Rationale, conduct, and outcome using hypofractionated radiotherapy in prostate cancer.

Seminars in Radiation Oncology
Mark A Ritter

Abstract

Hypofractionated radiation therapy for prostate cancer has become of increasing interest with the recognition of a potential improvement in therapeutic ratio with treatments delivered in larger-sized fractions. In addition, the associated reduction in fraction number produces attractive cost and patient convenience advantages as well. A still limited but growing number of hypofractionation trials have reported acceptable short-term levels of toxicity and biochemical control, but most have insufficient follow-up to ensure the long-term safety and efficacy of this approach. This situation will improve as many currently active trials mature, particularly several high-value randomized trials. In contrast, extreme hypofractionation, with schedules delivering only on the order of 5 fractions, is truly in its infancy for prostate cancer, with extremely limited tolerance and efficacy information currently available. Several uncertainties in the radiobiology of hypofractionation mitigate for an organized, cautious investigational approach. The fractionation response (alpha/beta ratio) of prostate cancers and, for that matter, late-responding normal tissues, has yet to be rigorously defined. Additionally, the linear-quadratic (LQ) model ...Continue Reading

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