Lancet Oncol 2016 Aug
Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
Related Questions
Has the HYDRA study of hypofractionated radiation, and its discussion in the 2026 NCCN guidelines for prostate cancer, changed your approach to moderate hypofractionation in either prostate-only or prostate and pelvic node radiation?
Very few of us can gain substantial wealth by giving 8 more fractions to prostate cancer. I certainly can't earn more by simply giving 28 or even 45 fractions or a 100 fx. The vast majority of us are now employed, and based on median RVU stats, a minority of us even reach a threshold to bonus or eve...
When treating prostate cancer with moderate hypo-fractionation, what urethral dose constraints do you consider when boosting the dominate intraprostatic lesion?
At this point in time, I don't think there is a good answer to this question. The CHHiP trial, which led to the adoption of the 60 Gy in 3 Gy fraction schedule, did not have a dose constraint for the urethra. The FLAME trial, which demonstrated safety and efficacy for an SIB to a dominant intraprost...
When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?
I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...
What dose do you prescribe when treating the prostate in patients with low metastatic burden and what are your dose constraints?
I follow the STAMPEDE regimen - either 55 Gy in 20 daily fractions or 36 Gy in 6 weekly fractions. One of the imperatives of the STAMPEDE investigators was to not subject men with low volume metastatic prostate cancer to toxicity - and they found these doses of did not, while still significantly imp...
Can SBRT be considered for high risk prostate cancer?
There are many ways to address this question:1. The academic "letter of the law" purist: "If a patient population was included within a clinical trial then the trial results apply to them. Subset analyses are hypothesis-generating."By this logic: HYPO-RT PC enrolled about 11% high-risk disease and s...
Is it appropriate to use moderate hypofractionation for the treatment of patients with high-risk prostate cancer?
At Fox Chase, we conducted a phase III randomized prospective clinical trial comparing conventionally fractionated IMRT with moderately hypofractionated IMRT from 2002-2008, for men with intermediate and high risk prostate cancer. Men were randomized to 76 Gy in 38 fractions or 70.2 Gy in 26 fractio...
When you do recommend conventional fractionation over moderate hypofractionation for prostate cancer?
I am routinely using 2.5-3 Gy in patients with low, intermediate, and some high risk patients so I guess I am an early adopter (or a cavalier nutjob). The exclusion criteria from the two published non-inferiority trials of moderate hypofractionation that are relevant to this question are quoted more...
Can any non-SBRT hypo fractionation regimen for prostate cancer be regarded as the new standard of care, or as an equal alternative standard of care?
RTOG 04-15 (N = 1092) – W Robert Lee et al. Disease state: Low risk PC Randomization: 73.8 Gy RT in 1.8 Gy fx’s versus 70 Gy RT in 2.5 Gy fx’s (Non-inferiority design) Median Follow up: 5.8 years Toxicity: Significant increases in both Gr 2 + and Gr 3 + late GI and late GU toxicity with hypofraction...