Ultrahypofractionated Versus Conventionally Fractionated Whole-pelvis Radiotherapy in Prostate Cancer: A Randomized...

Area of Science:

• Oncology
• Radiation Oncology
• Clinical Trials

Background:

• The role of ultrahypofractionated whole-pelvis radiotherapy (UH-WPRT) compared to conventionally fractionated WPRT (CF-WPRT) is not well-established.
• Prostate cancer treatment often involves pelvic radiotherapy, with varying fractionation schedules impacting outcomes and toxicity.

Purpose of the Study:

• To compare toxicity and patient-reported outcomes between UH-WPRT and CF-WPRT in prostate cancer patients receiving a high-dose-rate brachytherapy boost.
• To evaluate bowel and urinary function using the Expanded Prostate Cancer Index Composite (EPIC-50) questionnaire one year after treatment.

Main Methods:

• A phase 2, multi-institutional, randomized clinical trial (HOPE trial) involving 80 patients with intermediate- to very high-risk prostate cancer.
• Patients were randomized 1:1 to receive either CF-WPRT or UH-WPRT, with both groups receiving a high-dose-rate prostate brachytherapy boost.
• Patient-reported outcomes were assessed using the EPIC-50 questionnaire at one year post-treatment.

Main Results:

• At one year, mean EPIC bowel function scores were noninferior between UH-WPRT and CF-WPRT groups (88.4 ± 12.1 vs. 90.6 ± 11.1).
• No significant differences were observed in bowel total or bother scores, nor in urinary subdomains between the treatment arms.
• Late grade 3-5 genitourinary or gastrointestinal toxicities were minimal, with one case of grade 3 genitourinary toxicity in the UH-WPRT arm.

Conclusions:

• Ultrahypofractionated whole-pelvis radiotherapy is as well-tolerated as conventionally fractionated whole-pelvis radiotherapy when combined with a high-dose-rate brachytherapy boost for prostate cancer.
• These findings support UH-WPRT as a viable alternative fractionation schedule, offering comparable patient-reported outcomes and toxicity profiles.