Hypofractionated Radiotherapy for Prostate Cancer: Further Evidence to Tip the Scales
Mené sur 168 patients atteints d'un cancer de la prostate à haut risque de récidive et de stade localisé (durée médiane de suivi : 9 ans), cet essai de phase III compare l'efficacité, du point de vue de l'échec biochimique, de la survie spécifique et de la survie globale, et la toxicité à long terme d'une radiothérapie avec hypofractionnement modéré et d'une radiothérapie conventionnelle
The history of prostate external beam radiotherapy has been one of slow and steady progress: the hard mining of the knowledge by which to determine benefit and risk. Studies on how much radiation to give and how quickly (fractionation) may not be as sexy as the latest small-molecule or genome-wide analysis, but they have huge implications and can be applied immediately wherever modern radiotherapy is available. Whether we can shorten radiation courses has particular importance for prostate radiotherapy, where standard treatment can last 7 to 9 weeks. Shortening the therapy by even a couple of weeks could potentially save the health care system (and patients) millions of dollars. Dearnaley et al noted that the move toward hypofractionation in the United Kingdom has the potential to reduce the number of treatment fractions by > 200,000 per year. In the United States, the move to moderate hypofractionation is estimated to result in a reduction of technical reimbursement by approximately $9,000 per patient, which could lead to a total reduction of $678,070 for the average radiation oncology department. Thus, the authors of the studies in this issue of Journal of Clinical Oncology, and similar studies now completed, are to be applauded for investigating a technique that may increase value to patients and payers, despite potential decreased revenue for physicians.
Journal of Clinical Oncology , éditorial en libre accès, 2016