Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 1/2017

Open Access 01-01-2017 | Review Article

Hypofractionated radiotherapy for localized prostate cancer

Authors: Stefan Höcht, Daniel M. Aebersold, Clemens Albrecht, Dirk Böhmer, Michael Flentje, Ute Ganswindt, Tobias Hölscher, Thomas Martin, Felix Sedlmayer, Frederik Wenz, Daniel Zips, Thomas Wiegel

Published in: Strahlentherapie und Onkologie | Issue 1/2017

Login to get access

Abstract

Aim

This 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.

Methods

Based 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.

Results

Several 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.

Conclusion

Until 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.
Literature
1.
Budach W, Matuschek C, Bolke E et al (2015) DEGRO practical guidelines for radiotherapy of breast cancer V: therapy for locally advanced and inflammatory breast cancer, as well as local therapy in cases with synchronous distant metastases. Strahlenther Onkol 191:623–633CrossRefPubMedPubMedCentral
2.
Whelan TJ, Pignol JP, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520CrossRefPubMed
3.
Haviland JS, Owen JR, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094CrossRefPubMed
4.
Koontz BF, Bossi A, Cozzarini C et al (2015) A systematic review of hypofractionation for primary management of prostate cancer. Eur Urol 68:683–691CrossRefPubMed
5.
Baumann M, Hölscher T, Denham J (2010) Fractionation in prostate cancer – is it time after all? Radiother Oncol 96:1–5CrossRefPubMed
6.
Thames HD, Kuban D, Levy LB et al (2010) The role of overall treatment time in the outcome of radiotherapy of prostate cancer: an analysis of biochemical failure in 4839 men treated between 1987 and 1995. Radiother Oncol 96:6–12CrossRefPubMed
7.
Vogelius IR, Bentzen SM (2013) Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news? Int J Radiat Oncol Biol Phys 85:89–94CrossRefPubMed
8.
Pollack A, Hanlon AL, Horwitz EM et al (2006) Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial. Int J Radiat Oncol Biol Phys 64:518–526CrossRefPubMed
9.
Boehmer D, Maingon P, Poortmans P et al (2006) Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol 79:259–269CrossRefPubMed
10.
Deutschmann H, Kametriser G, Steininger P et al (2012) First clinical release of an online, adaptive, aperture-based image-guided radiotherapy strategy in intensity-modulated radiotherapy to correct for inter- and intrafractional rotations of the prostate. Int J Radiat Oncol Biol Phys 83:1624–1632CrossRefPubMed
11.
Lee WR, Dignam JJ, Amin MB et al (2016) Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol 34:2325–2332CrossRefPubMed
12.
Lukka H, Hayter C, Julian JA et al (2005) Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol 23:6132–6138CrossRefPubMed
13.
Aluwini S, Pos F, Schimmel E et al (2016) Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol 17:464–474CrossRefPubMed
14.
Aluwini S, Pos F, Schimmel E et al (2015) Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial. Lancet Oncol 16:274–283CrossRefPubMed
15.
Incrocci L, Wortel RC, Alemayehu WG et al (2016) Hypofractionated radiotherapy for patients with localised prostate cancer (HYPRO): Final efficacy results from a randomised, multicentre, open-label, phase3 trial. Lancet Oncol 17(8):1061–1069. doi:10.​1016/​s1470-2045(16)30070-5 CrossRefPubMed
16.
Dearnaley D, Syndikus I, Mossop H et al (2016) Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5‑year outcomes of the randomised, non-inferiority, phase3 CHHIP trial. Lancet Oncol 17:1047–1060CrossRefPubMedPubMedCentral
17.
Dearnaley D, Syndikus I, Sumo G et al (2012) Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial. Lancet Oncol 13:43–54CrossRefPubMed
18.
Pollack A, Walker G, Horwitz EM et al (2013) Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol 31:3860–3868CrossRefPubMedPubMedCentral
19.
Shaikh T, Li T, Johnson ME et al (2015) Long-term patient reported outcomes from a phase 3 randomized prospective trial of conventional versus hypofractionated IMRT radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 93:S34–S36CrossRef
20.
Yeoh EE, Botten RJ, Butters J et al (2011) Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys 81:1271–1278CrossRefPubMed
21.
Kuban D, Nogueras-Gonzalez GM, Hamblin L et al (2010) Preliminary report of a randomized dose escalation trial for prostate cancer using hypofractionation. Int J Radiat Oncol Biol Phys 78:S58–59CrossRef
22.
Hoffman KE, Voong KR, Pugh TJ et al (2014) Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial. Int J Radiat Oncol Biol Phys 88:1074–1084CrossRefPubMed
