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Thread: Seven or less Fractions is Not the Standard of Care for Intermediate-Risk PCa

  1. #1

    Seven or less Fractions is Not the Standard of Care for Intermediate-Risk PCa

    Seven or less Fractions is Not the Standard of Care for Intermediate-Risk Prostate Cancer [2019, Review, Full Text]

    https://www.sciencedirect.com/scienc...36655519304558

    Abstract

    Evidence is accumulating for seven and less fractions in localised prostate cancer, including one large randomised trial. However, there is much more evidence yet to come and changing practice in advance of this may be premature. We review the reasons to persist with moderate hypofractionation for prostate cancer radiotherapy, until the results of further phase III studies are known.
    Full Text:

    Introduction
    Prostate-specific Antigen Outcomes of Moderate Hypofractionation
    Deficit in Evidence for Stereotactic Body Radiotherapy
    Toxicity Outcomes of Moderate Hypofractionation
    Could Stereotactic Body Radiotherapy be Worse for Quality of Life?
    Radiobiology – Is all as It Seems?
    Cost-Effectiveness
    Conclusion

    The data supporting five-fraction SBRT looks encouraging. However, aside from the seven-fraction HYPO-RT trial, the equivalence of UHC to standard fractionation has not yet been proven. We propose that the global standard remains moderate hypofractionation, in 60 Gy in 20 fractions or similar, until current phase III trials of five-fraction SBRT are published. Better safe than sorry.
    I would note that "Seven or less Fractions..." is not the Standard of English for formal English in journals either, but I digress
    Last edited by DjinTonic; 11-12-2019 at 01:01 PM.

  2. #2
    Quote Originally Posted by DjinTonic View Post
    I would note that "Seven or less Fractions..." is not the Standard of English for formal English in journals either, but I digress
    'Snow White & The 7 Fractions' will save substantial time & $s to healthcare systems and 6 weeks of additional treatment time to the patient. This may draw more patients away from surgery over to SBRT. Will have to wait for the trail results.

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  3. #3
    Quote Originally Posted by Michael F View Post
    'Snow White & The 7 Fractions' will save substantial time & $s to healthcare systems and 6 weeks of additional treatment time to the patient. This may draw more patients away from surgery over to SBRT. Will have to wait for the trail results.

    MF
    Indeed, if the Phase III trial results are favorable, RT should gain more ground.

    See also this, just published:

    Hypofractionated radiotherapy versus conventional radiotherapy in patients with intermediate- to high-risk localized prostate cancer: a meta-analysis of randomized controlled trials [2019, Full Text]

    Abstract
    Background
    Prostate cancer is one of the most common cancers in the world. The results of treatment after hypofractionated radiotherapy only have been reported from several small randomized clinical trials. Therefore, we conducted a meta-analysis to compare clinical outcomes of hypofractionated radiotherapy versus conventional radiotherapy in the treatment of intermediate- to high-risk localized prostate cancer.

    Methods
    Relevant studies were identified through searching related databases till August 2018. Hazard ratio (HR) or risk ratio (RR) with its corresponding 95% confidence interval (CI) was used as pooled statistics for all analyses.

    Results
    The meta-analysis results showed that overall survival (HR = 1.12, 95% CI: 0.93–1.35, p = 0.219) and prostate cancer-specific survival (HR = 1.29, 95% CI: 0.42–3.95, p = 0.661) were similar in two groups. The pooled data showed that biochemical failure was RR = 0.90, 95% CI: 0.76–1.07, p = 0.248. The incidence of acute adverse gastrointestinal events (grade ≥ 2) was higher in the hypofractionated radiotherapy (RR = 1.70, 95% CI: 1.12–2.56, p = 0.012); conversely, for late grade ≥ 2 gastrointestinal adverse events, a significant increase in the conventional radiotherapy was found (RR = 0.75, 95% CI: 0.61–0.91, p = 0.003). Acute (RR = 1.01, 95% CI: 0.89–1.15, p = 0.894) and late (RR = 0.98, 95% CI: 0.86–1.10, p = 0.692) genitourinary adverse events (grade ≥ 2) were similar for both treatment groups.

    Conclusion
    Results suggest that the efficacy and risk for adverse events are comparable for hypofractionated radiotherapy and conventional radiotherapy in the treatment of intermediate- to high-risk localized prostate cancer.
    Djin
    Last edited by DjinTonic; 11-12-2019 at 03:13 PM.

 

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