Hypofractionated, Dose-Escalated Radiation Versus Conventionally Fractionated Radiation for Localized Prostate Cancer: Long-Term Update of a Phase III, Prospective, Randomized Controlled Trial
Menée à partir des données d'un essai randomisé de phase III, cette étude compare les résultats à long terme (durée médiane de suivi : 13,2 ans) d'une radiothérapie conventionnelle avec modulation d'intensité (75,6 Gy en fractions de 1,8 Gy) et une radiothérapie hypofractionnée avec modulation d'intensité (72 Gy en fractions de 2,4 Gy) chez des patients atteints d'un cancer de la prostate localisé à risque faible ou intermédiaire de récidive
The MD Anderson dose-escalated, hypofractionated prostate radiation study was a phase III randomized trial comparing conventionally fractionated intensity-modulated radiation therapy (CIMRT, 75.6 Gy in 1.8-Gy fractions) with dose-escalated, hypofractionated intensity-modulated radiation (HIMRT, 72 Gy in 2.4-Gy fractions) in patients with localized prostate cancer, predominantly low-risk and intermediate-risk disease. The initial publication highlighted statistically fewer treatment failures in the HIMRT arm. We present long-term updated 13-year outcomes to determine whether cancer control benefit was maintained and to evaluate distant metastases post hoc. With a median follow-up of 13.2 years (IQR, 8.8-15.9 years), treatment failure occurred less frequently in men undergoing HIMRT (n = 13) compared with those undergoing CIMRT (n = 22), although the difference no longer meets statistical significance (P = .08). Distant metastases were rare, and no statistically significant difference was noted (P = .2). There remained no statistically significant difference in late GI 2+ (10-year 10% HIMRT v 4% CIMRT, P = .09) or genitourinary grade 2+ toxicity (10-year 26% v 23%, P = .5).
Journal of Clinical Oncology , résumé, 2025