The shorter radiation treatment -
known as moderate hypofractionation - consists of four to five weeks of
daily radiation treatments.
Radiation therapy, along with surgery, hormone therapy, and
active surveillance - known as watchful waiting - has been a mainstay of
treatment for prostate cancer in the United States. Overall, about
one-third of men with prostate cancer receive some type of radiation
therapy. For men older than 65, radiation therapy is the most common
prostate cancer treatment.
‘Men with prostate cancer can receive shorter courses of radiation therapy than what is currently considered standard.’
Currently, standard radiation treatment for prostate cancer involves daily treatments that can last up to nine weeks.
Men with prostate cancer can receive shorter courses of radiation
therapy than what is currently considered standard, according to Justin
Bekelman, an associate professor of Radiation Oncology, Medical
Ethics, and Health Policy at the University of Pennsylvania's Perelman
School of Medicine and Abramson Cancer Center.
In his call for practice
change, Bekelman cites research showing that moderate hypofractionation is just as effective at treating
cancer, while costing less and easing the burden on patients. The
commentary was published online by the International Journal of Radiation Oncology Biology and Physics
and was co-authored by W. Robert Lee, a professor of Radiation Oncology at the Duke University School of Medicine.
"Moderate hypofractionation is high-quality, patient-friendly
cancer care at lower cost," Bekelman said. "It is equivalent to longer
radiation schedules in curing prostate cancer, has similar side effects,
and is more convenient. Men can get back to their lives more quickly,
which means less time away from the activities they enjoy and less time
distracted by their cancer treatments."
Moderate hypofractionation uses a slightly higher dosage of
radiation for each daily treatment compared to what is currently used
for most other radiation regimens in the United States. Three
multi-center randomized trials compared the shorter and longer
approaches. All told, the CHHiP, NRG 0415, and PROFIT trials looked at
5,537 patients with mostly low and intermediate risk prostate cancer.
They showed both approaches led to similar cancer control as well as
similar side effects - as measured by doctors and as reported by patients
themselves. The results held across different ages and races and
despite the severity of the disease. There was also no change based on
whether patients had undergone hormone therapy, a common treatment for
prostate cancer which lowers the male hormone and can be combined with
Bekelman points out that fewer radiation treatments not only
means less out-of-pocket costs and fewer visits to treatment centers for
patients; it also means lower costs for payers and employers.
"This is a win-win-win for patients, payers, and employers,"
Bekelman said, "The field of radiation oncology should be recognized for
technical advances in clinical care that have achieved safe, effective,
curative treatment for prostate cancer in fewer weeks."
While moderate hypofractionation should now be discussed
routinely with patients, Bekelman cautions the trials do not offer any
evidence for more extreme regimens lasting as few as five radiation
treatments. These much shorter courses may have additional risks and
remain under study in several large U.S. and European clinical trials.
This is not the first time Bekelman has argued for moderately
shorter radiation schedules. Two years ago, he found two-thirds of women
treated for early-stage breast cancer in the U.S. receive longer
radiation therapy than necessary, despite research that pointed to the
need for change years earlier. This time around, he says he doesn't want
to see this history of overtreatment repeat itself.
"If we take a clear-eyed look at the evidence, it is
unmistakable that many men can get radiation in 4 to 5 weeks, a shorter
time frame than in the past," Bekelman said. "We should move forward to
adopt moderate hypofractionation radiation schedules in routine care for
appropriate men with prostate cancer."