Stereotactic Radiosurgery for Prostate Cancer

Abstract

form in 2016 [2, 3]. 255 patients with low risk prostate cancer were randomised between SBRT, 36.25 Gy in five fractions or a hypofractionated dose of 51.6 Gy in 12 fractions. Both fractionations were well tolerated in terms acute and late toxicity, and patient-reported bowel and urinary outcomes at 1 year. Although not strictly SBRT, HYPO is Scandinavian-based phase II randomised multicentre trial, comparing a highly hypofractionated schedule of 42.7 Gy in seven fractions on alternate days, with conventional fractionation (78 Gy in 39 fractions) [7]. Recruitment is now closed having accrued 1200 patients with intermediate-risk prostate cancer (stage T3a disease also permitted). Treatment delivery was with either 3D conformal radiotherapy or VMAT, without the use of concomitant ADT. Two-year acute and late toxicity data has been published with a median patient follow up of 4.2 years [83]. No significant difference in toxicity was found between the two arms at 2 years follow up, which included 866 patients. RTOG grade 2 urinary toxicity was 5.4 and 4.6% for the hypofractionated and conventional arms respectively, and bowel toxicity 2.2 versus 3.7%. In results presented at ESTRO (2018) ultra hypofractioanted schedule was shown to be non-inferior to conventional fractionation at 5 years, in terms of freedom from biochemical or clinical failure, with no significant difference in toxicity rate at 4 and 6 years. LDR brachytherapy is a standard treatment option for suitable patients with lowand intermediate-risk prostate cancer. This is being compared to SBRT within a small randomised trial based in Finland (BRAVEROBO), now Early stage prostate cancerClinical stage T1c-T2c, Gleason Score ≤3+4, PSA≤20 ng/ml Surgical Considera on (Y/N)?