ASCO GU 2017: Best of Journals: Prostate Cancer - Radiation Oncologist Perspective - Session Highlights
Orlando, Florida USA (UroToday.com) Robert Den, Sidney Kimmel Medical College of Thomas Jefferson University, presented review of literature from a radiation oncologist perspective. The CHHIP trial assessed hypofractionation versus conventional IMRT with 3 arms 74Gy (standard) vs 60Gy or 57Gy (hypofractionated) regimens, respectively. A total of 2100 patients with T1b-T3aN0M0 prostate cancer were enrolled, median follow-up was 50 months. The primary endpoint was met with non-inferiority with no difference in efficacy endpoints. The 60 v 74 Gy arms favored the 60Gy arm. There was no significant difference in toxicity endpoints. In summary 60 Gy was non-inferior to 74 Gy. Similarly, RTOG 0415 randomized patients to 73.8 v 70 Gy with findings noting 70Gy being non-inferior to the 73.8 Gy arm. The HYPRO trial noted 64.6 Gy being not superior to 78 Gy, however, toxicity was not reported in this trial. Value in radiation oncology (quality/costs) noted hypofractionation with equivalent efficacy and decreased costs thus highlighting hypofractionation being a higher value based radiotherapy regimen. The STAMPEDE trial arm assessing 74Gy to the prostate with/without 46-50Gy to nodes (non-randomized) noted statistically significantly higher proportion of event free outcomes with 74 Gy patients. Rusthoven et al. examined androgen deprivation therapy with or without radiotherapy and showed significantly improved survival with the addition of local radiotherapy in the setting of N1 disease. These data support ongoing clinical trials assessing treatments among N1 and M1 patients.
Presenter: Robert Den, Sidney Kimmel Medical College of Thomas Jefferson University
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX