key: cord-1052378-p2h2ez29
authors: Griffiths, W.; Frew, J.A.; Chandler, R.; Jiang, X.Y.; Pedley, I.D.; Pearson, R.A.
title: Prostate Ultrahypofractionation – Rising to Challenges Presents Opportunities in the COVID-19 Era
date: 2020-11-04
journal: Clin Oncol (R Coll Radiol)
DOI: 10.1016/j.clon.2020.10.012
sha: b3cc4f556d7e618b6434633dc988bc7a5598e07e
doc_id: 1052378
cord_uid: p2h2ez29

nan

Prostate Ultrahypofractionation e Rising to Challenges Presents Opportunities in the COVID-19 Era

Madam d The provision of cancer care has had to adapt rapidly to the demands of COVID-19. A flurry of changes in the way we interact with patients and prioritise the use of treatment modalities has facilitated change in practice at an unprecedented rate.

Ultrahypofractionation (UHF) without hormone therapy is appealing as we move into the endemic COVID-19 era, as the shorter treatment schedules reduce exposure to staff and patients, and facilitate social distancing. A recent metaanalysis [1] reported similar disease-free survival in localised prostate cancer for UHF compared with conformal and hypofractionated radiotherapy. We eagerly await outcome and late toxicity data from the UK PACE-B PIII trial (36.25 Gy/five fractions versus 62 Gy/20 fractions without hormone therapy) [2] . Cancer Waiting Times Guidance now recognises active surveillance as management in low/loweintermediate prostate cancer, allowing time to consider treatment options that do not include hormone therapy, e.g. UHF [3] .

To estimate the impact on our clinical service if we implemented UHF in low/loweintermediate risk prostate cancer, we reviewed the case notes for 100 consecutive patients treated in 2019 with 60 Gy/20 fractions and applied the PACE-B criteria: clinical stage T2c and below, prostatespecific antigen <20 ng/ml, Gleason score 7 (3 þ 4 only) and performance status 0e2. Median age of the whole cohort was 71 years (range 51e80), 97% performance status 0e1, 27% on anticoagulants/antiplatelets. Twenty-seven percent were intermediate risk/eligible for PACE-B (73% high risk and ineligible). Eighty-nine per cent of eligible patients were prescribed hormone therapy, which would be avoided with PACE-B treatment.

Therefore, our centre is commencing UHF for this group of patients, using rectal spacers, and maintaining a streamlined pathway with a magnetic resonance-only workflow and cone-beam computed tomography softtissue matching, as described previously [4, 5] . COVID-19 is one of the biggest public health challenges we have faced, which the bringing forward of UHF can help mitigate for, but we remain mindful that novel treatment pathways must not compromise safe, high-quality care.

Ultrahypofractionated vs hypofractionated and conventionally fractionated radiation therapy for localized prostate cancer: a systematic review and meta-analysis of phase III randomized trials

Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial

National Cancer waiting times monitoring dataset guidance -Version 11

Magnetic resonance-only workflow: implementation in a UK centre

The accuracy of magnetic resonanceecone beam computed tomography soft-tissue matching for prostate radiotherapy

The Royal College of Radiologists

Prostate Ultrahypofractionation e Rising to Challenges Presents Opportunities in the COVID-19 Era

The authors declare no conflicts of interest.