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Alternate Fractionation in Radiotherapy pp 241–256Cite as

Hypofractionated Radiotherapy in Genitourinary Cancer: Better with Less

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Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Over the years, most innovations in hypofractionated radiotherapy for malignancies of the genitourinary tract have involved treatment of prostate cancer, which will therefore be the main focus of this chapter. The rationale for hypofractionated radiotherapy, contemporary treatment techniques, and results of clinical trials of hypofractionated external beam radiation therapy (EBRT) or stereotactic body radiation therapy (SBRT) are discussed. Finally, the implications of clinical data on general practice and future directions of research are discussed.

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References

  • Al-Mamgani A, van Putten WL, Heemsbergen WD et al (2008) Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 72:980–988

    Article  PubMed  Google Scholar 

  • Al-Mamgani A, Heemsbergen WD, Peeters ST, Lebesque JV (2009) Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys 73:685–691

    Article  PubMed  Google Scholar 

  • Aluwini S, van Rooij P, Hoogeman M et al (2013) Stereotactic body radiotherapy with a focal boost to the MRI-visible tumor as monotherapy for low- and intermediate-risk prostate cancer: early results. Radiat Oncol 8:84. doi:10.1186/1748-717X-8-84

    Article  PubMed  PubMed Central  Google Scholar 

  • Aluwini S, Pos F, Schimmel E et al (2015) Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomized non-inferiority phase 3 trial. Lancet Oncol 16:274–283

    Article  PubMed  Google Scholar 

  • Aluwini S, Pos FJ, Schimmel E et al (2016) Hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: late toxicity in the Dutch randomized phase III hypofractionation trial (HYPRO). Lancet Oncol 4:464–474

    Article  Google Scholar 

  • Arcangeli G, Saracino B, Gomellini S et al (2010) A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 78:11–18

    Article  PubMed  Google Scholar 

  • Arcangeli G, Fowler J, Gomellini S et al (2011) Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 79:1013–1021

    Article  PubMed  Google Scholar 

  • Arcangeli S, Strigari L, Gomellini S et al (2012) Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 84:1172–1178

    Article  PubMed  Google Scholar 

  • Beltran C, Herman MG, Davis BJ (2008) Planning target margin calculations for prostate radiotherapy based on intrafraction and interfraction motion using four localization methods. Int J Radiat Oncol Biol Phys 70:289–295

    Article  PubMed  Google Scholar 

  • Bolla M, Maingon P, Carrie C et al (2016) Short androgen suppression and radiation dose escalation for intermediate- and high-risk localized prostate cancer: results of EORTC trial 22991. J Clin Oncol 34:1748–1756

    Article  CAS  PubMed  Google Scholar 

  • Bolzicco G, Favretto MS, Satariano N et al (2013) A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy. BMC Urol 13:49-2490-13-49

    Article  Google Scholar 

  • Brenner DJ, Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43:1095–1101

    Article  CAS  PubMed  Google Scholar 

  • Brenner D, Armour E, Corry P, Hall E (1998) Sublethal damage repair times for a late-responding tissue relevant to brachytherapy (and external-beam radiotherapy): implications for new brachytherapy protocols. Int J Radiat Oncol Biol Phys 41:135–138

    Article  CAS  PubMed  Google Scholar 

  • Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-comparing-surgery-conventional-radiotherapy-and-stereotactic-radiotherapy-for-localised-prostate-cancer-pace#undefined, 2016a. Accessed 14 Oct 2016

  • Cancer Research UK. Prostate cancer statistics-key facts. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer, 2016b. Accessed 6 Oct 2016

  • Clinicaltrials.gov. Hypofractionated focal lesion ablative microboost in prostatE cancer (Hypo-FLAME) (NCT02853110), 2016. Accessed 14 Oct 2016 2016

    Google Scholar 

  • Collins CD, Lloyd-Davies RW, Swan AV (1991) Radical external beam radiotherapy for localized carcinoma of the prostate using a hypofractionation technique. Clin Oncol (R Coll Radiol) 3:127–132

