Advances in prostate cancer treatment with moderate and ultra-hypofractionated radiotherapy

Table 1 Summary of moderate hypofractionated radiation therapy/ultra hypofractionated radiation therapy schemes

Ref.	Year	Sample size	Dose/fractionation	ADT	Follow-up (median)	Conclusion
Okonogi et al[16]	2025	60	36-40 grays or 44 grays, 4 fractions	Low-risk patients: No ADT received. Intermediate-risk patients: Received 4-8 months of neoadjuvant ADT	42 months (IQR: 27-59 months)	4-fraction carbon-ion RT is safe and effective for prostate cancer; 40 grays balance efficacy/toxicity, but 44 grays increase GU toxicity
Zelefsky et al[25]	2020	551	37.5-40 grays SBRT, 5 fractions in total. Most patients (85.5%, 471/551) received 40.0 grays in 8 grays fractions	151 patients (27.4%) received ADT. Among patients with available data (n = 133), the median duration of hormone therapy was 5.9 months (IQR: 4.1-6.2 months)	17 months (IQR: 7-29 months)	High-dose SBRT for prostate cancer shows favorable short-term tumor control and low toxicity, especially with hydrogel rectal spacers
Abu-Gheida et al[26]	2019	854	70 grays, 28 fractions (2.5 grays per fraction)	61% of patients used ADT. Of these, most received 1-6 months of ADT, and 18% received > 6 months of ADT	11.3 years (maximum 19 years)	Moderately hypofractionated IMRT (70 grays in 28 fractions) for prostate cancer shows excellent 10-year oncologic outcomes with low toxicity across all risk groups
Fransson et al[36]	2021	1180 (591 vs 589)	Conventional fractionation group: 78.0 grays, 39 fractions, 2.0 grays per fraction. Ultra-hypofractionation group: 42.7 grays, 7 fractions, 6.1 grays per fraction	ADT was not permitted	48 months (IQR 25-72 months)	Ultra-hypofractionated radiotherapy for intermediate-to-high-risk prostate cancer shows similar long-term patient-reported quality of life as conventional fractionation, despite higher acute toxicity
Tree et al[53]	2025	1208 (601 to MHRT, 607 to SBRT)	MHRT group: 60 grays, completed in 20 daily fractions. SBRT group: 36.25 grays, 5 fractions	Mandatory ADT for at least 6 months. ADT continued neoadjuvant, concomitantly, and adjuvant until at least 6 months of therapy was complete. Prolongation of ADT (up to a maximum total duration of 18 months) was permitted	During follow-up	PACE-C trial found SBRT and MHRT have similar early RTOG toxicity for higher-risk prostate cancer, though SBRT led to more temporary bowel side-effects

MHRT: Moderate hypofractionated radiation therapy; SBRT: Stereotactic body radiation therapy; ADT: Androgen deprivation therapy; IQR: Interquartile range; Gu: Genitourinary; RTOG: Radiation therapy oncology group.