Top Line: Does hypofractionation result in a lower long-term risk of disease failure after prostate radiation?
The Study: There have been several randomized trials comparing dose-escalated conventional fractionation and moderate hypofractionation for intact prostate cancer. One of those was a randomized, phase 3 trial from MD Anderson in which 206 patients receiving definitive external beam RT for prostate cancer were randomized to receive 75.6 Gy in 42 fractions or 72 Gy in 30 fractions–both using IMRT. The majority (71%) had intermediate risk disease (43.7% favorable-IR, 27.7% unfavorable-IR), and 24.3% received short term ADT. In a previous report from this trial, hypofractionation resulted in a significantly lower risk of failure at 8 years compared to conventional fractionation (10.7% v 15.4%). Now, with over 13 years median follow up, hypofractionation maintained numerical superiority in the risk of failure at 10 years, but the difference was no longer statistically significant (21% v 11%, P=.08). Among those who did not receive ADT, the risk of failure was significantly lower with hypofractionation (13% v 26%). There were no differences in OS or DM between groups, and the cumulative rates of RTOG grade 2+ GU and GI toxicity were 26% v 23% and 10% v 4%, respectively.
TBL: Ten-year outcomes from the MD Anderson hypofractionation trial show a lower risk of failure after moderate hypofractionation particularly among those who do not receive ADT. | Hassanzadeh, J Clin Oncol 2025
The Study: There have been several randomized trials comparing dose-escalated conventional fractionation and moderate hypofractionation for intact prostate cancer. One of those was a randomized, phase 3 trial from MD Anderson in which 206 patients receiving definitive external beam RT for prostate cancer were randomized to receive 75.6 Gy in 42 fractions or 72 Gy in 30 fractions–both using IMRT. The majority (71%) had intermediate risk disease (43.7% favorable-IR, 27.7% unfavorable-IR), and 24.3% received short term ADT. In a previous report from this trial, hypofractionation resulted in a significantly lower risk of failure at 8 years compared to conventional fractionation (10.7% v 15.4%). Now, with over 13 years median follow up, hypofractionation maintained numerical superiority in the risk of failure at 10 years, but the difference was no longer statistically significant (21% v 11%, P=.08). Among those who did not receive ADT, the risk of failure was significantly lower with hypofractionation (13% v 26%). There were no differences in OS or DM between groups, and the cumulative rates of RTOG grade 2+ GU and GI toxicity were 26% v 23% and 10% v 4%, respectively.
TBL: Ten-year outcomes from the MD Anderson hypofractionation trial show a lower risk of failure after moderate hypofractionation particularly among those who do not receive ADT. | Hassanzadeh, J Clin Oncol 2025