Top

Published in:

Open Access 01-11-2021 | Prostate Cancer | Original Article

Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries

A survey of the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society (DKG-ARO)

Authors: Mohamed Shelan, Daniel M. Aebersold, Clemens Albrecht, Dirk Böhmer, Michael Flentje, Ute Ganswindt, Stefan Höcht, Tobias Hölscher, Arndt-Christian Müller, Peter Niehoff, Michael Pinkawa, Nina-Sophie Schmidt-Hegemann, Felix Sedlmayer, Frank Wolf, Constantinos Zamboglou, Daniel Zips, Thomas Wiegel, Prof. Dr. med. Pirus Ghadjar

Published in: Strahlentherapie und Onkologie | Issue 11/2021

Abstract

Purpose

Various randomized phase III clinical trials have compared moderately hypofractionated to normofractionated radiotherapy (RT). These modalities showed similar effectiveness without major differences in toxicity. This project was conducted by the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society. We aimed to investigate expert opinions on the use of moderately hypofractionated RT as a definitive treatment for localized prostate cancer in German-speaking countries.

Methods

A 25-item, web-based questionnaire on moderate-hypofractionation RT was prepared by an internal committee. The experts of the DEGRO were asked to complete the questionnaire.

Results

Fourteen active members of DEGRO completed the questionnaire. The questions described indications for selecting patients eligible to receive moderate hypofractionation based on clinical and pathological factors such as age, urinary symptoms, and risk-group. The questions also collected information on the technical aspects of selection criteria, including the definition of a clinical target volume, the use of imaging, protocols for bladder and rectal filling, the choice of a fractionation schedule, and the use of image guidance. Moreover, the questionnaire collected information on post-treatment surveillance after applying moderately hypofractionated RT.

Conclusion

Although opinions varied on the use of moderate-hypofractionation RT, the current survey reflected broad agreement on the notion that moderately hypofractionated RT could be considered a standard treatment for localized prostate cancer in German-speaking countries.

Wolf F, Sedlmayer F, Aebersold D et al (2021) Ultrahypofractionation of localized prostate cancer: statement from the DEGRO working group prostate cancer. Strahlenther Onkol 197(2):89–96CrossRef

Widmark A, Gunnlaugsson A, Beckman L et al (2019) Articles ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5‑year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet 394(10196):385–395CrossRef

Hickey BE, James ML, Daly T, Soh FY, Jeffery M (2019) Hypofractionation for clinically localized prostate cancer. Cochrane Database Syst Rev 9:CD11462PubMed

Höcht S, Aebersold DM, Albrecht C et al (2017) Hypofractionated radiotherapy for localized prostate cancer. Strahlenther Onkol 193:1–12CrossRef

Ghadjar P, Aebersold DM, Albrecht C et al (2018) Use of androgen deprivation and salvage radiation therapy for patients with prostate cancer and biochemical recurrence after prostatectomy. Strahlenther Onkol 194:619–626CrossRef

Beck M, Böhmer D, Aebersold DM et al (2020) Role of combined radiation and androgen deprivation therapy in intermediate-risk prostate cancer: statement from the DEGRO working group on prostate cancer. Strahlenther Onkol 196:109–116CrossRef

Ghadjar P, Aebersold DM, Albrecht C et al (2020) Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer: statement from the DEGRO working group prostate cancer. Strahlenther Onkol 196:589–597CrossRef

Mottet N, van den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II—2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol 79(2):263–282CrossRef

Catton CN, Lukka H, Gu CS et al (2017) Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol 35:1884–1890CrossRef

10.

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, phase 3 CHHiP trial. Lancet Oncol 17:1047–1060CrossRef

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 34:2325–2332CrossRef

12.

Wilson JM, Dearnaley DP, Syndikus I et al (2018) The efficacy and safety of conventional and hypofractionated high-dose radiation therapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial. Int J Radiat Oncol Biol Phys 100:1179–1189CrossRef

13.

Incrocci L, Wortel RC, Alemayehu WG et al (2016) Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 17:1061–1069CrossRef

14.

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 78:11–18CrossRef

15.

Murray JR, Tree AC, Alexander EJ et al (2020) Standard and hypofractionated dose escalation to intraprostatic tumor nodules in localized prostate cancer: efficacy and toxicity in the DELINEATE trial. Int J Radiat Oncol Biol Phys 106:715–724CrossRef

16.

Kerkmeijer LGW, Groen VH, Pos FJ et al (2021) Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer: results from the FLAME randomized phase III trial. J Clin Oncol 39(7):787–796CrossRef

17.

Syndikus I, Cruickshank C, Staffurth J et al (2020) PIVOTALboost: a phase III randomised controlled trial of prostate and pelvis versus prostate alone radiotherapy with or without prostate boost (CRUK/16/018). Clin Transl Radiat Oncol 25:22–28CrossRef

18.

