The aim of this guideline is to present recommendations regarding moderately hypofractionated (240-340 cGy per fraction) and ultrahypofractionated (500 cGy or more per fraction) radiation therapy for localized prostate cancer.
The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and Society-approved tools for grading evidence quality and recommendation strength.
Based on high-quality evidence, strong consensus was reached for offering moderate hypofractionation across risk groups to patients choosing external beam radiation therapy. The task force conditionally recommends ultrahypofractionated radiation may be offered for low- and intermediate-risk prostate cancer but strongly encourages treatment of intermediate-risk patients on a clinical trial or multi-institutional registry. For high-risk patients, the task force conditionally recommends against routine use of ultrahypofractionated external beam radiation therapy. With any hypofractionated approach, the task force strongly recommends image guided radiation therapy and avoidance of nonmodulated 3-dimensional conformal techniques.
Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer. The limits in the current evidentiary base-especially for ultrahypofractionation-highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients.
The Journal of urology. 2019 Mar [Epub]
Scott C Morgan, Karen Hoffman, D Andrew Loblaw, Mark K Buyyounouski, Caroline Patton, Daniel Barocas, Soren Bentzen, Michael Chang, Jason Efstathiou, Patrick Greany, Per Halvorsen, Bridget F Koontz, Colleen Lawton, C Marc Leyrer, Daniel Lin, Michael Ray, Howard Sandler
Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada., Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas., Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Department of Radiation Oncology, Stanford University, Stanford, California., American Society for Radiation Oncology, Arlington, Virginia., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland., Hunter Holmes McGuire Veterans Affairs Medical Center and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia., Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts., Patient Representative, Tallahassee, Florida., Department of Radiation Oncology, Lahey Hospital and Medical Center, Burlington, Massachusetts., Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Department of Radiation Oncology, Wake Forest University, Winston-Salem, North Carolina., Department of Urology, University of Washington, Seattle, Washington., Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, Wisconsin., Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.