Abstract：
OBJECTIVE: The aim of this guideline is to present recommendations regarding moderately hypofractionated (240-340 cGy per fraction) and ultrahypofractionated (500 cGy or more per fraction) radiation therapy for localized prostate cancer.
METHODS: The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and Society-approved tools for grading evidence quality and recommendation strength.
RESULTS: Based on high-quality evidence, strong consensus was reached for offering moderate hypofractionation across risk groups to patients choosing external beam radiation therapy. The task force conditionally recommends ultrahypofractionated radiation may be offered for low- and intermediate-risk prostate cancer but strongly encourages treatment of intermediate-risk patients on a clinical trial or multi-institutional registry. For high-risk patients, the task force conditionally recommends against routine use of ultrahypofractionated external beam radiation therapy. With any hypofractionated approach, the task force strongly recommends image guided radiation therapy and avoidance of nonmodulated 3-dimensional conformal techniques.
CONCLUSIONS: Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer. The limits in the current evidentiary base-especially for ultrahypofractionation-highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients.
METHODS: The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and Society-approved tools for grading evidence quality and recommendation strength.
RESULTS: Based on high-quality evidence, strong consensus was reached for offering moderate hypofractionation across risk groups to patients choosing external beam radiation therapy. The task force conditionally recommends ultrahypofractionated radiation may be offered for low- and intermediate-risk prostate cancer but strongly encourages treatment of intermediate-risk patients on a clinical trial or multi-institutional registry. For high-risk patients, the task force conditionally recommends against routine use of ultrahypofractionated external beam radiation therapy. With any hypofractionated approach, the task force strongly recommends image guided radiation therapy and avoidance of nonmodulated 3-dimensional conformal techniques.
CONCLUSIONS: Hypofractionated radiation therapy provides important potential advantages in cost and convenience for patients, and these recommendations are intended to provide guidance on moderate hypofractionation and ultrahypofractionation for localized prostate cancer. The limits in the current evidentiary base-especially for ultrahypofractionation-highlight the imperative to support large-scale randomized clinical trials and underscore the importance of shared decision making between clinicians and patients.
摘要：
目的：本指南的目的是提出有关局部前列腺癌的中度高分割（每级分240-340cGy）和超低分割（每级分500cGy或更多）放射治疗的建议。
方法：美国放射肿瘤学学会召集了一个特别工作组，以解决有关中度和超低分割放射治疗的适当适应症和剂量分割的8个关键问题。以及技术问题，包括正常组织剂量限制，治疗量,以及图像引导和调强放射治疗的使用。建议基于系统的文献回顾，并使用预定义的共识建立方法和社会批准的工具对证据质量和建议强度进行分级。
结果：基于高质量的证据，对于选择外部束放射治疗的患者,在各风险组之间提供中等的低分割,达成了强烈的共识.工作组有条件地建议可以为低风险和中危前列腺癌提供超分割辐射，但强烈鼓励在临床试验或多机构注册中对中危患者进行治疗。对于高危患者，特别工作组有条件地建议不要常规使用超小分割外束放射治疗。任何小分割方法，特别工作组强烈建议图像引导放射治疗和避免非调制三维适形技术.
结论：小分割放射治疗在成本和便利性方面为患者提供了重要的潜在优势，这些建议旨在为局限性前列腺癌的中度高分割和超低分割提供指导。当前证据基础的局限性-特别是对于超低分割-突出了支持大规模随机临床试验的必要性，并强调了临床医生和患者之间共同决策的重要性。
方法：美国放射肿瘤学学会召集了一个特别工作组，以解决有关中度和超低分割放射治疗的适当适应症和剂量分割的8个关键问题。以及技术问题，包括正常组织剂量限制，治疗量,以及图像引导和调强放射治疗的使用。建议基于系统的文献回顾，并使用预定义的共识建立方法和社会批准的工具对证据质量和建议强度进行分级。
结果：基于高质量的证据，对于选择外部束放射治疗的患者,在各风险组之间提供中等的低分割,达成了强烈的共识.工作组有条件地建议可以为低风险和中危前列腺癌提供超分割辐射，但强烈鼓励在临床试验或多机构注册中对中危患者进行治疗。对于高危患者，特别工作组有条件地建议不要常规使用超小分割外束放射治疗。任何小分割方法，特别工作组强烈建议图像引导放射治疗和避免非调制三维适形技术.
结论：小分割放射治疗在成本和便利性方面为患者提供了重要的潜在优势，这些建议旨在为局限性前列腺癌的中度高分割和超低分割提供指导。当前证据基础的局限性-特别是对于超低分割-突出了支持大规模随机临床试验的必要性，并强调了临床医生和患者之间共同决策的重要性。
