Editorial Comment: Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial

Abstract

Anders Widmark 1, Adalsteinn Gunnlaugsson 2, Lars Beckman 3, Camilla Thellenberg-Karlsson 4, Morten Hoyer 5, Magnus Lagerlund 6, et al. 1 Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; 2 Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden; 3 Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden; 4 Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; 5 Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; 6 Department of Oncology, Kalmar Hospital, Kalmar, Sweden Lancet. 2019 Aug 3;394(10196):385-395. DOI: 10.1016/S0140-6736(19)31131-6 | ACCESS: 10.1016/S0140-6736(19)31131-6 COMMENT Due the low alpha/beta ratio, the hypofractionation of the external radiotherapy treatment of prostate cancer can increase the therapeutic ratio and reduce the health-care cost and improve the patient comfort. It can be done by moderate hypofractionation (using 2.4 – 3.4 Gy) or by ultra-hypofractionation (at least 5 Gy per fraction) ( 1 - 3 ). This phase 3 non-inferiority randomized trial is the first to report on the efficacy and side-effects on ultra-fractionation compared with conventional and has the PSA relapse and clinical failure as primary endpoint. The most relevant secondary endpoints were the overall survival and prostate cancer-specific survival and the median follow-up time was 5yr. The ultra-hypofractionation was non-inferior to the conventional fractionation (HR 1.002) and no significant differences were found in terms of relevant urinary or gastrointestinal toxicity.