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This was followed by a more hypofractionated regimen in a study with comparable inclusion criteria, increasing applied dose from 30 Gy E to 35.2 Gy E in 8 fractions.
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In recent years, the introduction of stereotactic ablative radiotherapy (SABR) has offered even more intensive tumor dose escalation using a hypofractionated regimen with reduced dose to the normal liver, usually below the threshold dose above which severe RILD is observed.
One of the first phase III prospective randomized controlled trials (RCTs) comparing CFRT and HFRT was published by Lukka et al. [ 33] in 2005: in this trial a conventional dose of 66 Gy in 33 fractions was compared to a hypofractionated regimen of 52.5 Gy in 20 fractions (dose per fraction = 2.625 Gy) in more than 900 men with low and intermediate risk prostate cancer.
Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients.
Benefits of addition of chemotherapy to hypofractionated regimen are yet to be proven and dose optimized.
Fowler compared conventional RT and hypofractionated RT and reported lower rate of late toxicity with hypofractionated regimen albeit comparable local control [ 24, 25].
While hypofractionated regimen are beginning to be integrated into clinical routine in first line treatment, data on postoperative hypofractionated radiotherapy is still sparse.
There were no differences in psychological distress between patients receiving conventional radiotherapy and those receiving a slightly hypofractionated regimen.
From our data, there appears to be no increase in late toxicity, using a 60 Gy hypofractionated regimen for localized prostate cancer.
According to the Linear Quadratic Model, the hypofractionated regimen is biologically equivalent to 77.1 Gy in 2 Gy fractions assuming an α/ β ratio of 1.5 Gy.
Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer with the 4-year actuarial biochemical control rate of 97.4%.
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