Top Line: How does prostate ultra-hypofractionation play out for elective pelvic nodes?
The Study: The phase 2 non-inferiority HOPE trial enrolled 80 men with unfavorable intermediate to very high risk prostate cancer planned for HDR brachytherapy boost (15 Gy). Patients were randomized 1:1 to receive whole pelvis irradiation either conventionally fractionated (45-46 Gy in 23-25 fractions) versus ultrahypofractionated (25 Gy in 5 fractions delivered every other day). ADT was added per risk group. The primary endpoint was EPIC-50 bowel function at one year with an a priori noninferiority margin set at ≤6 points. At a median follow-up of 3.3 years, ultrahypofractionation was noninferior with nearly identical mean bowel function scores at 1 year and no clinically meaningful differences across domains. Acute bowel declines were actually milder with ultrahypofractionation with no excess late grade 3+ GI events–granting it hasn’t gotten very late yet. Urinary and erectile scores were also nearly identical between arms.
TBL: For anyone out there still doing HDR prostate boosts and elective pelvic nodal coverage, 5-fraction whole pelvis radiation following HDR appears safe in the first two years. | Mendez, Eur Urol Oncol 2026
The Study: The phase 2 non-inferiority HOPE trial enrolled 80 men with unfavorable intermediate to very high risk prostate cancer planned for HDR brachytherapy boost (15 Gy). Patients were randomized 1:1 to receive whole pelvis irradiation either conventionally fractionated (45-46 Gy in 23-25 fractions) versus ultrahypofractionated (25 Gy in 5 fractions delivered every other day). ADT was added per risk group. The primary endpoint was EPIC-50 bowel function at one year with an a priori noninferiority margin set at ≤6 points. At a median follow-up of 3.3 years, ultrahypofractionation was noninferior with nearly identical mean bowel function scores at 1 year and no clinically meaningful differences across domains. Acute bowel declines were actually milder with ultrahypofractionation with no excess late grade 3+ GI events–granting it hasn’t gotten very late yet. Urinary and erectile scores were also nearly identical between arms.
TBL: For anyone out there still doing HDR prostate boosts and elective pelvic nodal coverage, 5-fraction whole pelvis radiation following HDR appears safe in the first two years. | Mendez, Eur Urol Oncol 2026