Hypofractionated Radiation Therapy for Localized Prostate Cancer

Published ahead of print October 11, 2018, DOI: 10.1200/JCO.18.01097

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, and Howard Sandler

This guideline is endorsed by the Society of Urologic Oncology, European Society for Radiotherapy & Oncology (ESTRO), and Royal Australian and New Zealand College of Radiologists.

The American Society for Radiation Oncology (ASTRO), in collaboration with the American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA), initiated development of an evidence-based clinical practice guideline on hypofractionated external beam radiation therapy (EBRT) in localized prostate cancer. The aim of the guideline is to provide recommendations on the use of moderate hypofractionation and ultrahypofractionation with particular reference to oncologic outcomes, toxicity, and quality of life. Hypofractionated radiation has the advantage of shortening treatment duration, is respectful of resource utilization, and appears cost-effective. While health economic endpoints were not directly considered, it is recognized that the very nature of hypofractionation is such that there are potential advantages in terms of cost and convenience for patients.^12,13

Optimal management of localized prostate cancer is complex and controversial and depends upon life expectancy, risk of progression, and patient preferences. Most practitioners agree that active surveillance is the preferred management strategy for patients with low-risk disease and agree that there is clinical equipoise between radiation and radical prostatectomy with respect to oncologic outcomes among men who require treatment for higher risk cancers or prefer treatment in the setting of low-risk disease.¹⁴ Therefore, the recommendations herein apply to men who require or prefer treatment instead of surveillance and who have opted for EBRT instead of radical prostatectomy, brachytherapy, or other treatment options.

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