23.
Arcangeli G, Fowler J, Gomellini S et al (2011) Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 79:1013–1021CrossRefPubMed
24.
Arcangeli G, Saracino B, Gomellini S et al (2010) A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 78:11–18CrossRefPubMed
25.
Arcangeli S, Strigari L, Gomellini S et al (2012) Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 84:1172–1178CrossRefPubMed
26.
Yeoh EE, Holloway RH, Fraser RJ et al (2006) Hypofractionated versus conventionally fractionated radiation therapy for prostate carcinoma: updated results of a phase III randomized trial. Int J Radiat Oncol Biol Phys 66:1072–1083CrossRefPubMed
27.
Tramacere F, Arcangeli S, Pignatelli A et al (2015) Hypofractionated dose escalated 3D conformal radiotherapy for prostate cancer: outcomes from a mono-institutional phase II study. Anticancer Res 35:3049–3054PubMed
28.
McDonald AM, Baker CB, Shekar K et al (2014) Reduced radiation tolerance of penile structures associated with dose-escalated hypofractionated prostate radiotherapy. Urology 84:1383–1387CrossRefPubMedPubMedCentral
29.
Putora PM, Engeler D, Haile SR et al (2016) Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients. Strahlenther Onkol 192:182–189CrossRefPubMed
30.
Cozzarini C, Fiorino C, Deantoni C et al (2014) Higher-than-expected severe (Grade 3–4) late urinary toxicity after postprostatectomy hypofractionated radiotherapy: a single-institution analysis of 1176 patients. Eur Urol 66:1024–1030CrossRefPubMed
31.
Lewis SL, Patel P, Song H et al (2016) Image guided hypofractionated postprostatectomy intensity modulated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 94:605–611CrossRefPubMed
32.
Catton CN, Lukka H, Julian JA et al (2016) A randomized trial of a shorter radiation fractionation schedule for the treatment of localized prostate cancer. J Clin Oncol 34:A5003
33.
King CR, Brooks JD, Gill Presti HJC Jr. (2012) Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys 82:877–882CrossRefPubMed
34.
Friedland JL, Freeman DE, Masterson-McGary ME et al (2009) Stereotactic body radiotherapy: an emerging treatment approach for localized prostate cancer. Technol Cancer Res Treat 8:387–392CrossRefPubMed
35.
Katz AJ, Kang J (2014) Quality of life and toxicity after SBRT for organ-confined prostate cancer, a 7‑year study. Front Oncol 4:301PubMedPubMedCentral
36.
Boike TP, Lotan Y, Cho LC et al (2011) Phase I dose-escalation study of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer. J Clin Oncol 29:2020–2026CrossRefPubMedPubMedCentral
37.
Loblaw A, Cheung P, D’Alimonte L et al (2013) Prostate stereotactic ablative body radiotherapy using a standard linear accelerator: toxicity, biochemical, and pathological outcomes. Radiother Oncol 107:153–158CrossRefPubMed
38.
Zietman AL, Bae K, Slater JD et al (2010) Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol 28:1106–1111CrossRefPubMedPubMedCentral
39.
Aluwini S, Beltramo G, Van Rooij P et al (2013) Stereotactic body radiotherapy with four fractions for low- and intermediate-risk prostate cancer: acute and late toxicity. Eur Urol 12:156CrossRef
40.
Bolzicco G, Favretto MS, Satariano N et al (2013) A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy. BMC Urol 13:49CrossRefPubMedPubMedCentral
41.
Chen LN, Suy S, Uhm S et al (2013) Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol 8:58CrossRefPubMedPubMedCentral
42.
D’Alimonte L, Loblaw A, Cheung P et al (2013) Long term outcomes of a novel five fraction hypofractionated protocol for low risk prostate cancer. J Med Imaging Radiat Sci 44:44–58
43.
Freeman D, Dickerson G, Perman M (2015) Multi-institutional registry for prostate cancer radiosurgery: a prospective observational clinical trial. Front Oncol 4:369CrossRefPubMedPubMedCentral
44.
Fuller DB, Mardirossian G, Wong D et al (2012) Prospective evaluation of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer: emulating high-dose-rate brachytherapy dose distribution. Int J Radiat Oncol Biol Phys 84:S149CrossRef
45.
Lukka H, Stephanie P, Bruner D et al (2016) Patient-reported outcomes in NRG oncology/RTOG 0938, a randomized phase 2 study evaluating 2 ultrahypofractionated regimens (UHRs) for prostate cancer. Int J Radiat Oncol Biol Phys 94(1):2CrossRef
46.
Mantz CA, Fernandez E, Zucker Harrison IS (2009) A phase II trial of Varian trilogy-based SBRT for low-risk prostate cancer: report of early toxicity and disease control outcomes. Int J Radiat Oncol Biol Phys 75:S326CrossRef
47.