Villeirs GM, Van Vaerenbergh K, Vakaet L et al (2005) Interobserver delineation variation using CT versus combined CT + MRI in intensity-modulated radiotherapy for prostate cancer. Strahlenther Onkol 181:424–430CrossRef

19.

Horsley PJ, Aherne NJ, Edwards GV et al (2015) Planning magnetic resonance imaging for prostate cancer intensity-modulated radiation therapy: impact on target volumes, radiotherapy dose and androgen deprivation administration. Asia Pac J Clin Oncol 11:15–21CrossRef

20.

Salambier C, Villeirs G, De Bari B et al (2018) ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer. Radiother Oncol 127:49–61CrossRef

21.

McLaughlin PW, Evans C, Feng M et al (2010) Radiographic and anatomic basis for prostate contouring errors and methods to improve prostate contouring accurcy. Int J Radiat Oncol Biol Phys 76:369–378CrossRef

22.

Hofman MS, Lawrentschuk N, Francis RJ et al (2020) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 395:1208–1216CrossRef

23.

Hayden AJ, Martin JM, Kneebone AB et al (2010) Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma. J Med Imaging Radiat Oncol 54:513–525CrossRef

24.

Roach M, Marquez C, Yuo HS et al (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28:33–37CrossRef

25.

Partin AW, Kattan MW, Subong ENP et al (2004) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer—a multi-institutional update. Aktuelle Urol 35:377–378CrossRef

26.

Ghadjar P, Fiorino C, Munck Af Rosenschöld P, Pinkawa M, Zilli T, van der Heide UA (2019) ESTRO ACROP consensus guideline on the use of image guided radiation therapy for localized prostate cancer. Radiother Oncol 141:5–13CrossRef

27.

Wilkins A, Naismith O, Brand D et al (2020) Derivation of dose/volume constraints for the anorectum from clinician- and patient-reported outcomes in the CHHiP trial of radiation therapy fractionation. Int J Radiat Oncol Biol Phys 106:928–938CrossRef

28.

Vassis S, Nöldeke B, Christiansen H, von Klot CA, Merten R (2020) Moderately HRT vs. CRT for localized prostate cancer using image-guided VMAT with SIB: evaluation of acute and late toxicities. Strahlenther Onkol 196:598–607CrossRef

29.

Schörghofer A, Groher M, Karner J et al (2019) Risk-adapted moderate hypofractionation of prostate cancer: a prospective analysis of acute toxicity, QOL and outcome in 221 patients. Strahlenther Onkol 195:894–901CrossRef

30.

Tamihardja J, Schortmann M, Lawrenz I et al (2021) Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis. Strahlenther Onkol 197:124–132CrossRef

31.

Moore A, Stav I, Den RB et al (2019) The financial impact of hypofractionated radiation for localized prostate cancer in the United States. J Oncol. https://doi.org/10.1155/2019/8170428CrossRefPubMedPubMedCentral

Title: Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries
A survey of the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society (DKG-ARO)
Authors: Mohamed Shelan
Daniel M. Aebersold
Clemens Albrecht
Dirk Böhmer
Michael Flentje
Ute Ganswindt
Stefan Höcht
Tobias Hölscher
Arndt-Christian Müller
Peter Niehoff
Michael Pinkawa
Nina-Sophie Schmidt-Hegemann
Felix Sedlmayer
Frank Wolf
Constantinos Zamboglou
Daniel Zips
Thomas Wiegel
Prof. Dr. med. Pirus Ghadjar
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 11/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01820-2

At a glance: The STEP trials

Springer Medicine

Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries

A survey of the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society (DKG-ARO)

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2021

Intraoperative Teilbrustbestrahlung mit Elektronen (ELIOT) vs. konventionelle Ganzbrustbestrahlung beim invasiven Mammakarzinom im frühen Stadium nach brusterhaltender Operation: Langzeitdaten einer kontrollierten, randomisierten Studie

Could pulmonary low-dose radiation therapy be an alternative treatment for patients with COVID-19 pneumonia? Preliminary results of a multicenter SEOR-GICOR nonrandomized prospective trial (IPACOVID trial)

Trimodal therapy with high-dose-rate brachytherapy and hypofractionated external beam radiation combined with long-term androgen deprivation for unfavorable-risk prostate cancer

Ein neuer Standard zeichnet sich ab: PD-1-Erhaltungstherapie nach neoadjuvanter Radiochemotherapie und kurativer Resektion bei Ösophagus- und AEG-Karzinomen (CheckMate 577)

Neoadjuvante Radiochemotherapie kombiniert mit regionaler Tiefenhyperthermie beim Rektumkarzinom?

Comparison of EBRT and I-125 seed brachytherapy concerning outcome in intermediate-risk prostate cancer