    Article  CAS  Google Scholar 

  • D’Amico AV, Denham JW, Crook J et al (2007) Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol 25:2420–2425

    Article  PubMed  Google Scholar 

  • D’Amico AV, Chen MH, Renshaw AA, Loffredo M, Kantoff PW (2008) Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA 299:289–295

    Article  PubMed  Google Scholar 

  • Dale RG (1985) The application of the linear-quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Radiol 58:515–528

    Article  CAS  PubMed  Google Scholar 

  • Dasu A, Toma-Dasu I (2012) Prostate alpha/beta revisited—an analysis of clinical results from 14,168 patients. Acta Oncol 51:963–974

    Article  PubMed  Google Scholar 

  • Dearnaley DP, Sydes MR, Graham JD et al (2007) Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomized controlled trial. Lancet Oncol 8:475–487

    Article  PubMed  Google Scholar 

  • Dearnaley D, Syndikus I, Mossop H et al (2016) Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomized, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 17:1047–1060

    Article  PubMed  PubMed Central  Google Scholar 

  • Deutschmann H, Kametriser G, Steininger P et al (2012) First clinical release of an online, adaptive, aperture-based image-guided radiotherapy strategy in intensity-modulated radiotherapy to correct for inter- and intrafractional rotations of the prostate. Int J Radiat Oncol Biol Phys 83:1624–1632

    Article  PubMed  Google Scholar 

  • Duncan W, Warde P, Catton CN et al (1993) Carcinoma of the prostate: results of radical radiotherapy (1970–1985). Int J Radiat Oncol Biol Phys 26:203–210

    Article  CAS  PubMed  Google Scholar 

  • Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidences and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 5:E359–E386

    Article  Google Scholar 

  • Fowler JF (2005) The radiobiology of prostate cancer including new aspects of fractionated radiotherapy. Acta Oncol 44:265–276

    Article  PubMed  Google Scholar 

  • Fuller DB, Naitoh J, Mardirossian G (2014) Virtual HDR CyberKnife® SBRT for localized prostatic carcinoma: 5-year disease-free survival and toxicity observations. Front Oncol 4:321

    PubMed  PubMed Central  Google Scholar 

  • Hoffman KE, Voong KR, Pugh TJ et al (2014) Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial. Int J Radiat Oncol Biol Phys 88:1074–1084

    Article  PubMed  Google Scholar 

  • Incrocci L, Wortel RC, Alemayehu WG et al (2016) Hypofractionated versus conventionally fractionated radiotherapy for patients with localized prostate cancer (HYPRO): final efficacy results from a randomized, multicentre, open-label, phase 3 trial. Lancet Oncol 8:1061–1069

    Article  Google Scholar 

  • ISRCTN Registry-Phase III study of HYPOfractionated radiotherapy of intermediate risk localized prostate cancer (ISRCTN45905321), 2016. Accessed 6 Oct 6 2016

    Google Scholar 

  • Jones CU, Hunt D, McGowan DG et al (2011) Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med 365:107–118

    Article  CAS  PubMed  Google Scholar 

  • Katz AJ, Kang J (2014a) Quality of life and toxicity after SBRT for organ-confined prostate cancer, a 7-year study. Front Oncol 4:301

    PubMed  PubMed Central  Google Scholar 

  • Katz A, Kang J (2014b) Stereotactic body radiotherapy with or without external beam radiation as treatment for organ confined high-risk prostate carcinoma: a six year study. Radiat Oncol 9:1. doi:10.1186/1748-717X-9-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Kilby W, Dooley JR, Kuduvalli G et al (2010) The CyberKnife® robotic radiosurgery system in 2010. Technol Cancer Res Treat 9:433–452