Meier R, Kaplan I, Beckman A et al (2012) Stereotactic body radiation therapy for intermediate-risk organ-confined prostate cancer: interim toxicity and quality of life outcomes from a multi-institutional study. Int J Radiat Oncol Biol Phys 84:S148CrossRef
48.
Meier R, Kaplan I, Beckman A et al (2013) Patient-reported quality of life outcomes in intermediate-risk prostate cancer patients treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 87:S25CrossRef
49.
Menkarios C, Vigneault E, Brochet N et al (2011) Toxicity report of once weekly radiation therapy for low-risk prostate adenocarcinoma: preliminary results of a phase I/II trial. Radiat Oncol 6:112CrossRefPubMedPubMedCentral
50.
Oliai C, Lanciano R, Sprandio B et al (2013) Stereotactic body radiation therapy for the primary treatment of localized prostate cancer. J Radiat Oncol 2:63–70CrossRefPubMed
51.
Quon H, Cheung P, Cesta A et al (2010) Prospective study of extreme hypofractionated radiotherapy (35GY in five fractions) for low-risk prostate cancer: toxicity results. Radiother Oncol 96:S46
52.
Chen LN, Suy S, Wang H et al (2014) Patient-reported urinary incontinence following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer. Radiat Oncol 9:148CrossRefPubMedPubMedCentral
53.
Yu JB, Cramer LD, Herrin J et al (2014) Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity. J Clin Oncol 32:1195–1201CrossRefPubMedPubMedCentral
54.
Behrendt K, Nowicka E, Gawkowska-Suwinska M et al (2014) Early closure of phase II prospective study on acute and late tolerance of hypofractionated radiotherapy in low-risk prostate cancer patients. Rep Pract Oncol Radiother 19:337–342CrossRefPubMedPubMedCentral
55.
Kim DW, Cho LC, Straka C et al (2014) Predictors of rectal tolerance observed in a dose-escalated phase 1–2 trial of stereotactic body radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 89:509–517CrossRefPubMed
56.
Rana Z, Cyr RA, Chen LN et al (2014) Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer. Front Oncol 4:290CrossRefPubMedPubMedCentral
57.
Simon M, Habeck M, Büttner D et al (2015) Approval procedures for clinical trials in the field of radiation oncology. Strahlenther Onkol 191:909–920CrossRefPubMed
58.
Ishikawa H, Tsuji H, Kamada T et al (2006) Carbon ion radiation therapy for prostate cancer: results of a prospective phase II study. Radiother Oncol 81:57–64CrossRefPubMed
59.
Okada T, Tsuji H, Kamada T et al (2012) Carbon ion radiotherapy in advanced hypofractionated regimens for prostate cancer: from 20 to 16 fractions. Int J Radiat Oncol Biol Phys 84:968–972CrossRefPubMed
60.
Nomiya T, Tsuji H, Maruyama K et al (2014) Phase I/II trial of definitive carbon ion radiotherapy for prostate cancer: evaluation of shortening of treatment period to 3 weeks. Br J Cancer 110:2389–2395CrossRefPubMedPubMedCentral
61.
Mendenhall NP, Hoppe BS, Nichols RC et al (2014) Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys 88:596–602CrossRefPubMed
62.
Vargas CE, Hartsell WF, Dunn M et al (2015) Hypofractionated versus standard fractionated proton-beam therapy for low-risk prostate cancer: interim results of a randomized trial PCG GU 002. Am J Clin Oncol. doi:10.​1097/​COC.​0000000000000241​ PubMed
63.
Habl G, Hatiboglu G, Edler L et al (2014) Ion Prostate Irradiation (IPI) – a pilot study to establish the safety and feasibility of primary hypofractionated irradiation of the prostate with protons and carbon ions in a raster scan technique. BMC Cancer 14:202CrossRefPubMedPubMedCentral
Metadata
Title
Hypofractionated radiotherapy for localized prostate cancer
Authors
Stefan Höcht
Daniel M. Aebersold
Clemens Albrecht
Dirk Böhmer
Michael Flentje
Ute Ganswindt
Tobias Hölscher
Thomas Martin
Felix Sedlmayer
Frederik Wenz
Daniel Zips
Thomas Wiegel
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 1/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-1041-5

Other articles of this Issue 1/2017

Strahlentherapie und Onkologie 1/2017 Go to the issue

Literatur kommentiert

Zeitintervall zwischen neoadjuvanter Radiochemotherapie und Operation beim Rektumkarzinom

Original Article

Prostate bed target interfractional motion using RTOG consensus definitions and daily CT on rails

Original Article

Accelerated partial breast irradiation with external beam radiotherapy

Original Article

Implementation of image-guided intensity-modulated accelerated partial breast irradiation

Case Study

Post-transplant lymphoproliferative disorder in the pelvis successfully treated with consolidative radiotherapy

Original Article

Dynamic contrast-enhanced MRI for automatic detection of foci of residual or recurrent disease after prostatectomy