Ultrahypofractionated radiotherapy in one or two sessions for localized prostate cancer: a review of the evidence and future perspectives

Abstract

This narrative review analyzes current evidence comparing single-session and two-session approaches in Stereotactic Body Radiation Therapy (SBRT) and high-dose-rate (HDR) brachytherapy for localized prostate cancer. These ultra-hypofractionated strategies deliver high-precision ablative doses while minimizing exposure to normal tissues. SBRT regimens with fewer than five fractions show tumor control comparable to conventional treatments, offering reduced treatment burden and increased convenience. While single-dose outcomes are often suboptimal, two-fraction regimens-especially in HDR brachytherapy-are widely used and may better preserve normal tissues and reduce toxicity. Studies utilizing advanced imaging, real-time motion management, and adaptive planning improve treatment accuracy. Two-session approaches appear safe and effective in the short to intermediate term, though long-term data for single-session SBRT remain limited. The review emphasizes tailoring treatment based on patient factors, tumor characteristics, and institutional capabilities, and calls for further research to refine ultra-hypofractionated radiotherapy protocols for prostate cancer.

Keywords: Brachytherapy; Localized prostate cancer; Prostate cancer; Radiotherapy; Stereotactic body radiotherapy (SBRT).