Men being treated for early-stage prostate cancer with external beam radiation therapy (EBRT) can safely choose an option that reduces the number of treatment sessions, according to a panel of experts from the American Society for Radiation Oncology, American Society of Clinical Oncology, and American Urological Association. The new guideline for doctors who treat men with prostate cancer was published October 11, 2018 in Practical Radiation Oncology, Journal of Clinical Oncology, and The Journal of Urology.
Men diagnosed with prostate cancer while it’s still at an early stage often have several treatment options, including active surveillance (also called watchful waiting), surgery, or radiation. All have about the same cure rates for the earliest stage prostate cancers, although each type of treatment has pros and cons.
External beam radiation therapy (ERBT), is a type of radiation therapy used to treat prostate cancer. A machine focuses beams of radiation on the prostate gland to kill the cancer cells. Patients typically receive treatments 5 days a week for several weeks. The new guideline uses hypofractionated radiation, where external beam radiation is given in larger doses and fewer treatments. Men treated with this approach can typically expect to complete treatment in 4 to 5 weeks, compared with 8 to 9 weeks for conventional EBRT. Ultrahypofractionated therapy increases the radiation dose even more and can be completed in as few as 5 treatments.
In developing the new guideline, the panel reviewed 61 journal articles published between December 2001 and March 2017. They concluded that hypofractionated radiation therapy is a safe option. Cure rates and side effects are similar to a conventional ERBT treatment schedule. However, there is a slightly greater risk of severe gastrointestinal complications with hypofractionated radiation therapy.
Benefits of a shorter radiation schedule, according to the panel, include more convenience for patients and reduced use of medical resources.
Howard Sandler, MD, co-chair of the guideline panel, said in a statement, "Conclusive evidence from several large, well-designed randomized trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation. Significant advances in treatment planning and delivery have enabled oncologists to deliver more powerful, life-saving doses of radiation in fewer visits and without compromising quality of life."
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Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline. Published October 11, 2018 in Practical Radiation Oncology, Journal of Clinical Oncology, and The Journal of Urology. First author Scott C. Morgan, MD, University of Ottawa, Ottawa.
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