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Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer

  • Justin E. Bekelman
    Correspondence
    Reprint requests to: Justin E. Bekelman, MD, Perelman School of Medicine, Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104. Tel: (215) 662-7266
    Affiliations
    Departments of Radiation Oncology and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • W. Robert Lee
    Affiliations
    Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
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      Three multicenter, randomized, noninferiority trials comparing moderate hypofractionation (2.5 Gy to 3.0 Gy per fraction) with conventional fractionation (1.8 Gy to 2.0 Gy per fraction) have reported similar effectiveness and toxicity for intact prostate cancer. The Conventional or Hypofractionated High-dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) and NRG Oncology 0415 trials have been published (
      • Dearnaley D.
      • Syndikus I.
      • Mossop H.
      • et al.
      Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
      ,
      • Lee W.R.
      • Dignam J.J.
      • Amin M.B.
      • et al.
      Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer.
      ). The Ontario Clinical Oncology Group/Trans-Tasman Radiation Oncology Group PROstate Fractionated Irradiation Trial (PROFIT) was initially presented at the 2016 American Society for Clinical Oncology meeting in Chicago (
      • Catton C.N.
      • Lukka H.
      • Julian J.A
      • et al.
      A randomized trial of a shorter radiation fractionation schedule for the treatment of localized prostate cancer.
      ). Most recently, all 3 studies were discussed at a standing-room-only panel session of the American Society for Radiation Oncology annual meeting in September 2016.
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      References

        • Dearnaley D.
        • Syndikus I.
        • Mossop H.
        • et al.
        Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
        Lancet Oncol. 2016; 17: 1047-1060
        • Lee W.R.
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        J Clin Oncol. 2016; 34: 2325-2332
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        Int J Radiat Oncol Biol Phys. 2016; 96: S2-S3
      1. Catton C. A randomized trial of a shorter radiation fractionation schedule for the treatment of localized prostate cancer: OCOG/TROG PROstate Fractionated Irradiation Trial. Presented at the Prostate Hypofractionation-Evidence and Economics session during the 58th Annual Meeting of the American Society for Radiation Oncology; September 25-28, 2016; Boston, MA.

      2. National Institutes of Health. National Cancer Institute Surveillance, Epidemiology, and End Results Program Stat Facts Sheets: Prostate Cancer. Available at: http://seer.cancer.gov/statfacts/html/prost.html. Accessed November 16, 2016.

        • Lee W.R.
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        Making radiation therapy for prostate cancer more economical and more convenient.
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        Long-term outcomes of a phase II trial of moderate hypofractionated image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer.
        Radiother Oncol. 2016 Nov 9; ([Epub ahead of print])https://doi.org/10.1016/j.radonc.2016.10.017
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        Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013.
        JAMA. 2014; 312: 2542-2550
        • Martin J.
        • Frantzis J.
        • Chung P.
        • et al.
        Prostate radiotherapy clinical trial quality assurance: How real should real time review be? (A TROG-OCOG Intergroup Project).
        Radiother Oncol. 2013; 107: 333-338

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