Ultra-Hypofractionated Radiation ‘Well Tolerated’ For Localised Prostate Cancer

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Patient-reported quality of life (QoL) outcomes in the HYPO-RT-PC trial add further support for use of ultra-hypofractionated radiotherapy for intermediate-to-high risk localised prostate cancer. 

The phase III open-label study investigators previously reported that the radiotherapy regimen of 42.7 Gy in seven fractions at a rate of 3 days/week offered noninferior 5-year failure-free survival and toxicity compared with a conventional regimen of 78.0 Gy in 39 fractions given 5 days/week for men with T1c–T3a disease with a Gleason score of at least 7 and/or a prostate-specific antigen level of 10–20 ng/mL. 

Patients were also assessed for the secondary endpoint of QoL using the Prostate Cancer Symptom Scale and the EORTC QLQ-C30 before and after radiotherapy, after 3, 6, 12 and 24 months, and then every other year for up to 10 years, with a final assessment at 15 years. Median follow-up in the study was 48 months. 

As reported in The Lancet Oncology, ultra-hypofractionated radiotherapy was associated with a higher frequency of clinically relevant deteriorations at the end of treatment than conventional radiation for seven of the 10 bowel symptoms reported.  

In particular, patients in the ultra-hypofractionated radiation arm were significantly more likely than those in the control arm to experience adverse changes in stool frequency, rush to toilet, flatulence, bowel cramps, mucus, bloody stools and limitations in daily life, say Per Fransson, from Umeå University in Sweden, and co-authors. 

However, there were no differences between the two treatment arms with regard to clinically relevant acute urinary symptoms or sexual functioning at the end of radiation, or indeed any discrepancies in bowel, urinary or sexual function measures at any later point in the study. 

Overall, 66% of the 220 patients given ultra-hypofractionation radiation and 71% of the 223 patients given conventional therapy completed the QoL questionnaire at 6 years. 

At this time, urinary bother occurred in a comparable 28% of patients given ultra-hypofractionated radiation and 33% of those given conventional therapy, with similar rates in the two arms also reported for bowel bother (28 vs 33%), sexual bother (50 vs 60%) and deterioration of global health/QoL (37 vs 42%). 

“Although acute toxicity was higher for ultra-hypofractionation than conventional fractionation, this long-term patient-reported QOL analysis shows that ultra-hypofractionation was as well tolerated as conventional fractionation up to 6 years after completion of treatment”, the team summarises. 

The authors conclude that their “study adds to the growing evidence for ultra-hypofractionated radiotherapy becoming standard treatment for intermediate-to-high-risk prostate cancer, but further long-term studies are needed to confirm this.” 

Reference  

Fransson P, Nilsson P, Gunnlaugsson A, et al. Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer (HYPO-RT-PC): patient-reported quality-of-life outcomes of a randomised, controlled, non-inferiority, phase 3 trial. Lancet Oncol; Advance online publication 11 January 2020. doi:10.1016/S1470-2045(20)30581-7