Hypofractionation infatuation.

June 16, 2017. This week’s JCO pub looks at 1206 patients with intermediate risk prostate cancer randomized to receive 78 Gy / 39 (8 wks) versus 60 Gy / 20 (4 wks) of definitive radiation without androgen deprivation therapy (ADT). With a median follow-up of 6 years, the primary endpoint of freedom from biochemical failure was 85% in both arms, meeting a predefined non-inferiority threshold without the expense of additional late GU and GI toxicity. This supports last year’s JCO pub establishing non-inferiority of 70 Gy / 28 for low risk prostate cancer. And on the other end of the disease spectrum, final results of a phase 3 trial of hypofractionation in high risk prostate cancer (though negative in terms of its primary endpoint of improving late toxicity) interestingly showed a trend towards improved cancer-specific survival at 10-years with 62 Gy / 20 (95%) versus 80 Gy / 40 (88%, p=0.066). Looks like curing prostate cancer is getting shorter and sweeter every day.

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