Ultrahypofractionation of localized prostate cancer Statement from the DEGRO working group prostate cancer

• Published in: Strahlentherapie und Onkologie Vol. 197; no. 2; pp. 89 - 96
• Main Authors: Wolf, Frank, Sedlmayer, Felix, Aebersold, Daniel, Albrecht, Clemens, Böhmer, Dirk, Flentje, Michael, Ganswindt, Ute, Ghadjar, Pirus, Höcht, Stefan, Hölscher, Tobias, Müller, Arndt-Christian, Niehoff, Peter, Pinkawa, Michael, Schmidt-Hegemann, Nina-Sophie, Zamboglou, Constantinos, Zips, Daniel, Wiegel, Thomas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2021
• Subjects: Clinical Trials as Topic; Humans; Male; Medicine; Medicine & Public Health; Oncology; Prostate - radiation effects; Prostatic Neoplasms - radiotherapy; Radiation Dose Hypofractionation; Radiotherapy; Review; Review Article; Treatment Outcome; Hypofractionation; SABR; Extreme hypofractionation; Radiotherapy; SBRT
• ISSN: 0179-7158; 1439-099X; 1439-099X
• DOI: 10.1007/s00066-020-01723-8

Due to its low fractionation sensitivity, also known as “alpha/beta ratio,” in relation to its surrounding organs at risk, prostate cancer is predestined for hypofractionated radiation schedules assuming an increased therapeutic ratio compared to normofractionated regimens. While moderate hypofractionation (2.2–4 Gy) has been proven to be non-inferior to normal fractionation in several large randomized trials for localized prostate cancer, level I evidence for ultrahypofractionation (>4 Gy) was lacking until recently. An accumulating body of non-randomized evidence has recently been strengthened by the publication of two randomized studies comparing ultrahypofractionation with a normofractionated schedule, i.e., the Scandinavian HYPO-RT trial by Widmark et al. and the first toxicity results of the PACE‑B trial. In this review, we aim to give a brief overview of the current evidence of ultrahypofractionation, make an overall assessment of the level of evidence, and provide recommendations and requirements that should be followed before introducing ultrahypofractionation into routine clinical use.