Table 1.
Summary table of randomized studies comparing moderate hypofractionation and conventional fractionation in prostate cancer
| Study | Risk | Technique | ADT (%) | Number of patients | Fractionation total dose/fractions/dose per fraction | Treatment duration | BED α/β 1.8 Gy | BED α/β 3.0 Gy | BED α/β 10 Gy | Acute toxicity ≥grade 2 GI | Acute toxicity ≥grade 2 GU | Late toxicity ≥grade 2 GI | Late toxicity ≥grade 2 GU | 5-year biochemical relapse-free survival (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Superiority randomized studies | ||||||||||||||
| Arcangeli [30] | LR/IR 24% HR 76% | CFRT | 100 | 85 | 80 Gy/40 fractions/2 Gy per fraction | 8 weeks | 168.9 | 133.3 | 96.0 | 21 | 40 | 14 | 11 | 92.0 |
| 100 | 83 | 62 Gy/20 fractions/3.1 Gy per fraction | 4 weeks | 168.8 | 126.1 | 81.2 | 35 | 47 | 17 | 16 | 96.0 | |||
| Hoffman [29] | LR 28% IR 71% HR 1% | IG-IMRT | 23 | 101 | 75.6 Gy/42 fractions/1.8 Gy per fraction | 8.4 weeks | 151.2 | 121.0 | 89.2 | 5.1 | 16.5 | 92.0 | ||
| 25 | 102 | 72 Gy/30 fractions/2.4 Gy per fraction | 6 weeks | 168.0 | 129.6 | 89.3 | 10 | 15.8 | 96.0 | |||||
| Pollack [31] | IR 36% HR 64% | IMRT | 47 | 151 | 76 Gy/38 fractions/2 Gy per fraction | 7.6 weeks | 160.4 | 126.7 | 91.2 | 47.7 | 22.5 | 13.4 | 85.0 | |
| 45 | 152 | 70.2 Gy/26 fractions/2.7 Gy per fraction | 5.2 weeks | 175.5 | 133.4 | 89.2 | 44.9 | 18.1 | 21.5 | 81.0 | ||||
| HYPRO [2–17, 18••, 19–21, 22•] | IR 27% HR 73% | CFRT | 67 | 410 | 78 Gy/39 fractions/2 Gy per fraction | 7.8 weeks | 164.7 | 130.0 | 93.6 | 31.2 | 57.8 | 17.7 (G3 + toxicity 2.6%) | 39 (G3 + toxicity 12.9%) | 77.0 |
| 67 | 410 | 64.6 Gy/19 fractions/3.4 Gy per fraction | 6.5 weeks | 186.6 | 137.8 | 86.6 | 42 | 60.5 | 21.9 (G3 + toxicity 3.3%) | 41.3 (G3 + toxicity 19%) | 81.0 | |||
| Non-inferiority randomized studies | ||||||||||||||
| RTOG 0415 [23•] | LR | IMRT 79–80% CFRT 20–21% | 0 | 542 | 73.8 Gy/41 fractions/1.8 Gy per fraction | 8.2 weeks | 147.6 | 118.1 | 87.1 | 10.3 | 27.1 | 14 | 22.8 | 85.3 |
| 0 | 550 | 70 Gy/28 fractions/2.5 Gy per fraction | 5.6 weeks | 167.2 | 128.3 | 87.5 | 10.7 | 27 | 22.4 | 29.7 | 86.3 | |||
| PROFIT [24•] | IR | IGRT | 0 | 598 | 78 Gy/39 fractions/2 Gy per fraction | 7.8 weeks | 164.7 | 130.0 | 93.6 | >G3 GI/GU 5.4% | 79.0 | |||
| IGRT | 0 | 608 | 60 Gy/20 fractions/3 Gy per fraction | 4 weeks | 160.0 | 120.0 | 78.0 | >G3 GI/GU 3.5% | 79.0 | |||||
| CHHiP [18••, 19, 27] | LR 15% IR 73% HR 12% | IMRT +/− IGRT | 97 | 1065 | 74 Gy/37 fractions/2 Gy per fraction | 7.4 weeks | 156.2 | 123.3 | 88.8 | 25 | 46 | 13.7 | 9.2 | 88.3 |
| 97 | 1074 | 60 Gy/20 fractions/3 Gy per fraction | 4 weeks | 160.0 | 120.0 | 78.0 | 38 | 49 | 12 | 11.7 | 90.6 | |||
| 97 | 1077 | 57 Gy/19 fractions/3 Gy per fraction | 3.8 weeks | 152.0 | 114.0 | 74.1 | 38 | 46 | 11.2 | 6.6 | 85.9 | |||
LR/IR/HR low/intermediate/high risk prostate cancer, CFRT conformal radiotherapy, IMRT intensity-modulated radiotherapy, IGRT image-guided radiotherapy, BED biological effective dose, ADT androgen deprivation therapy, GI gastrointestinal, GU genitourinary