Three prominent US medical societies today issued a new clinical guideline for physicians treating men with early-stage prostate cancer using external beam radiation therapy (EBRT).
Adoption of the guideline could make treatment shorter and more convenient for many patients with prostate cancer, the most common malignancy among American men.
Developed by a panel of experts from the American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO) and American Urological Association (AUA), the new guideline recommends offering patients a treatment option known as hypofractionated radiation therapy as an alternative to longer, conventional courses of radiation.
“Conclusive evidence from several large, well-designed randomised trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation,” said Howard Sandler, MD, FASTRO, FASCO, chair and professor of radiation oncology at Cedars-Sinai Medical Centre and co-chair of the guideline panel. “Significant advances in treatment planning and delivery have enabled oncologists to deliver more powerful, life-saving doses of radiation in fewer visits and without compromising quality of life.”
External beam radiation therapy is a standard definitive treatment option that confers outcomes equivalent to radical prostatectomy for men with localised prostate cancer.
When EBRT is hypofractionated, patients receive larger radiation doses across fewer treatment sessions—typically completing treatment in four to five weeks, compared with eight to nine weeks for conventional radiation.
Extremely hypofractionated courses, also known as ultrahypofractionation, stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR), can be completed in as few as five treatments.
The recommendations apply to patients who require or prefer treatment instead of surveillance and have opted for EBRT instead of radical prostatectomy, brachytherapy or other treatment options for localised prostate cancer.
Key recommendations are as follows:
“Men who opt to receive hypofractionated radiation therapy will be able to receive a shorter course of treatment, which is a welcomed benefit to many men. When clinicians can reduce overall treatment time while maintaining outcomes, it’s to our patients’ benefit, as they can spend less time away from family and less time traveling to and from treatment,” said Scott Morgan, MD, FRCPC, assistant professor of radiation oncology at the University of Ottawa and co-chair of the guideline panel.
“Image guidance and other advances in radiation therapy delivery have enabled radiation oncologists to treat prostate cancer with a therapeutic dose of radiation in a shorter treatment period than was previously possible,” said Daniel Barocas, MD, associate professor of urology at Vanderbilt University Medical Centre and guideline co-author. “Results so far show comparable early cancer control to conventional fractionation, while maintaining an acceptable side effect profile. This has benefits to the patient in terms of reducing the treatment burden and cost, and may increase the acceptability of external beam radiation therapy.”
To develop this guideline, a 16-member expert panel of clinicians, researchers and a patient advocate reviewed studies published from December 2001 through March 2017; sixty-one articles, including four large prospective randomised clinical trials with more than 6,000 patients, were evaluated. The guideline was approved by the ASTRO, ASCO and AUA Boards of Directors following a period of public comment. It has been endorsed by the Society of Urologic Oncology (SUO), the European Society for Radiotherapy and Oncology (ESTRO) and the Royal Australian and New Zealand College of Radiologists (RANZCR).
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