Ablative Radiation Therapy for Unfavorable Prostate Tumors (ABRUPT): Preliminary Analysis of Toxicity and Quality of Life from a Prospective Study

Two-fraction Versus Five-fraction Stereotactic Body Radiotherapy for Intermediate-risk Prostate Cancer: The TOFFEE Meta-analysis of Individual Patient Data from Four Prospective Trials

BACKGROUND AND OBJECTIVE

Recent randomized controlled trials have demonstrated the efficacy of five-fraction stereotactic body radiotherapy (5F-SBRT) for prostate cancer (PC), but there is no comparative evidence for fewer fractions. We compare outcomes of prostate two-fraction SBRT (2F-SBRT) and 5F-SBRT using prospective data for patients with intermediate-risk (IR) PC.

METHODS

This meta-analysis of individual patient data evaluated IR-PC from four prospective trials of prostate SBRT (two trials each of 2F- and 5F-SBRT). The primary endpoint was the cumulative incidence of biochemical failure (BCF). Secondary endpoints included the cumulative incidence of distant metastases (DM) and patient-reported quality of life (QoL).

KEY FINDINGS AND LIMITATIONS

Of the 199 patients meeting the eligibility criteria, 143 (72%) were in the 5F-SBRT group and 56 (28%) were in the 2F-SBRT group. Median follow-up was 9.4 years. There was no significant difference in BCF with a 5-year cumulative incidence of 3.6% (95% CI 0-8.6%) in the 2F-SBRT group and 6.0% (95% CI 1.8-10.2%) in the 5F-SBRT group (p = 0.73). There was no significant difference in DM incidence. We found no differences in acute and late urinary or bowel QoL. Limitations include the non-randomized comparison.

CONCLUSIONS AND CLINICAL IMPLICATIONS

We report the first prospective comparison of prostate 2F-SBRT and 5F-SBRT. We found no significant difference in efficacy, or in urinary or bowel QoL. This meta-analysis further encourages the potential of 2F-SBRT to be a standard-of-care option for IR PC.

Single-Dose Radiation Therapy for Localized Prostate Cancer: Where Does the Evidence Lead?

Prostate cancer (PCa) remains the most prevalent cancer among men and the second leading cause of cancer-related deaths worldwide. Early diagnosis is crucial as it opens up various treatment options with curative intent. Recent advancements confirm that radiotherapy (RT), particularly through modern techniques like stereotactic body RT (SBRT) and single-dose RT (SDRT), is a safe and effective treatment for both localized and advanced PCa. This manuscript reviews the evolution and current state of primary prostate SDRT, focusing on its benefits and limitations. SDRT offers advantages such as reduced treatment time and enhanced patient convenience, showing promising efficacy and safety, especially for low- and intermediate-risk PCa. Challenges include controlling intrafraction variability and organ motion, as well as minimizing urethral toxicity. Next-generation imaging and MR-guided RT are improving treatment accuracy. While SDRT shows potential for cost-effective PCa treatment, further research is needed to address its limitations and refine its clinical application.