The American Society for Radiation Oncology (ASTRO) has released an updated clinical guideline that recommends shorter-course external beam radiation therapy (EBRT) for patients with localized prostate cancer.
The update includes a strong recommendation for five-session stereotactic body radiation therapy (SBRT) as a standard option for many patients, ASTRO said. Published October 27 in Practical Radiation Oncology, the guideline replaces ASTRO’s 2018 recommendations, which had only conditionally recommended ultrahypofractionation.
Moderate hypofractionation is typically delivered over four to six weeks, while ultrahypofractionation, most often given as SBRT, is completed in five sessions over one to two weeks, ASTRO noted.
Key recommendations include the following:
Moderate hypofractionation over conventional fractionation for patients across all risk groups, regardless of age, comorbidity, anatomy, or baseline urinary function. Randomized trials involving more than 7,000 patients support this approach.
Ultrahypofractionation as a treatment option for patients with low-risk disease who decline active surveillance and for those with intermediate-risk disease. It is conditionally recommended for patients with high-risk or very high-risk disease.
Moderate hypofractionation over ultrahypofractionation for patients with significant baseline urinary symptoms (conditional).
Dose schedules of 6,000 cGy to 6,200 cGy in 20 fractions or 7,000 cGy in 28 fractions for moderate hypofractionation, and 3,625 cGy to 4,000 cGy in five fractions for ultrahypofractionation (conditional). Regimens of fewer than five fractions are not recommended outside a clinical trial.
Ultrahypofractionation for elective pelvic nodal treatment only as part of a clinical trial (conditional).
ASTRO developed the guideline with the American Society of Clinical Oncology, the American Urological Association (AUA), the European Society for Radiotherapy and Oncology (ESTRO), and the Society of Urologic Oncology (SUO). The AUA, ESTRO, and SUO have endorsed it.
