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Randomised trials showed that 20 treatments over four weeks, and for many men five, control localised prostate cancer as well as 37 to 39, and England's national guideline has offered the four-week course since 2019. In New South Wales its use rose from 5.2 to 40.3 per cent of men between 2014 and 2018, and an international survey found it used less for high-risk disease.
The evidence. CHHiP randomised 3,216 men between 74 Gy in 37 fractions over 7.4 weeks and two shorter schedules. At five years, 88.3 per cent were free of biochemical or clinical failure with 74 Gy and 90.6 per cent with 60 Gy in 20 fractions, which was non-inferior; 57 Gy in 19 fractions was not shown to be non-inferior. Long-term bowel and bladder side effects were similar. PACE-B randomised 874 men with low or, mostly, intermediate-risk disease between five-fraction stereotactic radiotherapy (36.25 Gy) and 20 or 39 fractions: five-year freedom from failure was 95.8 against 94.6 per cent, also non-inferior, but late grade 2 or worse urinary side effects were more common with five fractions, 26.9 against 18.3 per cent, while bowel effects were the same. The five-treatment course is therefore a trade a man can be offered with its numbers, not a free gain.
The guideline. NICE NG131 recommendation 1.3.19 (2019): "offer hypofractionated radiotherapy (60 Gy in 20 fractions) using image-guided intensity modulated radiation therapy (IMRT), unless contraindicated".
The measured gap. In New South Wales outpatient radiotherapy data for 4,915 men treated with curative intent between 2014 and 2018, the four-week schedule rose from 5.2 to 40.3 per cent, and the treating oncologist and the facility had the largest influence on which schedule a man received. In the 2018 to 2019 ESTRO Global Impact of Radiotherapy in Oncology survey of 1,157 radiation oncologists, 52 and 47 per cent reported using hypofractionation in at least half of low- and intermediate-risk patients, falling to 35 per cent for high-risk disease and 20 per cent where the pelvic nodes were treated; respondents in middle- and low-income countries were less likely to prefer it, and the commonest barrier given was fear of worse late side effects. OnCo did not find a national audit of fractionation in England.
One trial page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
One trial page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
Moderate hypofractionation (60 Gy in 20 fractions) is a standard of care for localised prostate cancer, halving the number of hospital visits.
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Shares Knowledge reaches practice too slowly and the tags protocol-upgrade, upgrade:proven-unevenly-used.
Shares Most of the world has almost no cancer care and the tags protocol-upgrade, upgrade:proven-unevenly-used.
Shares Knowledge reaches practice too slowly and the tags protocol-upgrade, upgrade:proven-unevenly-used.
Shares Knowledge reaches practice too slowly and the tags protocol-upgrade, upgrade:proven-unevenly-used.
Shares Knowledge reaches practice too slowly and the tags protocol-upgrade, upgrade:proven-unevenly-used.
Shares Prostate cancer and the tags protocol-upgrade, upgrade:proven-unevenly-used.
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