family and less time traveling to and from treatment,” said Scott Morgan, MD, FRCPC, co-chair of the guideline panel in the same prepared statement issued by ASTRO.