New possibilities for dose fractionation in radiotherapy for prostate cancer

Introduction: Optimizing radiotherapy fractionation schedules is crucial for improving outcomes in prostate cancer treatment. This study compared a hypofractionated radiotherapy regimen to conventional fractionation schedules. Material and methods: 198 patients with localized prostate cancer were treated with radical radiotherapy and hormonal therapy. Patients were divided into 3 groups: Group I received 60 Gy in 3 Gy fractions over 4 weeks; Group II received 70.2 Gy in 2.6 Gy fractions over 6 weeks; Group III received 76 Gy in 2 Gy fractions over 8 weeks. Acute and late toxicities, biochemical control and overall survival were analysed. Results: With a median of 60 months follow-up, 5-year overall survival was 84.5%, 84.8% and 88.5% in Groups I, II and III respectively (p = 0.7). Two patients (4.4%) in Group I developed local recurrence, compared to none in Group II and 1 patient (1.6%) in Group III. Ten patients developed distant metastases. Acute grade 2 gastrointestinal toxicity occurred in 31–38% of patients, most resolving by 6 months. Acute genitourinary toxicity was more common with hypofractionation. Late toxicity was minimal across all groups. Conclusions: Hypofractionated radiotherapy allowed safe dose escalation without increased toxicity. Local control and survival outcomes were excellent, and comparable to conventional fractionation. Hypofractionation enables treatment acceleration and optimization of resource utilization. Further dose escalation may improve tumour control. Hypofractionation should be considered for routine clinical practice.