    Article  CAS  PubMed  Google Scholar 

  • Kim DW, Cho LC, Straka C et al (2014) Predictors of rectal tolerance observed in a dose-escalated phase 1-2 trial of stereotactic body radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 89:509–517

    Article  PubMed  Google Scholar 

  • King CR, Brooks JD, Gill H et al (2012) Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys 82:877–882

    Article  PubMed  Google Scholar 

  • Kirkpatrick JP, Meyer JJ, Marks LB (2008) The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol 18:240–243

    Article  PubMed  Google Scholar 

  • Kratzik CW, Schatzl G, Lunglmayr G, Rucklinger E, Huber J (2005) The impact of age, body mass index and testosterone on erectile dysfunction. J Urol 174:240–243

    Article  PubMed  Google Scholar 

  • Kuban DA, Nogueras-Gonzalez GM, Hamblin L et al (2010) Preliminary report of a randomized dose escalation trial for prostate cancer using hypofractionation. Int J Radiat Oncol Biol Phys 78:S58–S59

    Article  Google Scholar 

  • Lee WR, Dignam JJ, Amin MB et al (2016) Randomized phase III non-inferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol 34:2325–2332

    Article  PubMed  PubMed Central  Google Scholar 

  • Lips IM, van der Heide UA, Haustermans K et al (2011) Single blind randomized phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial. Trials 12:255-6215-12-255

    Article  Google Scholar 

  • Loblaw A, Cheung P, D’Alimonte L et al (2013) Prostate stereotactic ablative body radiotherapy using a standard linear accelerator: toxicity, biochemical, and pathological outcomes. Radiother Oncol 107:153–158

    Article  PubMed  Google Scholar 

  • Lukka H, Hayter C, Julian JA et al (2005) Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol 23:6132–6138

    Article  PubMed  Google Scholar 

  • Mantz C (2014) A phase II trial of stereotactic ablative body radiotherapy for low-risk prostate cancer using a non-robotic linear accelerator and real-time target tracking: report of toxicity, quality of life, and disease control outcomes with 5-year minimum follow-up. Front Oncol 4:279

    Article  PubMed  PubMed Central  Google Scholar 

  • Michalski JM, Yan Y, Watkins-Bruner D et al (2013) Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the radiation therapy oncology group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys 87:932–938

    Article  PubMed  Google Scholar 

  • Miralbell R, Roberts SA, Zubizarreta E, Hendry JH (2012) Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: alpha/beta = 1.4 (0.9–2.2) Gy. Int J Radiat Oncol Biol Phys 82:e17–e24

    Article  PubMed  Google Scholar 

  • Nijkamp J, Pos FJ, Nuver TT et al (2008) Adaptive radiotherapy for prostate cancer using kilovoltage cone-beam computed tomography: first clinical results. Int J Radiat Oncol Biol Phys 70:75–82

    Article  PubMed  Google Scholar 

  • Peeters ST, Heemsbergen WD, Koper PC et al (2006) Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 24:1990–1996

    Article  PubMed  Google Scholar 

  • Pollack A, Zagars GK, Starkschall G et al (2002) Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 53:1097–1105

    Article  PubMed  Google Scholar 

  • Pollack A, Hanlon AL, Horwitz EM et al (2006) Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial. Int J Radiat Oncol Biol Phys 64:518–526

    Article  PubMed  Google Scholar 

  • Pollack A, Walker G, Horwitz EM et al (2013) Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol 31:3860–3868

    Article  PubMed  PubMed Central  Google Scholar 

  • Potters L, Gaspar LE, Kavanagh B et al (2010) American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guidelines for image-guided radiation therapy (IGRT). Int J Radiat Oncol Biol Phys 76:319–325

    Article  PubMed  Google Scholar 

  • Read G, Pointon RC (1989) Retrospective study of radiotherapy in early carcinoma of the prostate. Br J Urol 63:191–195

