Extreme HypoFractionated Radiotherapy (EHFRT)

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Extreme HypoFractionated Radiotherapy (EHFRT) for localised prostate cancer

Outcome of the appraisal


The evidence supports the routine adoption of extreme hypofractionated radiotherapy (EHFRT) to treat localised prostate cancer.


EHFRT is associated with equivalent short- and medium-term cancer recurrence and survival outcomes compared with standard care (moderately or conventionally fractionated radiotherapy). EHFRT reduces the number of visits required for treatment and is associated with a low incidence of adverse events.


EHFRT is likely to be cost effective when compared with standard care. Compared with moderately hypofractionated radiotherapy guided by fiducial markers, EHFRT (seven fractions) using fiducial markers is likely to be cost effective if it is delivered in treatment slots of 20 minutes or shorter. If EHFRT is delivered in five fractions, it is likely to be cost effective at all slot lengths up to 30 minutes.

Why was this topic appraised?


In the UK, prostate cancer is the most common cancer in men. In Wales, more than 2,500 men each year are diagnosed with prostate cancer. Radiotherapy is included as part of primary treatment in approximately 30% of patients diagnosed with prostate cancer.


EHFRT is an adaptation to conventional external beam radiotherapy and delivers the equivalent dose of radiotherapy in fewer sessions or fractions: EHFRT uses five or seven fractions over two weeks whereas standard radiotherapy treatment (moderately fractionated radiotherapy) usually uses 20 fractions over 4 weeks. Shorter treatment duration delivered over fewer treatment sessions has the potential to reduce hospital visits, reduce travelling costs, and alleviate some of the inconvenience of treatment for patients and their families.


This topic was proposed by Dr John Staffurth, Consultant Oncologist, Velindre University NHS Trust.

Plain language summary


Prostate cancer is a cancer that starts in the prostate. It can lead to urinary problems, pain and blood in the urine. Prostate cancer has the potential to grow and spread quickly, but if the cancer has not spread outside the prostate it can usually be managed or treated successfully.


Radiation therapy, or radiotherapy, is a therapy that uses radiation as part of cancer treatment to control or kill cancer cells. Beams of radiation are directed at cancerous cells by a machine. Radiotherapy is usually delivered daily over several weeks. Each visit to hospital for treatment is known as one ‘fraction’ of radiotherapy. For people with prostate cancer, standard practice is to have radiotherapy delivered in short sessions for 5 days a week, usually for 4 weeks.


Extreme hypofractionated radiotherapy (EHFRT) is a radiotherapy treatment where more radiation is delivered per treatment, so patients can complete their course of radiation therapy much faster. EHFRT can reduce treatment courses from 4 weeks to 2 weeks.


HTW looked for evidence on the effectiveness of EHFRT for people with localised prostrate cancer. The evidence supports the routine adoption EHFRT to treat localised prostate cancer as it indicates that EHFRT is as effective as standard care, it reduces the number of hospital visits, and is likely to be cost-effective.

Topic Exploration Report

TER244 05.2021

Evidence Appraisal Review

EAR034 11.2021


GUI034 02.2022

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