Evidence-based Clinical Recommendations for Hypofractionated Radiotherapy: Exploring Efficacy and Safety - Part 3. Genitourinary and Gynecological Cancers

Overview

Journal Radiat Oncol J

Specialty Oncology

Date 2024 Oct 2

PMID 39354820

Authors

Gyu Sang Yoo

Soo-Yoon Sung

Jin Ho Song

Byoung Hyuck Kim

Yoo-Kang Kwak

Kyung Su Kim

Hwa Kyung Byun

Yeon-Sil Kim

Yeon Joo Kim

Affiliations

Soon will be listed here.

Abstract

Hypofractionated radiotherapy (RT) has become a trend in the modern era, as advances in RT techniques, including intensity-modulated RT and image-guided RT, enable the precise and safe delivery of high-dose radiation. Hypofractionated RT offers convenience and can reduce the financial burden on patients by decreasing the number of fractions. Furthermore, hypofractionated RT is potentially more beneficial for tumors with a low α/β ratio compared with conventional fractionation RT. Therefore, hypofractionated RT has been investigated for various primary cancers and has gained status as a standard treatment recommended in the guidelines. In genitourinary (GU) cancer, especially prostate cancer, the efficacy, and safety of various hypofractionated dose schemes have been evaluated in numerous prospective clinical studies, establishing the standard hypofractionated RT regimen. Hypofractionated RT has also been explored for gynecological (GY) cancer, yielding relevant evidence in recent years. In this review, we aimed to summarize the representative evidence and current trends in clinical studies on hypofractionated RT for GU and GY cancers addressing several key questions. In addition, the objective is to offer suggestions for the available dose regimens for hypofractionated RT by reviewing protocols from previous clinical studies.

References

Lee W, Dignam J, Amin M, Bruner D, Low D, Swanson G . Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. J Clin Oncol. 2016; 34(20):2325-32. PMC: 4981980. DOI: 10.1200/JCO.2016.67.0448. View

Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M . Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet. 2019; 394(10196):385-395. DOI: 10.1016/S0140-6736(19)31131-6. View

Arruda Viani G, Viana B, Martin J, Rossi B, Zuliani G, Stefano E . Intensity-modulated radiotherapy reduces toxicity with similar biochemical control compared with 3-dimensional conformal radiotherapy for prostate cancer: A randomized clinical trial. Cancer. 2016; 122(13):2004-11. DOI: 10.1002/cncr.29983. View

Huddart R, Hafeez S, Lewis R, McNair H, Syndikus I, Henry A . Clinical Outcomes of a Randomized Trial of Adaptive Plan-of-the-Day Treatment in Patients Receiving Ultra-hypofractionated Weekly Radiation Therapy for Bladder Cancer. Int J Radiat Oncol Biol Phys. 2020; 110(2):412-424. PMC: 8114997. DOI: 10.1016/j.ijrobp.2020.11.068. View

Potter R, Tanderup K, Schmid M, Jurgenliemk-Schulz I, Haie-Meder C, Fokdal L . MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol. 2021; 22(4):538-547. DOI: 10.1016/S1470-2045(20)30753-1. View

Solanki A, Martin B, Korpics M, Small C, Harkenrider M, Mitin T . Bladder-Preserving Therapy Patterns of Care: A Survey of US Radiation Oncologists. Int J Radiat Oncol Biol Phys. 2017; 99(2):383-387. DOI: 10.1016/j.ijrobp.2017.04.009. View

Goldsmith B, Baumann B, He J, Tucker K, Bekelman J, Deville C . Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys. 2014; 88(3):603-10. DOI: 10.1016/j.ijrobp.2013.11.211. View

Kraus R, Weil C, Abdel-Wahab M . Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries. JCO Glob Oncol. 2022; 8:e2200215. PMC: 10166538. DOI: 10.1200/GO.22.00215. View

Wakatsuki M, Kato S, Ohno T, Karasawa K, Ando K, Kiyohara H . Dose-escalation study of carbon ion radiotherapy for locally advanced squamous cell carcinoma of the uterine cervix (9902). Gynecol Oncol. 2013; 132(1):87-92. DOI: 10.1016/j.ygyno.2013.10.021. View

10.

Viswanathan A, Cormack R, Rawal B, Lee H . Increasing brachytherapy dose predicts survival for interstitial and tandem-based radiation for stage IIIB cervical cancer. Int J Gynecol Cancer. 2009; 19(8):1402-6. DOI: 10.1111/IGC.0b013e3181b62e73. View

11.

Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D . Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys. 2015; 92(5):971-977. DOI: 10.1016/j.ijrobp.2015.04.030. View

12.

Ciammella P, Podgornii A, Galeandro M, Micera R, Ramundo D, Palmieri T . Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors. Radiat Oncol. 2014; 9:97. PMC: 4029983. DOI: 10.1186/1748-717X-9-97. View

13.

Tree A, Ostler P, van der Voet H, Chu W, Loblaw A, Ford D . Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomised, phase 3, non-inferiority trial. Lancet Oncol. 2022; 23(10):1308-1320. DOI: 10.1016/S1470-2045(22)00517-4. View

14.

Choudhury A, Porta N, Hall E, Song Y, Owen R, Mackay R . Hypofractionated radiotherapy in locally advanced bladder cancer: an individual patient data meta-analysis of the BC2001 and BCON trials. Lancet Oncol. 2021; 22(2):246-255. PMC: 7851111. DOI: 10.1016/S1470-2045(20)30607-0. View

15.

Albuquerque K, Tumati V, Lea J, Ahn C, Richardson D, Miller D . A Phase II Trial of Stereotactic Ablative Radiation Therapy as a Boost for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys. 2019; 106(3):464-471. DOI: 10.1016/j.ijrobp.2019.10.042. View

16.

Haas J, Witten M, Clancey O, Episcopia K, Accordino D, Chalas E . CyberKnife Boost for Patients with Cervical Cancer Unable to Undergo Brachytherapy. Front Oncol. 2012; 2:25. PMC: 3356152. DOI: 10.3389/fonc.2012.00025. View

17.

Kang H, Kay C, Son S, Kim M, Jo I, Lee S . Hypofractionated intensity-modulated radiotherapy in patients with localized prostate cancer: a preliminary study. Radiat Oncol J. 2016; 34(1):45-51. PMC: 4831968. DOI: 10.3857/roj.2016.34.1.45. View

18.

Koukourakis M, Tsoutsou P, Abatzoglou I, Soulimioti G, Sismanidou K, Liberis V . Postoperative accelerated radiotherapy with cytoprotection followed by three-dimensional conformal boost in patients with early endometrial/cervical cancer. Tumori. 2009; 95(4):455-60. DOI: 10.1177/030089160909500408. View

19.

Smith Z, Christodouleas J, Keefe S, Malkowicz S, Guzzo T . Bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy. BJU Int. 2013; 112(1):13-25. DOI: 10.1111/j.1464-410X.2012.11762.x. View

20.

Marnitz S, Kohler C, Budach V, Neumann O, Kluge A, Wlodarczyk W . Brachytherapy-emulating robotic radiosurgery in patients with cervical carcinoma. Radiat Oncol. 2013; 8:109. PMC: 3695857. DOI: 10.1186/1748-717X-8-109. View