The final results from the randomised CHHiP Trial were published on 20 June 216. If anyone, especially newcomers to the Forum, is interested in the results and what happens next I have put together some information and links about the findings from the trial.
Previously when men have had external beam radiotherapy (EBRT) the gold standard has been to have 74 Gray’s (Gy) over 37 fractions each of 2 Gy. However, some Oncology Teams may give RT for a shorter period. The trial looked to find the best way to deliver EBRT for men with localised prostate cancer who are in the range T1b - T3a N0 M0. Full details of the study are in the first link below, the section “Methods” on page 2 is s good starting point.
The trial compared hypofractionated high dose intensity modulated radioptherapy (IMRT), that is a higher dose of RT for a shorter period with the standard RT. To put this into perspective a “Gray” (Gy) is a dose of RT and a” fraction” is a single treatment. A single treatment may be for more than one Gy.
The trial had 3 arms (or groups): men in Group 1 had the current treatment; men in Group 2 had 60 Gy in 20 fractions each of 3 Gy over 4 weeks and men in Group 3 had 57 Gy in 19 fractions at 3 Gy over 3.8 weeks. Most men received neoadjuvant and concurrent ADT.
The findings from the trial showed that 60 Gy in 20 fractions (ie. 3 Gy for each treatment) was as effective as 74 Gy in 37 fractions (ie. 2 Gy for each treatment). The findings also showed that the 60 Gy in 20 fractions does not cause an increase in the serious side effects. The result is that the 60 Gy dose of IMRT has been recommended as the standard of care for EBRT for localised prostate cancer.
The Group 3 option of 57 Gy in 19 fractions produced less favourable results than the 60 Gy used in Group 2.
The advantages from the new recommendation are that men have fewer daily visits to hospital which results in significant savings in the cost of RT but there is a downside to this. The findings are based on EBRT being delivered by IMRT so before the new 60 Gy treatment option can become widely used as the new gold standard Public Health England (PHE) will have to roll out a programme to make IMRT widely available across the NHS. This means that some men will not have immediate access to the benefits of the new recommendation.
You can find more information about the detail of the findings and how they have been received in the links below.
Men who are T3b N0 M0 or more advanced were not included in the trial and I understand that if they have RT they will receive the current 74 Gy over 37 fractions/days at 2 Gy per day, subject to any local clinical deviations from this.
The findings have been known for some time by Oncology Teams following a preliminary announcement of the results at a conference in 2015. At my review with my Nurse Practitioner in October 2015 I learnt that their procedure for external beam RT for localised prostate cancer has been changed. Due to reports about the CHHiP Trial IMRT is now based on 60 Gy with 20 fractions of 3 Gy over 4 weeks. For completeness, HT is given for 3 months before RT starts and later for up to 2 years if HT is needed to control any spread. The treatment plan is subject to the man’s individual circumstances.
“Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial”
http://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(16)30102-4.pdf
“Hypofractionation for prostate cancer: tested and proven”
http://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(16)30150-4.pdf
“Prostate cancer trial results should mean fewer hospital trips to have radiotherapy”
http://scienceblog.cancerresearchuk.org/2016/06/20/prostate-cancer-trial-results-should-mean-fewer-hospital-trips-to-have-radiotherapy/
“Quicker radiation trial shows ‘no-brainer’ win for men with prostate cancer”
http://prostatecanceruk.org/about-us/news-and-views/2016/6/quicker-radiation-trial-shows-no-brainer-win-for-men-with-prostate-cancer
A final point, this is my view of the findings from the CHHiP Trial after speaking with others about this. You must speak with your Oncology Team to find out what changes, if any, have been made or will be made in the way that EBRT is delivered to men with localised prostate cancer in your area.
I hope this is useful.
Alan
Edited by member 24 Aug 2016 at 07:56
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