The Role of Hypofractionated Radiotherapy in Prostate Cancer.
OBJECTIVE
It is now accepted that prostate cancer has a low alpha/beta ratio, establishing a strong basis for hypofractionation of prostate radiotherapy. This review focuses on the rationale for hypofractionation and presents the evidence base for establishing moderate hypofractionation for localised disease as the new standard of care. The emerging evidence for extreme hypofractionation in managing localized and oligometastatic prostate cancer is reviewed.


RESULTS
The 5-year efficacy and toxicity outcomes from four phase III studies have been published within the last 12 months. These studies randomizing over 6000 patients to conventional fractionation (1.8-2.0 Gy per fraction) or moderate hypofractionation (3.0-3.4 Gy per fraction). They demonstrate hypofractionation to be non-inferior to conventional fractionation. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Extreme hypofractionation may have a role in managing prostate oligometastases, but further studies are needed.
Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, London, UK.
Linus C
LC
Benjamin
Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, London, UK.|Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Downs Road, Sutton Surrey, SM2 5PT, London, UK.
Alison C
AC
Tree
Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, London, UK. David.Dearnaley@icr.ac.uk.|Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Downs Road, Sutton Surrey, SM2 5PT, London, UK. David.Dearnaley@icr.ac.uk.
David P
DP
Dearnaley
D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D000069473:Radiation Dose Hypofractionation; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D016896:Treatment Outcome
CHHiP; HYPRO; Hypofractionation; Prostate cancer; Radiotherapy