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In Prostate Cancer, Moderate Hypofractionation Could Be New Standard

Shannon Connelly
Published: Tuesday, Mar 28, 2017

James B. Yu, MD

James B. Yu, MD

A recent emergence of data is showcasing the efficacy of moderate hypofractionation as a quicker way to administer radiation therapy in patients with prostate cancer, compared with the conventional radiation treatment. The novel method, according to James B. Yu, MD, may very well be on its way to an adoption as the new standard of care.

, Yu, associate professor of therapeutic oncology, and director, Prostate and Genitourinary Cancer Radiotherapy Program, at Yale Cancer Center, discussed the current data in support of using moderate hypofractionation in prostate cancer, as well as recent data showing how genomic testing can help with treatment decision making postoperatively.

OncLive: Can you give an overview of your talk on current and emerging standards in radiation therapy for prostate cancer?

Yu: I talked about both current and emerging standards. Currently, the new standard with the most evidence behind it is something called moderate hypofractionation for prostate cancer. There’s been 3 randomized trials now showing that you can speed up the radiation treatment with equivalent cancer control.

The other topics I talked about were proton radiation, high-dose rate brachytherapy, prostate rectum spacing using something called a hydrogel gel, and finally, I talked briefly about genomic tests and their ability to help with decision making postoperatively—whether you should give radiation or not.

What data has there been so far in support of moderate hypofractionation?

There have been multiple randomized trials. The key trials are what is called noninferiority trials, which are trials that are trying to show that this new treatment is not inferior to the control treatment. These noninferiority trials need a lot more patients [than usual], so kudos to them for finishing them.

The US studies, including RTOG 0415, which was presented by W. Robert Lee, MD, [during the 2016 Genitourinary Cancers Symposium] showed equivalent, noninferior cancer control, and basically equivalent side effects, and maybe a slight increase in moderate side effects.1

Recently, the PROFIT study came out, by Charles N. Catton, MD, and team, also showing the same thing that RTOG 0415 showed, with a slightly different fractionation scheme. Then the CHIPS study out of the United Kingdom also showed the same thing. Basically, everyone’s showing maybe a little more toxicity, acutely, mainly because you’re giving the radiation faster, but noninferior cancer control.

In your opinion, will everyone adopt moderate hypofractionation as the new standard?

Moderate hypofractionation will be adopted across the country to replace hypofractionation if there’s a couple more years of data. I think the comparison is with breast cancer where they took 8 to 10 years of follow-up, even sometimes 12 years of follow-up, before the community accepted this faster radiation treatment. It looks like it’s on the way. I think many academics are of the opinion that moderate hypofractionation is the new standard, but there’s always many academics and people in the community who I think will still wait for more data to accrue.

What did you discuss in terms of genomic tests and their ability to help with decision making postoperatively?

I mentioned the University of Michigan’s PORTOS test and the Decipher test. The one with more data right now is Decipher. A paper that came out in the Journal of Clinical Oncology, the first author was Robert Den, MD, showed that this score can prognosticate about whether someone will benefit from radiation or not in the postoperative setting.2 That’s a big deal because when we radiate people postoperatively, it’s a little bit of a gamble because we’re hoping that there is cancer in the treatment volume you’re radiating. If the cancer is away from what you’re radiating, no amount of radiation in the world is going to help because you’re not radiating in the right spot.


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