    Article  CAS  PubMed  Google Scholar 

  • Ritter M (2008) Rationale, conduct, and outcome using hypofractionated radiotherapy in prostate cancer. Semin Radiat Oncol 18:249–256

    Article  PubMed  PubMed Central  Google Scholar 

  • Saylor PJ, Smith MR (2009) Metabolic complications of androgen deprivation therapy for prostate cancer. J Urol 181:1998–2006. discussion 2007–8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Spratt DE, Pei X, Yamada J et al (2013) Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 85:686–692

    Article  PubMed  Google Scholar 

  • Tucker SL, Thames HD, Michalski JM et al (2011) Estimation of alpha/beta for late rectal toxicity based on RTOG 94-06. Int J Radiat Oncol Biol Phys 81:600–605

    Article  PubMed  PubMed Central  Google Scholar 

  • van de Water S, Valli L, Aluwini S et al (2014) Intrafraction prostate translations and rotations during hypofractionated robotic radiation surgery: dosimetric impact of correction strategies and margins. Int J Radiat Oncol Biol Phys 88:1154–1160

    Article  PubMed  Google Scholar 

  • Wilkins A, Mossop H, Syndikus I et al (2015) Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localized prostate cancer: 2-year patient-reported outcomes of the randomized, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 16:1606–1616

    Article  Google Scholar 

  • Wortel RC, Incrocci L, Pos FJ et al (2015) Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 91:737–744

    Article  PubMed  Google Scholar 

  • Wortel RC, Incrocci L, Pos FJ et al (2016a) Late side effects after image guided intensity modulated radiation therapy compared to 3D-conformal radiation therapy for prostate cancer: results from 2 prospective cohorts. Int J Radiat Oncol Biol Phys 95:680–689

    Article  PubMed  Google Scholar 

  • Wortel RC, Pos FJ, Heemsbergen WD, Incrocci L (2016b) Sexual function after hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: results from the randomized phase III HYPRO trial. J Sex Med 11:1695–1703

    Article  Google Scholar 

  • Xie Y, Djajaputra D, King CR, Hossain S, Ma L, Xing L (2008) Intrafractional motion of the prostate during hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys 72:236–246

    Article  PubMed  PubMed Central  Google Scholar 

  • Yeoh EE, Botten RJ, Butters J et al (2011) Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys 81:1271–1278

    Article  PubMed  Google Scholar 

  • Zimmermann M, Taussky D, Menkarios C et al (2016) Prospective phase II trial of once-weekly hypofractionated radiation therapy for low-risk adenocarcinoma of the prostate: late toxicities and outcomes. Clin Oncol (R Coll Radiol) 28:386–392

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Erasmus Medical Center, Rotterdam, The Netherlands

    Ruud C. Wortel & Luca Incrocci

Authors
  1. Ruud C. Wortel
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  2. Luca Incrocci
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Correspondence to Ruud C. Wortel .

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Editors and Affiliations

  1. Allegheny General Hospital Allegheny Health Network Cancer Institute, Drexel University College of Medicine, Pittsburgh, PA, USA

    Mark Trombetta

  2. Radiation Oncology Department, Erasmus University Medical Center, Rotterdam, The Netherlands

    Jean-Philippe Pignol

  3. Allegheny Health Network, Temple University School of Medicine, Pittsburgh Campus, Pittsburgh, PA, USA

    Paolo Montemaggi

  4. Hylda Cohn/American Cancer Society, Drexel University College of Medicine, Philadelphia, PA, USA

    Luther W. Brady

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Wortel, R.C., Incrocci, L. (2017). Hypofractionated Radiotherapy in Genitourinary Cancer: Better with Less. In: Trombetta, M., Pignol, JP., Montemaggi, P., Brady, L.W. (eds) Alternate Fractionation in Radiotherapy. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_37

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  • DOI: https://doi.org/10.1007/174_2017_37

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  • Print ISBN: 978-3-319-51197-9

  • Online ISBN: 978-3-319-51198-6

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