The big short.

Top Line: Another year, another meta-analysis looking to prove the merits of ultra-hypofractionated radiation for prostate cancer.

The Study: This one includes phase 3 randomized prospective trials (n=7) comprising 6795 patients. Of these, 42% received conventional fractionation (≥40 fractions), 49% hypofractionation (15-25 fractions), and only 9% ultra-hypofractionation (7 fractions). Now you can see why we’re still left looking to meta-analyses. Across all cohorts, 73-90% of patients had intermediate risk disease, and no patient receiving ultra-hypofractionation had low-risk disease, namely because they were all drawn from a single trial (HYPO-RT-PC). The primary outcome here was disease-free survival (DFS) rates at 5-years, typically defined as alive without evidence of biochemical failure (PSA nadir + 2 ng/mL), using a random effects model to address study heterogeneity. These were 85%, 86% and 85%, respectively. Rates of late grade 2+ GI toxicity were 12%, 15%, and 10%, respectively, and of late grade 2+ GU toxicity 19%, 20%, and 18%.

TBL: Until more prospective head-to-head data emerges, comparing other trial data to HYPO-RT-PC indicates ultra-hypofractionated radiation for prostate cancer is as effective and safe as more protracted treatments. | Lehrer, Radiother Oncol 2020