Hypofractionation mode in the treatment of prostate cancer
V.A. Solodkii, A.Yu. Pavlov, G.A. Panshin, R.A. Gafanov, P.V. Polushkin, T.R. Izmailov
Russian Research Center of Radiology and Nuclear Medicine, Moscow
In the 1980s, a significant difference in the response of normal and malignant tissues to irradiation depending on the fractionation time and mode was revealed. Most likely, this is due to the difference in the proportion of dividing cells. In 1999, it was proved that this relationship is true for most tumors, but it was completely unsuitable for prostate cancer due to the fact that this tumor is characterized by slow growth. Using data from the results of remote radiotherapy and brachytherapy, it was shown that the reaction to the fractionation regime in prostate cancer is more similar to that of late-responsive, rather than early-responsive tissues. Moderate hypofractionation, usually involving 15–25 fractions with a single fraction dose of 2.5–3.5 Gy, is not inferior to standard fractionation, including 40 to 45 fractions with a single fraction dose of 2 Gy. Recently, extreme hypofractionation, usually comprising from 4 to 7 fractions with much higher doses per fraction, has been studied. It is too early to judge the significance of extreme hypofractionation in routine practice, however, early toxicity is a concern.
Key words: prostate cancer, external beam radiation therapy, hypofractionation, single fraction dose.
For citation: Solodkii V.A., Pavlov A.Yu., Panshin G.A. Hypofractionation mode in the treatment of prostate cancer // RMJ. Medical Review. 2018. № 12. P. 52–56.
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2. Coutard H. The Results and Methods of Treatment of Cancer by Radiation // Ann Surg. 1937. Vol. 106. P.584–598.
3. Thames H.D. Jr, Withers H.R., Peters L.J. et al. Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships // Int. Journal Radiat. Oncol. Biol. Phys. 1982. Vol. 8. P.219–226.
4. Horiot J.C., Le Fur R., N’Guyen T. et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy // Radiother. Oncol. 1992. Vol. 25. P.231–241.
5. Brenner D.J., Hall E.J. Fractionation and protraction for radiotherapy of prostate carcinoma // Int. Journal Radiat. Oncol. Biol. Phys. 1999. Vol. 43. P.1095–1101.
6. Duchesne G.M., Peters L.J. What is the a/b ratio for prostate cancer? Rationale for hypofractionated high-dose-rate brachytherapy // Int. Journal Radiat. Oncol. Biol. Phys. 1999. Vol. 44. P.747–748.
7. Brenner D.J., Martinez A.A., Edmundson G.K. et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low a/b ratio), similar to late-responding normal tissue // Int. Journal Radiat. Oncol. Biol. Phys. 2002. Vol. 52. P.6–13.
8. Wang J.Z., Guerrero M., Li X.A. How low is the a/b ratio for prostate cancer? // Int. Journal Radiat. Oncol. Biol. Phys. 2003. Vol. 55. P.194–203.
9. Bentzen S.M., Ritter M.A. The alpha/beta ratio for prostate cancer: what is it, really? // Radiother. Oncol. 2005. Vol. 76. P.1–3.
10. Williams S.G., Taylor J.M., Liu N. et al. Use of individual fraction size data from 3756 patients to directly determine the alpha/beta ratio of prostate cancer // Int. Journal Radiat. Oncol. Biol. Phys. 2007. Vol. 68. P.24–33.
11. Proust-Lima C., Taylor J.M., Secher S. et al. Confirmation of a low alpha/beta ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics // Int. Journal Radiat. Oncol. Biol. Phys. 2011. Vol. 79. P.195–201.
12. Miralbell R., Roberts S.A., Zubizarreta E. et al. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: alpha/beta = 1.4 (0.9–2.2) Gy // Int. Journal Radiat. Oncol. Biol. Phys. 2012. Vol. 82. P.17–24.
13. Vogelius I.R., Bentzen S.M. Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news? // Int. Journal Radiat. Oncol. Biol. Phys. 2013. Vol. 85. P.89–94.
14. Pedicini P., Strigari L., Benassi M. Estimation of a self-consistent set of radiobiological parameters from hypofractionated versus standard radiation therapy of prostate cancer // Int. Journal Radiat. Oncol. Biol. Phys. 2013. Vol. 85. P.231–237.
15. Boonstra P.S., Taylor J.M., Smolska-Ciszewska B. et al. Alpha/beta (alpha/beta) ratio for prostate cancer derived from external beam radiotherapy and brachytherapy boost // Br. Journal Radiol. 2016. Vol. 89(1061). P.20150957.
16. Thames H.D., Bentzen S.M., Turesson I. et al.
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