Hypofractionation for prostate cancer. Cancer J 2009;15(1):1-6
Date
02/07/2009Pubmed ID
19197165Pubmed Central ID
PMC3039916DOI
10.1097/PPO.0b013e3181976614Scopus ID
2-s2.0-61449210091 (requires institutional sign-in at Scopus site) 67 CitationsAbstract
Hypofractionation for prostate cancer was originally carried out in the pursuit of efficiency and convenience but has now attracted greatly renewed interest based upon a hypothesis that prostate cancers have a higher sensitivity to fraction size, reflected in a low alpha/beta ratio, than do late responding organs at risk such as the rectum or bladder. Tumor control and acceptable toxicity outcomes from several hypofractionation or brachytherapy analyses do in fact support an alpha/beta ratio for prostate cancer that is low, perhaps even lower that that for the normal organs that ordinarily constrain the delivery of radiation therapy. However, many of these studies lack sufficient patient numbers and follow-up, are clouded by dose inhomogeneity issues in the case of brachytherapy, or delivered effective doses that were too low by contemporary standards. Thus, the clinical efficacy of the approach has yet to be fully validated. However, a number of newer prospective trials, some randomized, are underway or have reached accrual but await sufficient follow-up for analysis. These studies, which cover a wide range of doses per fraction, should ultimately be capable of validating the utility of prostate hypofractionation and the models that predict its effects. With hypofractionation's significant potential for therapeutic gain, cost savings, and improved patient convenience, the future management of localized prostate cancer could be profoundly altered in the process.
Author List
Ritter M, Forman J, Kupelian P, Lawton C, Petereit DMESH terms used to index this publication - Major topics in bold
BrachytherapyDose-Response Relationship, Radiation
Humans
Linear Models
Male
Prostatic Neoplasms
