ESTRO PT 2018

Prospective Comparison of Outcomes in Prostate Cancer Patients Treated with Photons or Protons:

Rationale for Embedded RCT in Fractionation in Proton Cohort

 Published Level I evidence of safety and efficacy of two moderate hypofractionation regimens in photon therapy: • Lee et al. 2016. J Clin Oncol. 73.8/41 vs 70/28. 1 • Catton et al. 3/15/2017. J Clin Oncol. 78/39 vs 60/20 2  No published Level I evidence of safety and efficacy of moderate or extreme hypofractionation with protons • Henderson et al. 2017 Acta Oncol. 70/28 3  Great interest on part of insurance stakeholders  Major impact on cost of proton therapy  Potential to more safely/effectively hypofractionate with protons  If protons prove superior, hypofractionation could be a pathway to implementation without increasing cost over IMRT

1 Lee et al. 2016 J Clin Oncol. 73.8/41 vs 70/28, low risk. N = 1092 2 Catton et al. 3/15/2016. J Clin Oncol. Low & favorable intermediate risk, no ADT 3 Henderson et al. 2017. Acta Oncol. Low, favorable, & unf. intermediate risk, no ADT