Win-win.

We’re talking shorter radiation treatments with better cancer control. We’ve known for a while that moderate hypofractionation (MHFX) for prostate cancer is safe and doesn’t forfeit cancer outcomes. While most fractionation trials had non-inferiority designs, the plot thickens as long-term results start trickling in. Moderate, as opposed to extreme, hypofractionation is generally delivered at 2.5-3 Gy per fraction versus the more orthodox 1.8 Gy per fraction. This phase 3 trial is one of many similar studies initiated circa 2000. It randomized 222 men with any-risk prostate cancer (excluding clinically apparent seminal vesicle invasion, nodal involvement or PSA ≥20) to definitive radiation of 75.6 Gy at 1.8 Gy/fx (>8 weeks) or 72 Gy at 2.4 Gy/fx (6 weeks). Androgen deprivation therapy was per physician preference, which happened in a quarter of cases. Rate of biochemical failure was the primary endpoint, but the kicker here was the authors hypothesized significantly less failures with MHFX. At 8 years, biochemical failures occurred in 11% versus 15% with and without MHFX, meeting statistical significance. TBL: Hypofractionation of definitive radiation for prostate cancer may prove with longer follow-up to be better than non-inferior. | Hoffman, J Clin Oncol 2018