The results of the largest randomized treatment trial ever undertaken in localized prostate cancer has concluded that fewer, higher doses of radiotherapy are as effective as lower doses over a longer period for the treatment of prostate cancer. The findings were presented at the 2015 European Cancer Congress (25–29 September, Vienna, Austria) by researchers from The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust (both London, UK).
Approximately 41,000 men are diagnosed with prostate cancer annually in the UK, with in excess of 10,800 deaths attributed to the disease. Radiotherapy is the most commonly used therapeutic strategy for localized prostate cancer in the UK.
This CHHiP trial, funded by Cancer Research UK, administered different schedules of radiotherapy to 3216 men with prostate cancer. The results indicate that men could require fewer hospital visits – receiving their treatment over 4 weeks rather than the current 7.5 weeks – without any decreases in quality and impact of the treatment.
Lead investigator David Dearnaley, of The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, commented: “These data are encouraging news for men. Excellent control rates and a low side effect profile have been seen across the trial. Giving patients larger doses of radiotherapy for a shorter time will mean fewer hospital trips and less radiotherapy needed overall.
“These findings are the result of many years of research and should help to further refine treatment,” he continued. “It appears to be safe and effective and we recommend it as a new standard of care. The study has facilitated the widespread introduction of high-quality modern radiotherapy and these advanced techniques are necessary to deliver short high-dose treatments safely.”
A proportion of participants received the standard treatment of 74 Gy over 37 days (2 Gy per day), while others received either 60 Gy over 20 days or 57Gy over 19 days (both 3 Gy per day). Patients were then followed-up over 5 years and it was discovered that administering 60 Gy over 20 days was as effective as standard treatment, even when considering factors including disease control and long-term side effects.
Short-term side effects of the higher radiotherapy doses were more common than those observed in standard therapy; however these were not long lasting. No difference was observed in side effects after 6 months or the next 5 years.
Emma Hall, of The Institute of Cancer Research, which coordinated the study, added: “The technique used to give the radiotherapy has led to low levels of side effects even with the higher daily dose. We have also shown that the 20 day schedule is at least as good at controlling disease as the current 37 day schedule. We estimate that over 150,000 trips to hospital could be saved per year”.
Malcolm Mason from Cancer Research UK explained: “These results are great news for men. From a logistical and patient convenience point of view, being able to treat patients over a shorter period of time has been a goal for specialists, but the question has always been whether it was safe to do so. This study shows that it is safe and effective, and there should be no reason why this cannot be implemented immediately – it is saving the NHS resources.”