Three prominent medical societies have issued a new clinical guideline for physicians treating men with early-stage prostate cancer using external-beam radiation therapy (EBRT). Adoption of the guideline could make treatment shorter and more convenient for many patients with prostate cancer.
Developed by a panel of experts from the American Society for Radiation Oncology (ASTRO), ASCO, and the American Urological Association (AUA), the new guideline recommends offering patients hypofractionated radiation therapy as an alternative to longer, conventional courses of radiation. ASTRO, ASCO, and AUA published the guideline in their respective journals, Practical Radiation Oncology, the Journal of Clinical Oncology, and The Journal of Urology.
“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,” said Howard Sandler, MD, FASTRO, FASCO, Chair and Professor of Radiation Oncology at Cedars-Sinai Medical Center, Los Angeles, and Co-Chair of the guideline panel. “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.”
External-beam radiation therapy is a standard definitive treatment option that confers outcomes equivalent to radical prostatectomy for men with localized prostate cancer, according to research by Hamdy et al in The New England Journal of Medicine. When EBRT is hypofractionated, patients receive larger radiation doses across fewer treatment sessions—typically completing treatment in 4 to 5 weeks, compared with 8 to 9 weeks for conventional radiation. Extremely hypofractionated courses—also known as ultrahypofractionation, stereotactic body radiation therapy (SBRT), or stereotactic ablative radiation therapy (SABR)—can be completed in as few as five treatments.
Key Guideline Recommendations
The recommendations apply to patients who require or prefer treatment instead of surveillance and have opted for EBRT instead of radical prostatectomy, brachytherapy, or other treatment options for localized prostate cancer. Key recommendations are as follows:
Benefits of Hypofractionation
“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, Assistant Professor of Radiation Oncology at the University of Ottawa and Co-Chair of the Guideline Panel.
“Image guidance and other advances in radiation therapy delivery have enabled radiation oncologists to treat prostate cancer with a therapeutic dose of radiation in a shorter treatment period than was previously possible,” said Daniel Barocas, MD, Associate Professor of Urology at Vanderbilt University Medical Center and guideline coauthor. “Results so far show comparable early cancer control to conventional fractionation, while maintaining an acceptable side-effect profile. This has benefits to the patient in terms of reducing the treatment burden and cost, and may increase the acceptability of external-beam radiation therapy.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.