Hypofractionated RT Noninferior for Localized Prostate Cancer

By: Jason Hoffman, PharmD, RPh

(Cancer Therapy Advisor)

Hypofractionated radiotherapy at a dose of 60 Gy in fractions is non-inferior to conventional radiotherapy using 74 Gy in 37 fractions for the treatment of patients with localized prostate cancer after 5 years' follow-up, a study published in the journal The Lancet Oncology has shown.1

Because prostate cancer might have high radiation-fraction sensitivity that gives a therapeutic advantage to hypofractionated therapy, researchers compared the efficacy and safety of conventional radiotherapy with hypofractionated therapy.

For this phase 3 CHHiP trial, investigators enrolled 3216 patients from 71 centers; each patient enrolled had localized prostate cancer. Participants were randomly assigned 1:1:1 to conventional (74 Gy administered in 37 fractions over 7.4 weeks) or 1 of 2 hypofractionated schedules (60 Gy in 20 fractions over 4 weeks or 57 Gy in 19 fractions over 3.8 weeks). All approaches were delivered with intensity-modulated techniques; most patients received 3 to 6 months of neoadjuvant and concurrent androgen suppression.

At a median follow-up of 62.4 months, the 5-year biochemical or clinical failure-free rate was 88.3% (95% CI, 86.0-90.2) in the 74 Gy group, 90.6% (95% CI, 88.5-92.3) in the 60 Gy group, and 85.9% (95% CI, 83.4-88.0) in the 57 Gy group.

Researchers found that 60 Gy was non-inferior to 74 Gy (hazard ratio, 0.84; 90% CI, 0.68-1.03; P = .0018), though 57 Gy was not non-inferior to 74 Gy (hazard ratio, 1.20; 90% CI, 0.99-1.46; P = .48).

Long-term adverse events were similar between the hypofractionated radiotherapy arms and the conventional group. Investigators did not observe a significant difference in the cumulative incidence of adverse events within 5 years of treatment. 

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