<p><strong> </strong><strong>Clinicians should offer moderate hypofractionated EBRT for patients with high-risk prostate cancer who are candidates for EBRT. <em>(Moderate Recommendation; Evidence Level: Grade C)</em></strong></p>
Discussion
Discussion
<p>As noted previously, moderate hypofractionation holds important advantages in terms of patient convenience and resource utilization. Moreover, multiple large-scale randomized prospective clinical trials have been completed comparing moderately hypofractionated and conventionally fractionated EBRT.<sup>231, 256, 298, 299</sup> These studies have demonstrated that moderate hypofractionation confers similar prostate-cancer-control outcomes and similar rates of late toxicity compared to conventional fractionation. In one study, men with intermediate- to high-risk prostate adenocarcinoma were randomized to receive C-IMRT (76 Gy in 38 fractions; n=152) or H-IMRT (70.2 Gy in 26 fractions; n=151).<sup>256</sup> High-risk patients were prescribed 24 months of ADT. Intermediate-risk patients were prescribed 4 months of ADT at the discretion of the treating physician. The primary end point was the cumulative incidence of biochemical and/or clinical disease failure. Median follow up was 130 months (range 7 to 181 months). Ten-year biochemical disease-free survival was similar in both arms (25.9% in the C-IMRT arm and 30.6% in the H-IMRT arm; HR 1.31, 95% CI 0.82 to 2.11). The two treatment groups also had similar rates of 10-year freedom from metastatic disease, prostate cancer-specific, and OS. The authors concluded that H-IMRT demonstrated no difference in disease outcomes when compared to C-IMRT at 10 years.<sup>256</sup><sup> </sup></p>
<p><span>Of note, </span>ultra hypofractionation in high-risk patients receiving EBRT with elective nodal coverage is not currently recommended outside a clinical trial or multi-institutional registry due to insufficient comparative evidence.<sup>260</sup></p>