Three prominent medical societies issued a new clinical guideline for physicians treating men with early-stage prostate cancer using external beam radiation therapy (EBRT). Adoption of the guideline could make treatment shorter and more convenient for many patients with prostate cancer.
Developed by a panel of experts from the American Society for Radiation Oncology (ASTRO), ASCO, and American Urological Association (AUA), the new guideline recommends offering patients hypofractionated radiation therapy as an alternative to longer, conventional courses of radiation. The organizations published the guideline in their respective journals, Practical Radiation Oncology, Journal of Clinical Oncology, and The Journal of Urology.
“Conclusive evidence from several large, well-designed randomized trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation,” said Howard Sandler, MD, FASTRO, FASCO, Chair and Professor of Radiation Oncology at Cedars-Sinai Medical Center and Co-Chair of the guideline panel. “Significant advances in treatment planning and delivery have enabled oncologists to deliver more powerful, life-saving doses of radiation in fewer visits and without compromising quality of life.”
EBRT is a standard definitive treatment option that confers outcomes equivalent to radical prostatectomy for men with localized prostate cancer. When EBRT is hypofractionated, patients receive larger radiation doses across fewer treatment sessions—typically completing treatment in 4-5 weeks, compared with 8-9 weeks for conventional radiation. Extremely hypofractionated courses, also known as ultrahypofractionation, stereotactic body radiation therapy, or stereotactic ablative radiation therapy, can be completed in as few as five treatments.
The recommendations apply to patients who require or prefer treatment instead of surveillance and have opted for EBRT instead of radical prostatectomy, brachytherapy, or other treatment options for localized prostate cancer. Key recommendations are as follows:
“Men who opt to receive hypofractionated radiation therapy will be able to receive a shorter course of treatment, which is a welcomed benefit to many men. When clinicians can reduce overall treatment time while maintaining outcomes, it’s to our patients’ benefit, as they can spend less time away from family and less time traveling to and from treatment,” said Scott Morgan, MD, FRCPC, Assistant Professor of Radiation Oncology at the University of Ottawa and Co-Chair of the guideline panel.
“Image guidance and other advances in radiation therapy delivery have enabled radiation oncologists to treat prostate cancer with a therapeutic dose of radiation in a shorter treatment period than was previously possible,” noted Daniel Barocas, MD, Associate Professor of Urology at Vanderbilt University Medical Center and guideline co-author. “Results so far show comparable early cancer control to conventional fractionation, while maintaining an acceptable side effect profile. This has benefits to the patient in terms of reducing the treatment burden and cost and may increase the acceptability of external beam radiation therapy.”
To develop this guideline, a 16-member expert panel of clinicians, researchers, and a patient advocate reviewed studies published from December 2001 through March 2017; 61 articles, including four large prospective randomized clinical trials with more than 6,000 patients, were evaluated. The guideline was approved by the ASTRO, ASCO, and AUA Boards of Directors following a period of public comment. It has been endorsed by the Society of Urologic Oncology, European Society for Radiotherapy and Oncology, and Royal Australian and New Zealand College of Radiologists.