Setting the PACE for prostate radiotherapy
Mené sur 1 208 patients atteints d'un adénocarcinome de la prostate à risque intermédiaire ou élevé et présentant un indice de performance de l'OMS de 0-2, cet essai randomisé international de phase III évalue la non-infériorité, du point de vue de l'absence d'échec biochimique ou clinique, et la toxicité précoce d'une radiothérapie stéréotaxique par rapport à une radiothérapie modérément hypofractionnée
In The Lancet Oncology, Alison C Tree and colleagues report results1 from the phase 3 PACE-C trial comparing stereotactic body radiotherapy (SBRT) with moderately hypofractionated radiotherapy (MHRT) for unfavourable intermediate-risk or high-risk prostate cancer. In the past decade, there has been an evolution away from conventional fractionation (delivered in 1·8–2 Gy fractions over a course lasting 8–9 weeks) towards shorter fractionation regimens that reduce treatment duration. The first step in this evolution was MHRT, with fraction sizes ranging from 2·4 Gy to 4·0 Gy over 4–6 weeks. The results of multiple randomised trials support non-inferiority in cancer control and similar rates of toxicity with MHRT when using isodose regimens, including 60 Gy in 20 fractions.2 SBRT has been the next development, leveraging improvements in treatment planning and image-guidance systems to deliver radiotherapy in fewer treatments of higher fractional dose. Several phase 2 trials and consortium data of prostate SBRT delivering mostly 36·25 Gy to 40 Gy in five fractions showed favourable recurrence-free survival with acceptable and low toxicity, including for patients with high-risk disease.
The Lancet Oncology , commentaire, 2025