Comparison of hypofractionated high-dose intensity-modulated radiotherapy schedules for prostate cancer: Results from the phase III randomized CHHiP trial (CRUK/06/016).

Genitourinary Cancer
Session Type and Session Title: 
Oral Abstract Session A: Prostate Cancer
Poster Session A: Prostate Cancer
Abstract Number: 


Poster Board Number: 
Poster Session A Board #A2
J Clin Oncol 34, 2016 (suppl 2S; abstr 2)
David P. Dearnaley, Isabel Syndikus, Helen Mossop, Alison J. Birtle, DJ Bloomfield, Clare Cruickshank, John Graham, Shama Hassan, Vincent Khoo, John P. Logue, Helen Mayles, Julian Money-Kyrle, Olivia Frances Naismith, Miguel Panades, Helen Patterson, Christopher D Scrase, John Staffurth, Jean Tremlett, Clare Griffin, Emma Hall; The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom; Brighton and Sussex University Hospitals, Hassocks, United Kingdom; Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom; Musgrove Park Hospital, Taunton, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Department of Physics, Royal Marsden NHS Foundation Trust, London, United Kingdom; Lincoln County Hospital, Lincoln, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; Velindre Hospital, Cardiff, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Institute of Cancer Research, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom

Abstract Disclosures


Background: We aimed to explore the dose response relationship for two 3 Gray (Gy) hypofractionated radiotherapy (hRT) schedules for localised prostate cancer (PCa). Methods: hRT schedules of 60Gy/20 fractions (f) and 57Gy/19f were compared with conventional RT (cRT) 74Gy/37f; iso-effective for alpha-beta ratios of 2.5Gy and 1.5Gy respectively. The trial was powered to demonstrate non-inferiority between each hRT schedule and cRT, with 3,213 patients (pt) needed to rule out 5% inferiority (80% power, 1-sided alpha 5%) assuming 70% event-free rate in cRT, corresponding to a critical hazard ratio (HR) of 1.21. The trial was not formally powered to directly compare the two hRT schedules. Pt with N0 T1b-T3a localised PCa were randomized (1:1:1 ratio). The primary endpoint was PCa progression (freedom from biochemical failure by Phoenix consensus guidelines or PCa recurrence). Acute toxicity was assessed up to 18 weeks post treatment and late side effects to 5 years (yr) by RTOG, LENT-SOM and patient reported outcomes (PROs). Results: 3,216 pts were randomized between 2002 and 2011; 1,065 (74Gy), 1,074 (60Gy), 1,077 (57Gy). Baseline characteristics were well balanced across groups: median age 69 yr; NCCN risk group 15% low, 73% intermediate, 12% high. With median follow up 5.2yr, 5yr progression-free rate (95% CI) was 74Gy: 88.3% (86.0%, 90.2%); 60Gy: 90.6% (88.5%, 92.3%), 57Gy: 85.9 (83.4, 88.0); HR60/74: 0.83, 90% CI (0.68, 1.03), HR57/74: 1.20, 90% CI (0.99, 1.45). Significantly more events were observed with 57Gy compared to 60Gy; HR57/60: 1.44, 90% CI (1.18, 1.75),log-rank p=0.003. No significant difference in acute RTOG bladder or bowel toxicity was observed between hRT schedules. Late toxicity profile was favorable; with grade 2+ RTOG bladder (60Gy: 16/960 (1.7%); 57Gy: 11/962 (1.1%), p=0.34) and bowel (60Gy: 28/960 (2.9%); 57Gy: 17/962 (1.8%), p=0.10) toxicity at 2yr. Analysis of LENT-SOM and PROs supported these results. Conclusions: With 5 yr follow-up treatment with a 3Gy schedule of 60Gy/20f shows improved treatment efficacy compared to 57Gy/19f and is non-inferior to 74Gy/37f with a similar low level of acute and late normal tissue damage. Clinical trial information: ISRCTN97182923.