Hypofractionated Radiation Therapy for Localized Prostate Cancer

Publication Date: October 1, 2018
Last Updated: March 14, 2022

Guideline Statements

In men with low-risk prostate cancer who decline active surveillance and receive EBRT to the prostate with or without radiation to the seminal vesicles, moderate hypofractionation should be offered.
6731
In men with intermediate-risk prostate cancer receiving EBRT to the prostate with or without radiation to the seminal vesicles, moderate hypofractionation should be offered.
6731

In men with high-risk prostate cancer receiving EBRT to the prostate, but not including pelvic lymph nodes, moderate hypofractionation should be offered.

6731
In patients who are candidates for EBRT, moderate hypofractionation should be offered regardless of patient age, comorbidity, anatomy, or urinary function. However, physicians should discuss the limited follow-up beyond five years for most existing RCTs evaluating moderate hypofractionation.
6731
Men should be counseled about the small increased risk of acute gastrointestinal (GI) toxicity with moderate hypofractionation. Moderately hypofractionated EBRT has a similar risk of acute and late genitourinary (GU) and late GI toxicity compared to conventionally fractionated EBRT. However, physicians should discuss the limited follow-up beyond five years for most existing RCTs evaluating moderate hypofractionation.
6731
Regimens of 6000 cGy delivered in 20 fractions of 300 cGy and 7000 cGy delivered in 28 fractions of 250 cGy are suggested since they are supported by the largest evidentiary base. One optimal regimen cannot be determined since most of the multiple fractionation schemes evaluated in clinical trials have not been compared head to head.
6731
One moderately hypofractionated regimen is not suggested over another for cancer control for specific risk groups and the efficacy of moderately hypofractionated EBRT regimens does not appear to be impacted by patient age, comorbidity, anatomy, or urinary function.
6731
In men with low-risk prostate cancer who decline active surveillance and choose active treatment with EBRT, ultrahypofractionation may be offered as an alternative to conventional fractionation.
6731
In men with intermediate-risk prostate cancer receiving EBRT, ultrahypofractionation may be offered as an alternative to conventional fractionation. The task force strongly encourages that these patients be treated as part of a clinical trial or multi-institutional registry.
6731
In men with high-risk prostate cancer receiving EBRT, the task force does not suggest offering ultrahypofractionation outside of a clinical trial or multi-institutional registry due to insufficient comparative evidence.
6731
Ultrahypofractionated prostate EBRT of 3500 to 3625 cGy in 5 fractions of 700 to 725 cGy to the planning target volume may be offered to low- and intermediate-risk patients with prostate sizes less than 100 cm3. The key dose constraints in KQ5B should be followed.
6731
Five-fraction prostate ultrahypofractionation at doses above 3625 cGy to the planning target volume is not suggested outside the setting of a clinical trial or multi-institutional registry due to risk of late toxicity.
6731
Five-fraction prostate ultrahypofractionation using consecutive daily treatments is not suggested due to potential increased risk of late urinary and rectal toxicity.
6731
At least two dose-volume constraint points for rectum and bladder should be used for moderately or ultrahypofractionated EBRT: one at the high-dose end (near the total dose prescribed) and one in the mid-dose range (near the midpoint of the total dose).
6731
Use of normal tissue constraints for moderately or ultrahypofractionated EBRT that differ from those of a published reference study is not recommended due to the risk of both acute and late toxicity.
6731
Use of target volume and associated margin definitions for hypofractionated EBRT that deviate from those of a published reference study is not recommended, especially for ultrahypofractionated regimens.
6731
IGRT is universally recommended when delivering moderately or ultrahypofractionated EBRT.
6731
Non-modulated 3-D CRT techniques are not recommended when delivering moderately or ultrahypofractionated prostate EBRT.
6731

Recommendation Grading

Overview

Title

Hypofractionated Radiation Therapy for Localized Prostate Cancer

Authoring Organization

Publication Month/Year

October 1, 2018

Last Updated Month/Year

January 11, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer.

Inclusion Criteria

Male, Adult

Health Care Settings

Ambulatory, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D011471 - Prostatic Neoplasms

Keywords

prostate cancer, Hypofractionated Radiation