Ultrahypofractionation of localized prostate cancer
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REVIEW ARTICLE
Ultrahypofractionation of localized prostate cancer Statement from the DEGRO working group prostate cancer Frank Wolf1 · Felix Sedlmayer1 · Daniel Aebersold2 · Clemens Albrecht3 · Dirk Böhmer4 · Michael Flentje5 · Ute Ganswindt6 · Pirus Ghadjar4 · Stefan Höcht7 · Tobias Hölscher8 · Arndt-Christian Müller9 · Peter Niehoff10 · Michael Pinkawa11 · Nina-Sophie Schmidt-Hegemann12 · Constantinos Zamboglou13 · Daniel Zips9 · Thomas Wiegel14 Received: 12 November 2020 / Accepted: 17 November 2020 © The Author(s) 2020
Abstract Due to its low fractionation sensitivity, also known as “alpha/beta ratio,” in relation to its surrounding organs at risk, prostate cancer is predestined for hypofractionated radiation schedules assuming an increased therapeutic ratio compared to normofractionated regimens. While moderate hypofractionation (2.2–4 Gy) has been proven to be non-inferior to normal fractionation in several large randomized trials for localized prostate cancer, level I evidence for ultrahypofractionation (>4 Gy) was lacking until recently. An accumulating body of non-randomized evidence has recently been strengthened by the publication of two randomized studies comparing ultrahypofractionation with a normofractionated schedule, i.e., the Scandinavian HYPO-RT trial by Widmark et al. and the first toxicity results of the PACE-B trial. In this review, we aim to give a brief overview of the current evidence of ultrahypofractionation, make an overall assessment of the level of evidence, and provide recommendations and requirements that should be followed before introducing ultrahypofractionation into routine clinical use.
Keywords Extreme hypofractionation · Radiotherapy · Hypofractionation · SBRT · SABR
Frank Wolf
[email protected] 1
Universitätsklinik für Radiotherapie und Radio-Onkologie, LKH, Universitätsklinikum, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020 Salzburg, Austria
7
Xcare Praxis für Strahlentherapie Saarlouis, Xcare Gruppe, Saarlouis, Germany
8
Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
9
Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Tübingen, Germany
10
Sana Klinikum Offenbach, Offenbach, Germany
11
MediClin Robert Janker Klinik, Bonn, Germany
Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin, Berlin, Germany
12
Klinik für Radio-Onkologie, Universitätsklinikum der LMU, Munich, Germany
Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg, Germany
13
Klinik für Radio-Onkologie, Universitätsklinikum Freiburg, Freiburg, Germany
Universitätsklinik für Strahlentherapie-Radioonkologie, Innsbruck, Austria
14
Abteilung Strahlentherapie, Universitätsklinikum Ulm, Ulm, Germany
2
Universitätsklinik für Radio-Onkologie, Inselspital, Universität Bern, Bern, Switzerland
3
Klinik für Radioonkologie und Gemeinschaftspraxis für Strahlentherapie, Klinikum Nürnberg Nord, Univer
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