Research Perspectives:

Hypofractionation: less is more?

Neethu Billy Graham Mariam, Yee Pei Song, Nuradh Joseph, Peter Hoskin, Kimberley Reeves, Nuria Porta, Nicholas James and Ananya Choudhury _

PDF  |  Full Text  |  How to cite

Oncotarget. 2021; 12:1729-1733. https://doi.org/10.18632/oncotarget.28023

Metrics: PDF 1245 views  |   Full Text 3199 views  |   ?  


Neethu Billy Graham Mariam1, Yee Pei Song1,2, Nuradh Joseph3, Peter Hoskin2,4, Kimberley Reeves2, Nuria Porta5, Nicholas James6 and Ananya Choudhury1,2

1 Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK

2 Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

3 Ministry of Health, Colombo, Sri Lanka

4 Mount Vernon Cancer Centre, Northwood, UK

5 Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK

6 Prostate and Bladder Cancer Research Team, The Institute of Cancer Research, London, UK

Correspondence to:

Ananya Choudhury, email: [email protected]

Keywords: hypofractionation; BC2001; BCON; bladder cancer

Received: June 18, 2021     Accepted: June 21, 2021     Published: August 17, 2021

Copyright: © 2021 Mariam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


One third of patients with bladder cancer present with muscle invasive bladder cancer (MIBC) which has a poor prognosis. International guidelines for the management of MIBC recommend radical cystectomy or bladder-preserving treatment based on radical radiotherapy with a form of radiosensitisation. In the UK, both conventional fractionation with 64 Gy in 32 fractions and hypofractionation with 55 Gy in 20 fractions are standard of care options with the choice varying between centres. A meta-analysis of individual patients with locally advanced bladder cancer from two UK multicentre phase 3 trials was published recently. This study evaluated the non-inferiority of a hypofractionated schedule compared to a conventional regime. This analysis confirmed the non-inferiority of the hypofractionated regimen, and noted superior locoregional control. We discuss the relevance of these findings to current practice while considering the radiobiology of hypofractionation, the role of systemic therapies and radiosensitisation, as well as the socioeconomic benefits.

Creative Commons License All site content, except where otherwise noted, is licensed under a Creative Commons Attribution 4.0 License.
PII: 28023