Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries

Mohamed Shelan,Pirus Ghadjar,Clemens Albrecht,Michael Pinkawa,Felix Sedlmayer,Tobias Hölscher,Michael Flentje,Ute Ganswindt,Daniel Zips,Nina-Sophie Schmidt-Hegemann,Dirk Böhmer,Frank Wolf,Stefan Höcht,Arndt-Christian Müller,Peter Niehoff,Thomas Wiegel,Constantinos Zamboglou,Daniel M Aebersold

doi:10.1007/s00066-021-01820-2

Abstract

PurposeVarious randomized phase III clinical trials have compared moderately hypofractionated to normofractionated radiotherapy (RT). These modalities showed similar effectiveness without major differences in toxicity. This project was conducted by the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society. We aimed to investigate expert opinions on the use of moderately hypofractionated RT as a definitive treatment for localized prostate cancer in German-speaking countries.MethodsA 25-item, web-based questionnaire on moderate-hypofractionation RT was prepared by an internal committee. The experts of the DEGRO were asked to complete the questionnaire.ResultsFourteen active members of DEGRO completed the questionnaire. The questions described indications for selecting patients eligible to receive moderate hypofractionation based on clinical and pathological factors such as age, urinary symptoms, and risk-group. The questions also collected information on the technical aspects of selection criteria, including the definition of a clinical target volume, the use of imaging, protocols for bladder and rectal filling, the choice of a fractionation schedule, and the use of image guidance. Moreover, the questionnaire collected information on post-treatment surveillance after applying moderately hypofractionated RT.ConclusionAlthough opinions varied on the use of moderate-hypofractionation RT, the current survey reflected broad agreement on the notion that moderately hypofractionated RT could be considered a standard treatment for localized prostate cancer in German-speaking countries.

Highlights

Materials and methodsIn recent years, hypofractionated radiotherapy (RT), where high doses per fraction are delivered over a relatively short overall treatment duration, has become increasingly popular
Conclusion opinions varied on the use of moderate-hypofractionation RT, the current survey reflected broad agreement on the notion that moderately hypofractionated RT could be considered a standard treatment for localized prostate cancer in German-speaking countries
Nine (64%) experts apply prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) computed tomography (CT) for staging and/or treatment planning

Summary

Introduction

In recent years, hypofractionated radiotherapy (RT), where high doses per fraction are delivered over a relatively short overall treatment duration, has become increasingly popular. Ultrahypofractionated external beam RT is currently emerging, where doses of 5 Gy or more are delivered per fraction [1, 2]. More data are available on moderately hypofractionated RT, which delivers doses between 2.2 and 4 Gy per fraction. A Cochrane methodology review covered 10 randomized trials, and of those, three provided long-term followup data [3]. Fractionation schemes and study endpoints differed among the trials, but the trials showed no differences in oncological outcomes between normal and hypofractionated RT. Due to the differences in these trials regarding patient characteristics, fractionation, treatment planning, and treatment delivery, an “optimal” protocol for moderately hypofractionated RT remains to be determined

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