Hypofractionated Radiotherapy Could Improve QoL and Be Cost-Effective in Prostate Cancer

In men with low-risk prostate cancer, hypofractionation is non-inferior than the standard treatment dose with respect to outcomes and has the potential for saving treatment costs, according to a new study in the Journal of Clinical Oncology.¹

Nearly 1100 men were enrolled in a trial that randomly assigned them to receive either conventional radiotherapy (C-RT, 73.8 Gy in 41 fractions over 8.2 weeks) or hypofractionated radiotherapy (H-RT, 70 Gy in 28 fractions over 5.6 weeks). The trial, designed to establish non-inferiority of H-RT with C-RT, assigned 542 patients diagnosed with prostate cancer to C-RT and 550 to H-RT. AT a median follow-up of 5.8 years, the estimated 5-year disease-free survival (DFS) was 85.3% (95% CI, 81.9-88.1) in the C-RT arm and 86.3% (95% CI, 83.1-89.0) in the H-RT arm. Patients in the H-RT arm experienced an increase in late grade 2 and 3 gastrointestinal and genitourinary adverse events. However, the frequency of more serious side effects was the same in both groups (observed in less than 5% patients).

The study’s lead author W. Robert Lee, MD, professor in the Department of Radiation Oncology at Duke University Medical Center, finds their study may have public policy implications. “Because the shorter regimen has advantages such as greater patient convenience and lower costs, it’s important to establishing whether we can cure as many patients with the shorter regimen. Our study provides that information for the first time,” Lee said in a statement.

The cost argument is definitely relevant. A study published just last month in the Journal of Oncology Practice evaluated the impact of increased use of hypofractionation on reimbursement in a radiation oncology practice.² The authors found that the reduction in the number of sittings per patient would result in a budget shortfall for the practice: a 40% use rate could result in an annual reduction in technical revenue of about $540,661, the study estimated. A much earlier study published in 2012 estimated a 35% cost reduction to Medicare with the use of 26 H-RT doses compared with the standard 40 of C-RT.³

In Lee’s opinion, their findings have particular relevance for the majority of more than 220,000 men who are annually diagnosed with early stage prostate cancer in the United States. “These findings should help guide clinical decisions, and doctors should be comfortable recommending a shorter radiotherapy course as an alternative to the conventional schedule.”

References

1. Lee WR, Dignam JJ, Amin MB, et al. Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer [published online April 4, 2016]. J Clin Oncol. pii: JCO670448.
2. Konski A, Yu JB, Freedman G, et al. ReCAP: radiation oncology practice: adjusting to a new reimbursement model [published March 22, 2016]. J Oncol Pract. pii: JOPR007385.
3. Aneja S, Pratiwadi RR, Yu JB. Hypofractionated radiation therapy for prostate cancer: risks and potential benefits in a fiscally conservative health care system. Oncology (Williston Park). 2012;26(6):512-518.