Physician-scored and patient-reported bowel toxicity higher with dose-escalated moderately hypofractionated radiotherapy
By Elana Gotkine HealthDay Reporter
TUESDAY, April 1, 2025 (HealthDay News) — For patients with prostate cancer, isodose and dose-escalated moderately hypofractionated radiotherapy (MHFRT) have similar efficacy as conventionally fractionated radiotherapy (CFRT), but bowel toxicity is seen in association with dose-escalated MHFRT, according to a study published online March 17 in The Lancet Oncology.
Amar U. Kishan, M.D., from the University of California, Los Angeles, and colleagues conducted an individual patient data meta-analysis from randomized phase 3 trials of CFRT versus MHFRT for prostate cancer. Seven phase 3 trials were eligible for inclusion; data were obtained for 3,454 patients from three trials comparing CFRT to isodose MHFRT and 2,426 patients from four trials comparing CFRT to dose-escalated MHFRT.
The researchers found no differences in progression-free survival at a median follow-up of 5.4 years for isodose MHFRT and 7.1 years for dose-escalated MHFRT. For isodose and dose-escalated MHFRT, there were no increased odds of grade 2 or higher genitourinary toxic effects. With dose-escalated, but not isodose MHFRT, the odds of grade 2 or higher gastrointestinal toxic effects were significantly greater (odds ratio, 1.48). Odds of urinary quality-of-life decrement or bowel quality-of-life decrement were no different for isodose MHFRT. Greater odds of bowel quality-of-life decrement were seen with dose-escalated MHFRT (odds ratio, 1.68), but no greater urinary quality-of-life decrement was seen.
“This meta-analysis provides the strongest evidence to date suggesting an isodose MHFRT regimen could be the preferred MHFRT regimen for all risk groups,” the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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