Shorter Course of Radiation Therapy Supported for Prostate Cancer by Oncologists in Editorial

Shorter Course of Radiation Therapy Supported for Prostate Cancer by Oncologists in Editorial

Shorter courses of radiation therapy to fight prostate cancer may be just as effective and safe as longer ones, but less costly and burdening to men with the disease, according to a commentary by two professors of radiation oncology.

The opinion piece, “Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer,” was published online in the International Journal of Radiation Oncology Biology and Physics. It was co-written by Justin Bekelman at the University of Pennsylvania’s Perelman School of Medicine and W. Robert Lee at Duke University School of Medicine.

Prostate cancer treatment currently involves daily radiation sessions that can extend to up to nine weeks. Moderate hypofractionation is a shorter radiation therapy consisting of daily sessions with a slightly higher dosage of radiation, taking only four or five weeks.

“Moderate hypofractionation is high-quality, patient-friendly cancer care at lower cost,” Bekelman said in a news release. “It is equivalent to longer radiation schedules in curing prostate cancer, has similar side effects, and is more convenient. Men can get back to their lives more quickly, which means less time away from the activities they enjoy and less time distracted by their cancer treatments.”

Three clinical trials (CHHiP, NRG 0415, and PROFIT) compared the effectiveness and safety of shorter and longer radiation programs. The trials enrolled a total of 5,537 men at low and intermediate risk of prostate cancer. Medical measurements and patients’ reports showed that both programs had similar effectiveness and side effects, regardless of age, race, disease severity or whether patients had previously received hormone therapy, the commentary states.

Moderate hypofractionation also costs less, both for patients and treatment centers.

“For patients, moderate hypofractionation would reduce transportation costs and out-of-pocket expenses, especially as high-deductible health plans become more prevalent in American health care,” researchers wrote. “Moderate hypofractionation would reduce time away from work (absenteeism) and distracted work (presenteeism), defined as when employees are at work but not present or productive. In short, moderate hypofractionation would reduce the financial toxicity of prostate cancer and its treatment.”

“This is a win-win-win for patients, payers and employers,” Bekelman said, “The field of radiation oncology should be recognized for technical advances in clinical care that have achieved safe, effective, curative treatment for prostate cancer in fewer weeks.”

Doctors say this information should routinely be discussed with patients. But, Bekelman noted, trials to date show no evidence that much shorter regimens lasting as few as five sessions are effective and further study is needed.

Still, he argued: “If we take a clear-eyed look at the evidence, it is unmistakable that many men can get radiation in four to five weeks, a shorter time frame than in the past. We should move forward to adopt moderate hypofractionation radiation schedules in routine care for appropriate men with prostate cancer.”