Prostate cancer: targeted radiotherapy could safely cut treatment time to 1-2 weeks

  • Brand DH & et al.
  • Lancet Oncol
  • 17 Sep 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 5-fraction stereotactic body radiotherapy (SBRT) could safely cut treatment time to 1-2 weeks for patients with low-/intermediate-risk localized prostate cancer.
  • Acute gastrointestinal and genitourinary toxicities were similar vs conventionally fractionated or moderately hypofractionated radiotherapy.

Why this matters

  • If survival and late toxicity data confirm noninferiority, ultra-hypofractionated radiotherapy will considerably reduce treatment duration.

Study design

  • Phase 3, noninferiority PACE-B study of 874 patients with performance status 0-2, low-/intermediate-risk prostate adenocarcinoma who were randomly assigned to:
    • Conventionally (78 Gy in 39 fractions over 7.8 weeks) or moderately hypofractionated radiotherapy (62 Gy in 20 fractions over 4 weeks).
    • Ultra-hypofractionated SBRT (36.25 Gy in 5 fractions over 1-2 weeks).
  • Funding: Accuray; National Institute of Health Research.

Key results

  • Median follow-up was 12 weeks. 
  • Fractionated radiotherapy and SBRT yielded similar rates of:
    • worst Radiation Therapy Oncology Group (RTOG) grade ≥2 severe gastrointestinal toxicities (12% vs 10%; P=.38);
    • worst RTOG grade ≥2 severe genitourinary toxicities (27% vs 23%; P=.16);
    • worst RTOG grade ≥3 gastrointestinal (1% vs
  • No significant differences were observed in international prostate symptom score (IPSS) total, week 12 IPSS total, worst IPSS QoL, or week 12 IPSS QoL scores between the 2 groups.
  • No treatment-related deaths reported.

Limitations

  • Open-label design.