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Author Notes:


SP and TJ oversaw the conception and design of the study. JS and CZ oversaw the statistical analysis of the database. SP, JS, CZ, BFV, TJ analyzed and interpreted the patient data. BR, RC, and AJ made substantial revisions to the manuscript. All authors read and approved the final manuscript.

Chen: Consulting or Advisory Role with Medivation/Astellas, Accuray, Bayer, Blue Earth Diagnostics. Research Funding with Accuray.

Jani: Consulting or Advisory Role with Blue Earth Diagnostics.


Research Funding:

Research was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Radiology, Nuclear Medicine & Medical Imaging
  • Ultrahypofractionation
  • Prostate cancer
  • High risk

Stereotactic body radiotherapy versus conventional/moderate fractionated radiation therapy with androgen deprivation therapy for unfavorable risk prostate cancer


Journal Title:



Volume 15, Number 1


, Pages 217-217

Type of Work:

Article | Final Publisher PDF


Background: Ultrahypofractionation using stereotactic body radiotherapy (SBRT) is an increasingly utilized technique for men with prostate cancer (PC). The comparative efficacy of SBRT plus androgen deprivation therapy (ADT) compared to fractionated radiotherapy (EBRT) plus ADT in higher-risk prostate cancer is unknown. Methods: Men > 40 years old with localized PC treated with external beam radiation and concomitant ADT for curative intent between 2004 and 2016 were analyzed from the National Cancer Database. Patients who lacked ADT or risk stratification data were excluded. 558 men treated with SBRT versus 40,797 men treated with conventional or moderately hypofractionated EBRT were included. Patients were stratified by unfavorable intermediate (UIR) and high (HR) risk using NCCN criteria. Kaplan Meier and Cox proportional hazards were used to compare overall survival (OS) between RT modality, adjusting for age, race, and comorbidity index. Results: With a median follow up of 74 months, there was no difference in estimated 6-year OS between men treated with SBRT versus EBRT regardless of risk group. On multivariable analysis, there was no difference in risk of death for men treated with SBRT compared to EBRT (UIR: adjusted HR 1.09, 95% CI 0.68-1.74, p =.72; HR: adjusted HR 0.93, 95% CI 0.76-1.14, p =.51). On sensitivity analyses, when confining the cohort to men treated with NCCN-preferred dose fractionations, with no comorbidities, or < 65 years old, there remained no survival difference between treatment groups for both UIR and HR. Conclusion: Within study limitations, we found no difference in survival between SBRT+ADT and standard of care EBRT+ADT for UIR or HR PC. These results support recent NCCN guideline updates, which include SBRT as a non-preferred option for higher risk men. Prospective validation would further strengthen the evidence basis behind these recommendations.

Copyright information:

© The Author(s) 2020

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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