Radiotherapy given in high doses over a shorter period of time is safe and effective for patients with prostate cancer, according to research from a phase III trial presented at the European Society for Radiotherapy & Oncology (ESTRO) 37 Conference.1
The treatment—called ultrahypofractionated radiotherapy—involves hospital treatment every other day for 2.5 weeks, compared to every weekday for 8 weeks for standard radiotherapy.
This is the first large patient trial of its kind, and it shows that ultrahypofractionated radiotherapy is just as effective as standard radiotherapy at stopping prostate cancer from returning.— Anders Widmark, MD, PhD, and colleagues
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Researchers say this method of giving radiotherapy saves time for patients. It also frees up radiotherapy equipment, saving money and benefiting other patients on the waiting list for treatment.
The study was presented by Anders Widmark, MD, PhD, a senior consultant based in the department of radiation sciences and cancer center at Umeå University, Sweden. He said, “We already know that radiotherapy can destroy cancer cells in the prostate, and that it has advantages over surgery and hormone therapy because it is less likely to cause impotence or incontinence. However, radiotherapy requires expensive specialist equipment and patients can end up on a waiting list for treatment. Ultrahypofractionated radiotherapy offers a number of practical benefits to patients as well as time and cost-savings for hospitals, so we wanted to test if it is as safe and effective as standard radiotherapy.”
The researchers conducted a trial with 1,200 patients who were treated at 10 hospitals in Sweden and two in Denmark between July 2005 and November 2015. All had been diagnosed with medium or high-risk cancer, where clinical factors suggest there was a risk that the cancer could spread if it was not treated. None had received treatment to block the male hormone testosterone, which can stimulate prostate tumors to grow.
Half of patients received standard radiotherapy of 39 treatments each with a standard radiation dose of two Gray (Gy), spread over 8 weeks (78 Gy in total). The other half received ultrahypofractionated radiotherapy with seven treatments of high dose radiation of 6.1 Gy, every other week day for 2.5 weeks (42.7 Gy in total). Patients were monitored for an average of 5 years following treatment to see whether their cancer returned, indicated by a rising level of prostate-specific antigen (PSA) and whether they suffered any side effects.
Researchers found that at 5 years after treatment, 83.8% of patients treated with standard radiotherapy had no signs of their cancer returning. In patients treated with ultrahypofractionated radiotherapy, the figure was 83.7%.
Although patients who had the ultrahypofractionated treatment suffered slightly worse side effects at the end of treatment, long-term side effects were the same as those experienced by patients who had the standard treatment.
Dr. Widmark added, “Previous research has already shown that it’s possible to increase individual doses and give them over 4 to 5 weeks. Now we have shown that we can condense the therapy further, raising the dose at each hospital visit so that the whole schedule lasts only 2.5 weeks. This is the first large patient trial of this kind, and it shows that ultrahypofractionated radiotherapy is just as effective as standard radiotherapy at stopping prostate cancer from returning. Importantly, it also shows that patients treated in this way do not suffer any more side effects than those treated with conventional radiotherapy.”
The researchers plan to continue to study the patients in the trial to check whether there are differences in their survival or side effects in the longer term. ■
DISCLOSURE: Dr. Widmark reported no conflicts of interest.
1. Widmark A, Gunnlaugsson A, Beckman L, et al: Ultrahypofractionation for prostate cancer: Outcome from the Scandinavian phase 3 HYPO-RT-PC trial. 2018 European Society for Radiotherapy & Oncology Conference. Abstract OC-0599. Presented April 23, 2018.