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Shortened course of radiotherapy the new standard following prostatectomy

Conference
American Society for Radiation Oncology (ASTRO) Annual Meeting
Reuters Health - 28/10/2021  - After prostate removal, use of fewer but higher doses of radiation does not increase long-term side effect or lead to lower quality of life compared with conventional radiation, according to results of a phase-3 study.

Hypofractionated radiotherapy (HYPORT) "represents a new acceptable practice standard" for men receiving post-prostatectomy radiotherapy, said Dr. Mark Buyyounouski in a presentation of the results at the American Society for Radiation Oncology (ASTRO) annual meeting.

HYPORT is already used routinely in men with prostate cancer who choose not to undergo prostatectomy, based on the results of multiple randomized trials. This trial is the first to assess whether HYPORT is a viable option for men who elect to have their prostates removed, explained Dr. Buyyounouski of Stanford University School of Medicine in California.

He and his colleagues compared patient-reported genitourinary (GU) and gastrointestinal (GI) side effects following post-prostatectomy HYPORT delivered over five weeks versus conventionally fractionated post-operative radiotherapy (COPORT) delivered over seven weeks in 296 men (1:1 randomization).

GU and GI side effects were measured using the Expanded Prostate Cancer Index Composite (EPIC) at the completion of treatment and again at six, 12 and 24 months after treatment.

At the completion of radiation therapy, the average change to patients' GU scores did not differ between treatment groups, but patients treated with HYPORT initially reported worse GI symptoms.

However, by six months there were no between-group differences in patient-reported GU or GI side effects and quality of life, as measured by changes in GU or GI scores, which remained similar to the end of the two-year study period.

HYPORT was "non-inferior to COPORT in terms of patient-reported GU or GI toxicity at two years," Dr. Buyyounouski told attendees.

Dr. Buyyounouski said it's not surprising that men reported some side effects early after treatment.

"Short-term side effects of radiation therapy are well-established, and patients understand that. What patients ultimately want to know is whether the side effects will go away, and that's what we saw in our study," he noted in a conference statement.

Invited discussant for the study, Dr. Sophia Kamran of Massachusetts General Hospital Cancer Center, in Boston, said "the field is moving towards hypofractionated radiation therapy for prostate cancer and it has been widely accepted in the intact setting and it has now been evaluated in the post-prostatectomy setting."

The results of the study in the post-prostatectomy setting are "potentially practice changing," she said.

HYPORT provides "time-saving" and "cost-saving" benefits for patients and allows radiation departments to utilize resources in an improved manner, Dr. Kamran said.

SOURCE: https://bit.ly/2ZvRpxR American Society for Radiation Oncology (ASTRO) Annual Meeting, presented October 25, 2021.

By Megan Brooks



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