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  • Stereotactic body...

Stereotactic body radiotherapy Noninferior to Conventional Radiotherapy for Low-to-Intermediate Risk Prostate Cancer: Study

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-01-03T21:45:56+05:30  |  Updated On 4 Jan 2025 11:54 AM IST
Stereotactic body radiotherapy Noninferior to Conventional Radiotherapy for Low-to-Intermediate Risk Prostate Cancer: Study
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Researchers have found that stereotactic body radiotherapy (SBRT) is noninferior to conventional or moderately hypofractionated radiotherapy for low-to-intermediate-risk localized prostate cancer. A new study was recently published in The New England Journal of Medicine by Nicholas Van and colleagues.

This was a study of 874 patients with localized prostate cancer stages T1 or T2, a Gleason score of 3+4 or less, and PSA levels of no higher than 20 ng per milliliter. There were a total of 62 patients who were randomly assigned to one of two arms: SBRT in a cumulative dose of 36.25 Gy in 5 fractions over 1-2 weeks or conventional radiotherapy, administered to a total dose of 78 Gy in 39 fractions over 7.5 weeks or 62 Gy in 20 fractions over 4 weeks. Importantly, this was not an androgen-deprivation therapy (ADT) study but a study designed to directly look at the effect of radiation modalities per se. From August 2012 through January 2018, participants were enrolled at 38 centers, and analyses were done with the intention to treat.

Results

• During a median follow-up of 74.0 months, results of the trial confirmed that for SBRT, in comparison to conventional radiotherapy, freedom from biochemical or clinical failure was non-inferior for the primary outcome.

• The 5-year biochemical or clinical failure-free rate was 95.8% (95% CI, 93.3 to 97.4) in the SBRT group and 94.6% (95% CI, 91.9 to 96.4) in the control group, with an unadjusted hazard ratio of 0.73 (90% CI, 0.48 to 1.12; P=0.004 for noninferiority).

• These findings indicate that a shorter, easier SBRT course was not associated with an increased risk of prostate cancer recurrence or progression and thus could be an acceptable treatment strategy for many patients.

• Although SBRT was not inferior according to the standards of cancer control, the trial also measured levels of toxicity.

• It was seen that cumulative incidence of late Radiation Therapy Oncology Group grade 2 or higher genitourinary toxic effects at 5 years was significantly higher in SBRT group, 26.9% (95% CI, 22.8 to 31.5) than in the control radiotherapy group, 18.3% (95% CI, 14.8 to 22.5; P<.001).

• Cumulative incidence of late gastrointestinal toxic effects (RTOG grade 2 or higher) was comparable for the two arms: 10.7% (95% CI, 8.1 to 14.2) for SBRT and 10.2% (95% CI, 7.7 to 13.5) for controls (P=0.94).

In conclusion, this phase II randomized trial showed that five-fraction SBRT is equivalent to conventional radiotherapy in preventing biochemical and clinical failure of low-intermediate risk localized prostate cancer. This study provides very strong evidence to demonstrate the use of SBRT as a highly efficacious alternative in the management of localized prostate cancer.

Reference:

van As, N., Griffin, C., Tree, A., Patel, J., Ostler, P., van der Voet, H., Loblaw, A., Chu, W., Ford, D., Tolan, S., Jain, S., Camilleri, P., Kancherla, K., Frew, J., Chan, A., Naismith, O., Armstrong, J., Staffurth, J., Martin, A., … Hall, E. (2024). Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. The New England Journal of Medicine, 391(15), 1413–1425.https://doi.org/10.1056/nejmoa2403365

The New England Journal of MedicineStereotactic body radiotherapy (SBRT)prostate cancerbiochemical failureclinical failureconventional radiotherapyrandomized controlled trialgenitourinary toxicitygastrointestinal toxicity
Source : The New England Journal of Medicine
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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