Hypofractionated radiotherapy for localized prostate can-cer: is less treatment time better? Narrative Review

Abstract

Introduction: Moderate hypofractionation (hRt) in prostate cancer consists of reducing the total time of treatment with radiotherapy, which improves therapeutic adherence and optimizes technological resources. In prostate cancer, there is robust evidence with mature data at 5 years of follow-up, where it was evidenced that hRt is not inferior to treatment with standard fractionation in oncological control, with less or equal acute and late toxicity. A review of the evidence, tolerance dose, contouring of target volumes (GTV-CTV-PTV) / organs at risk, planning and reproducibility of hRt in localized prostate cancer is made.

Discussion: Technical recommendations are made for hRT in prostate cancer: Simulation axial tomography, definition of volumes, isodose targets, limiting doses and definition of volumes for organs at risk, radiotherapy treatment planning, rules to follow if not meet dose, treatment delivery, verification, and accuracy restrictions.

Conclusion: At present there is convincing evidence that allows reducing the number of radiotherapy fractions for localized prostate cancer. Image-guided intensity-modulated radiation therapy (intraprostatic fiducial markers, cone beam CT) enables more precise treatment to be delivered and positions hypofractionation as a new standard of radiation therapy treatment for localized prostate cancer. Additionally, reducing radiation therapy time to 4 weeks will lower the cost of treatment and shorten waiting lists in radiation therapy departments.