Different radiation therapy schedules: Hyopfractioned EBRT is as effective as standard EBRT

This study compared the safety and effectiveness of external beam radiation therapy (EBRT) and hypofractioned EBRT (H-EBRT) for localized prostate cancer. Researchers reported no differences in survival or disease recurrence rates between high H-EBRT and EBRT.

Radiation therapy is a common treatment for localized (confined) prostate cancer. External beam radiation therapy (EBRT) involves directing high-energy rays from outside the body at the tumor site to kill cancer cells. EBRT is associated with effective cancer control. Increasing evidence is suggesting that hypofractioned EBRT (H-EBRT) may achieve similar results. H-EBRT involves giving larger doses of radiation per treatment, reducing the number of total treatments. Fewer treatments are generally more convenient for the patient and can decrease health care costs. More studies are needed to demonstrate that H-EBRT can achieve similar results to EBRT.

This study aimed to compare H-EBRT with EBRT in men with intermediate- or high-risk localized prostate cancer.

3,216 men with intermediate- or high-risk localized prostate cancer were included in this study. Men were randomly assigned to either EBRT (74 Gy in 37 fractions over 7.4 weeks), high H-EBRT (60 Gy in 20 fractions over 4 weeks), or low H-EBRT (57 Gy in 19 fractions over 3.8 weeks). 97% of men were undergoing hormone therapy at the same time. Treatment outcomes were followed for an average of 62.4 months.

88.3% of men undergoing EBRT were recurrence-free at 5 years. This was comparable to 90.6% of men in the high H-EBRT group. 5-year recurrence-free rates were slightly lower in the low H-EBRT group (85.9%). 

Of 252 deaths reported during the study period, 16% were prostate cancer related. No significant differences in overall survival (time from treatment until death from any cause) were observed between radiation therapy groups.

The rate of side effects were similar between radiation therapy groups. Side effects of the bowel or bladder were reported in 6.6 to 13.7% of men. Bowel and bladder symptoms peaked sooner in the H-EBRT schedules (at 4 to 5 weeks) than in the EBRT schedule (at 7 to 8 weeks). No treatment-related deaths were reported.

Researchers concluded that high H-EBRT is as effective as conventional EBRT in achieving cancer control.