Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026
Ultrahypofractionation of localized prostate cancer-an updated statement of the prostate cancer working group of the German Society of Radiation Oncology (DEGRO).
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Müller A-C, Aebersold D M, Albrecht C, Boehmer D, Ganswindt U, Schmidt-Hegemann N-S, Höcht S, Hoffmann E, Hölscher T, Koerber S A, Niehoff P, Peeken J C, Pinkawa M, Polat B, Shelan M, Spohn S K B, Wolf F, Zamboglou C, Zips D, Wiegel T
Аннотация
BACKGROUND: Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Germany. Radiation therapy is a standard treatment for localized PCa. Ultrahypofractionation (UHF) delivers high doses in fewer fractions, thus offering a time-efficient option compared to traditional standard fractionation lasting for 7-8 weeks. The German Society of Radiation Oncology (DEGRO) expert panel statement provides an updated evaluation of randomized trials with at least 5 years of follow-up.
METHODS: The members of the DEGRO PCa working group performed a literature search for randomized trials of UHF for localized prostate cancer in March 2025. The analysis included phase III randomized trials with at least 5 years of follow-up: HYPO-RT-PC, PACE‑B, and a proton therapy trial.
RESULTS: All trials demonstrated noninferiority of UHF radiotherapy in maintaining disease control. The HYPO-RT-PC trial reported a 5‑year failure-free survival rate of 84% in both treatment groups and PACE‑B reported noninferiority with a 95.8% rate in the SBRT group compared to 94.6% in the control group. Acute urinary and bowel toxicities were more pronounced in UHF arms but resolved over time. Late urinary toxicity was significantly higher in SBRT patients (26.9% vs. 18.3%, p < 0.001, PACE-B). Proton SBRT showed slightly increased toxicity measured by sexual and urinary EPIC.
CONCLUSION: Ultrahypofractionation represents an effective alternative to conventional fractionation in low- to intermediate-risk PCa with similar oncologic outcomes. However, physicians should inform their patients-particularly those with suboptimal urinary function-about an increased risk for GU toxicity.
METHODS: The members of the DEGRO PCa working group performed a literature search for randomized trials of UHF for localized prostate cancer in March 2025. The analysis included phase III randomized trials with at least 5 years of follow-up: HYPO-RT-PC, PACE‑B, and a proton therapy trial.
RESULTS: All trials demonstrated noninferiority of UHF radiotherapy in maintaining disease control. The HYPO-RT-PC trial reported a 5‑year failure-free survival rate of 84% in both treatment groups and PACE‑B reported noninferiority with a 95.8% rate in the SBRT group compared to 94.6% in the control group. Acute urinary and bowel toxicities were more pronounced in UHF arms but resolved over time. Late urinary toxicity was significantly higher in SBRT patients (26.9% vs. 18.3%, p < 0.001, PACE-B). Proton SBRT showed slightly increased toxicity measured by sexual and urinary EPIC.
CONCLUSION: Ultrahypofractionation represents an effective alternative to conventional fractionation in low- to intermediate-risk PCa with similar oncologic outcomes. However, physicians should inform their patients-particularly those with suboptimal urinary function-about an increased risk for GU toxicity.