Patient-reported bowel symptoms were similar between patients with intermediate-risk localized prostate cancer who received hypofractionated radiotherapy compared with patients who received a standard fractionation schedule, according to a study published online ahead of print in The Lancet Oncology.1

Patient-reported outcomes (PROs) sometimes are more indicative of toxic effects of radiotherapy than clinician-reported outcomes.

Therefore, investigators conducted a substudy of the phase 3 CHHiP trial to assess PROs up to 24 months following conventionally fractionated or hypofractionated radiotherapy.

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Patients included men with localized prostate cancer undergoing radiotherapy. Patients had histologially confirmed T1b-T3aN0M0 prostate cancer, prostate-specific antigen concentration less than 30 ng/mL, and a WHO performance score of 0 to 1.

A total of 2,100 patients were randomly assigned to receive standard fractionation at a schedule of 74 Gy in 37 fractions (n = 696) or one of either 60 Gy in 20 fractions (n = 698) or 57 Gy in 19 fractions (n = 706).

At 2 years, comparison among the 3 groups showed no difference in overall bother, with 66% of patients in the 74 Gy reporting none, 65% of patients in the 60 Gy reporting none, and 65% of patients in the 57 Gy group reporting none. Very small bother was reported in 22%, 22%, and 21% of patients, respectively.

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Small bother was reported in 6%, 7%, and 9% of men, respectively; moderate bother was reported in 5%, 6%, and 5% of patients; and severe bother was reported in < 1% of all participants in all groups (74 Gy vs 60 Gy, ptrend  =  .64, 74 Gy vs 57 Gy, ptrend = .59).

Results indicated that if efficacy data from the CHHip trial show non-inferiority for hypofractionated radiotherapy, it should become the standard treatment for localized prostate cancer.


  1. Wilkins A, Mossop H, Syndicus I, et al. Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial [published online ahead of print October 28, 2015]. Lancet Oncol. doi: 10.1016/ S1470-2045(15)00280-6.