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World Journal of Urology

Erschienen in:

03.11.2023 | Invited Review

The march toward single-fraction stereotactic body radiotherapy for localized prostate cancer—Quo Vadimus?

verfasst von: Wee Loon Ong, Andrew Loblaw

Erschienen in: World Journal of Urology | Ausgabe 12/2023

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Abstract

Purpose

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for localized prostate cancer. There is increasing interest to reduce the number of fractions for prostate SBRT.

Methods

We provide a narrative review and summary of prospective trials of different fractionation schedules for prostate SBRT, focusing on efficacy, toxicities, and quality of life outcomes.

Results

There are two randomized phase 3 trials comparing standard external beam radiotherapy with ultra-hypofractionated radiotherapy. HYPO-RT-PC compared 78 Gy in 39 fractions vs 42.7 Gy in 7 fractions (3D-CRT or IMRT) showing non-inferiority in 5-year biochemical recurrence-free survival and equivalent tolerability. PACE-B trial compared 78 Gy in 39-fraction or 62 Gy in 20-fraction vs 36.25 Gy in 5-fraction prostate SBRT, with no significant differences in toxicity outcomes at 2 years. Five-year efficacy data for PACE-B are expected in 2024. Five-fraction prostate SBRT is currently the most common and well-established fractionation schedule with multiple prospective phase 2 trials published to date. There is more limited data on 1–4 fraction prostate SBRT. All fractionation schedules had acceptable toxicity outcomes. Experience from a high-dose-rate brachytherapy randomized trial showed inferior efficacy with single-fraction compared to two-fraction brachytherapy. Hence, caution should be applied in adopting single-fraction prostate SBRT.

Conclusion

Two-fraction SBRT is likely the shortest fractionation schedule that maintains the therapeutic ratio. Several randomized trials currently recruiting will likely provide us with more definite answers about whether two-fraction prostate SBRT should become a standard-of-care option. Enrollment of eligible patients into these trials should be encouraged.

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Titel: The march toward single-fraction stereotactic body radiotherapy for localized prostate cancer—Quo Vadimus?
verfasst von: Wee Loon Ong
Andrew Loblaw
Publikationsdatum: 03.11.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 12/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04663-x

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The march toward single-fraction stereotactic body radiotherapy for localized prostate cancer—Quo Vadimus?

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Urologie

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Costims – das nächste heiße Ding in der Krebstherapie?

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Update Urologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

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Abstract

Purpose

Methods

Results

Conclusion

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