title: [The hypofractionated radiotherapy in the treatment of the prostate cancer: radiate less to treat more].
abstract: The principle of the hypofractionation in radiotherapy is to deliver a higher dose by session and to reduce the duration of treatment. In the particular case of the cancer of prostate, a hypofractionned protocol allows to deliver an equivalent radiobiological dose identical even higher than a standard plan of irradiation. The hypofractionation is presented as a solution to improve the access to the care (fewer processing times by patient, more patients treated by machine) while increasing the quality of the care: better carcinologic control, less radiotoxicity. The objective of this article is to make a clarification on the hypofractionned radiotherapy in first intention in the treatment of the localized prostate cancer. We count three studies on large cohorts, comparing standard plans to 1.8-2 Gy/session and hypofractionned plans (2.5-3 Gy/session). The inferior carcinologic results of the two first comparative studies with regard to the study of phase I/II of the Cleveland clinic were owed to a sub-dosage of hypofractionned plans. The administered equivalent biological doses were lower than the at present recommended total doses and lower than the theoretical doses, calculated on the bases of an erroneous evaluation of the radiosensibility of the prostate cancer. In the comparative study of Arcangeli, the rate of survival without biological recurrence in 4 years (82%) was significantly to the advantage of the hypofractionned group, while reducing the duration of treatment of 3 weeks. Four comparative studies reported aigues/late toxicity, gastrointestinal (GI)/genito-urinary acceptable (GU) even lower with a hypofractionned plan. The hypofractionation is potentially the future of the radiotherapy in the treatment of the localized prostate cancer thanks to the technological innovation, but for all that does not constitute at present a standard.
authors.affiliation: Service d'urologie et transplantation rénale, hôpital de la Conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France. romainboissier@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Boissier
authors.forename: E
authors.initials: E
authors.lastname: Gross
mesh_terms: D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*