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. 2024 May 26:47:100800.
doi: 10.1016/j.ctro.2024.100800. eCollection 2024 Jul.

Weekly ultra-hypofractionated radiotherapy in localised prostate cancer

Nora Sundahl  1   2   3 , Douglas Brand  1   2   4 , Chris Parker  1   2 , David Dearnaley  2   1 , Alison Tree  1   2 , Angela Pathmanathan  1   2 , Yae-Eun Suh  1 , Nicholas Van As  1   2 , Rosalind Eeles  5   1 , Vincent Khoo  1   2 , Robert Huddart  2   1 , Julia Murray  1   2
Affiliations

Weekly ultra-hypofractionated radiotherapy in localised prostate cancer

Nora Sundahl et al. Clin Transl Radiat Oncol. .

Abstract

Background: Moderately hypofractionated radiotherapy regimens or stereotactic body radiotherapy (SBRT) are standard of care for localised prostate cancer. However, some patients are unable or unwilling to travel daily to the radiotherapy department and do not have access to, or are not candidates for, SBRT. For many years, The Royal Marsden Hospital NHS Foundation Trust has offered a weekly ultra-hypofractionated radiotherapy regimen to the prostate (36 Gy in 6 weekly fractions) to patients unable/unwilling to travel daily.

Methods: The current study is a retrospective analysis of all patients with non-metastatic localised prostate cancer receiving this treatment schedule from 2010 to 2015.

Results: A total of 140 patients were included in the analysis, of whom 86 % presented with high risk disease, with 31 % having Gleason Grade Group 4 or 5 disease and 48 % T3 disease or higher. All patients received hormone treatment, and there was often a long interval between start of hormone treatment and start of radiotherapy (median of 11 months), with 34 % of all patients having progressed to non-metastatic castrate-resistant disease prior to start of radiotherapy. Median follow-up was 52 months. Median progression-free survival (PFS) and overall survival (OS) for the whole group was 70 months and 72 months, respectively. PFS and OS in patients with hormone-sensitive disease at time of radiotherapy was not reached and 75 months, respectively; and in patients with castrate-resistant disease at time of radiotherapy it was 20 months and 61 months, respectively.

Conclusion: Our data shows that a weekly ultra-hypofractionated radiotherapy regimen for prostate cancer could be an option in those patients for whom daily treatment or SBRT is not an option.

Keywords: Prostate cancer; Radiotherapy; Ultra-hypofractionation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NS reports speaker fees from Janssen-Cilag. CP reports fees from ITM Radiopharma and institutional fees from Bayer, AAA. DD reports personal fees through the Rewards to Discoverer’s Scheme from The Institute of Cancer Research which receives royalty income from abiraterone, support from Cancer Research UK Program Grants C33589/A19727 “Advances in Physics for Precision Radiotherapy”, honoraria for advisory boards from Janssen and additionally has a patent EP1933709B1 issued for a localisation and stabilization device. AT reports research funding from Elekta, Varian and Accuray and travel grants/honoraria from Elekta, Accuray and Janssen. YS reports travel grants/honoraria from Janssen, Astellas, Bayer, AstraZeneca. RE reports income as a sole trader (variable and declared to HRMC) from private practices, as well as fees from Janssen, Bayer, Ipsen, AstraZeneca, University of Chicago and is a member of external Expert Committee for AstraZeneca UK. VK reports honoraria for speakers bureaus, personal fees and non-financial support from Accuray, Astellas, Bayer, Boston Scientific, Bristol Myers Squibb, Janssen and Merck Sharp Dohme. RH reports fees from Roche, Merck Sharp Dohme, BMS, Gilead, Astellas, Janssen, Nektar, and Merck/Pfizer, and research funding from Merck Sharp Dohme, Roche, and Elekta. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
CONSORT diagram of patients included in the analysis.
Fig. 2
Fig. 2
Progression-free survival (top chart) and overall survival (bottom chart) Kaplan-Meier curves. The patients are split into two groups: those with hormone sensitive prostate cancer at time of radiotherapy (blue) and those with castration-resistant prostate cancer at time of radiotherapy (yellow). Numbers at risk are presented below each chart. Abbreviations: CRPC: castration-resistant prostate cancer; RT: radiotherapy. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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