• Karen E Hoffman, K Ranh Voong, Lawrence B Levy, Pamela K Allen, Seungtaek Choi, Pamela J Schlembach, Andrew K Lee, Sean E McGuire, Quynh Nguyen, Thomas J Pugh, Steven J Frank, Rajat J Kudchadker, Weiliang Du, and Deborah A Kuban.
• Karen E. Hoffman, Lawrence B. Levy, Pamela K. Allen, Seungtaek Choi, Pamela J. Schlembach, Sean E. McGuire, Quynh Nguyen, Steven J. Frank, Rajat J. Kudchadker, Weiliang Du, and Deborah A. Kuban, The University of Texas, MD Anderson Cancer Center, Houston; Andrew K. Lee, Texas Center for Proton Therapy, Irving, TX; K. Ranh Voong, The Johns Hopkins Hospital, Baltimore, MD; and Thomas J. Pugh, University of Colorado School of Medicine, Boulder, CO.
• J. Clin. Oncol. 2018 Oct 10; 36 (29): 2943-2949.

PurposeHypofractionated radiotherapy delivers larger daily doses of radiation and may increase the biologically effective dose delivered to the prostate. We conducted a randomized trial testing the hypothesis that dose-escalated, moderately hypofractionated intensity-modulated radiation therapy (HIMRT) improves prostate cancer control compared with conventionally fractionated IMRT (CIMRT) for men with localized prostate cancer.Patients And MethodsMen were randomly assigned to 75.6 Gy in 1.8-Gy fractions delivered over 8.4 weeks (CIMRT) or 72 Gy in 2.4 Gy fractions delivered over 6 weeks (HIMRT, biologically equivalent to 85 Gy in 1.8-Gy fractions assuming prostate cancer α-to-β ratio of 1.5). Failure was defined as prostate-specific antigen (PSA) failure (nadir plus 2 ng/mL) or initiation of salvage therapy. Modified Radiation Therapy Oncology Group criteria were used to grade late (≥ 90 days after completion of radiotherapy) GI and genitourinary toxicity.ResultsMost of the 206 men (72%) had cT1, Gleason score 6 or 7 (99%), and PSA level ≤ 10 ng/mL (90%) disease. Androgen deprivation therapy was received by 24%. With a median follow-up of 8.5 years, men treated with HIMRT experienced fewer treatment failures (n = 10) than men treated with CIMRT (n = 21; P = .036). The 8-year failure rate was 10.7% (95% CI, 5.8% to 19.1%) with HIMRT and 15.4% (95% CI, 9.1% to 25.4%) with CIMRT. There was no difference in overall survival ( P = .39). There was a nonsignificant increase in late grade 2 or 3 GI toxicity with HIMRT (8-year 5.0% v 12.6%; P = .08). However, GI toxicity was only 8.6% when rectal volume receiving 65 Gy of HIMRT was ≤ 15%. Late genitourinary toxicity was similar ( P = .84). There was no grade 4 toxicity.ConclusionThe results of this randomized trial demonstrate superior cancer control for men with localized prostate cancer who receive dose-escalated moderately hypofractionation radiotherapy while shortening treatment duration.

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