Patients treated for prostate cancer may be getting more courses of radiation therapy than needed, according to a new study published online by the International Journal of Radiation Oncology Biology and Physics.

The current standard treatment in the U.S. involves daily treatments for up to nine weeks. Dr. Justin Bekelman of the University of Pennsylvania’s Perelman School of Medicine is calling for a transition to four to five weeks of daily — moderate hypofractionated — treatments.

Moderate hypofractionation uses a slightly higher dose of radiation for each daily treatment compared to the standard. But since the treatment time is shorter, moderate hypofractionation costs less and eases the burden on patients.
The treatment approaches have comparable outcomes and side effects, but moderate hypofractionation costs less and is more convenient.

Three multicenter randomized trials called CHHiP, NRG 0415 and PROFIT compared both treatment approaches. A total of 5,537 patients with mostly low and intermediate risk prostate cancer were evaluated in the studies.

In addition to showing that outcomes were similar for both treatment courses, the researchers also found that there was no change in effectiveness or side effects if the patients underwent hormone therapy.

“This is a win-win-win for patients, payers, and employers,” Bekelman said in a statement. “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.”

However, he cautioned against more highly hypofractionated regimens because there isn’t any evidence of benefits, and such a treatment course may carry additional risks. Several large U.S. and European clinical trials are currently investigating these shorter courses of treatment.

“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,” he said. “We should move forward to adopt moderate hypofractionation radiation schedules in routine care for appropriate men with prostate cancer.”

A couple of years ago, Bekelman made a similar discovery in breast cancer treatment. He found that two-thirds of women treated for early-stage breast cancer in the U.S. underwent longer radiation therapy than necessary.

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