Seven year itch.

The 7-year results of the HYPRO trial confirm 5-year initial reporting that moderately hypofractionated prostate radiation doesn’t confer superior relapse-free survival compared to conventional fractionation. As a reminder, in contrast to many of the other hypofractionated prostate trials, HYPRO was ambitiously designed as a superiority trial. It included men with intermediate- and high-risk disease randomized to 3.4 Gy x 19 = 64.6 Gy or 2 Gy x 39 = 78 Gy. At 7 years, just over 25% of patients in each arm experienced treatment failure. The primary endpoint of relapse-free survival was 72% with the 19 treatments and 68% with 39. In other words, not statistically different. While this may technically be billed as a loss for hypofractionation, especially considering toxicity and patient-reported quality of life wasn’t non-inferior, half the treatment time still makes for double the patient convenience. TBL: While clearly not worse, prostate hypofractionation wasn’t clearly better than conventional fractionation per long-term results of the phase 3 HYPRO trial. | de Vries, Int J Radiat Oncol Biol Phys 2019