Investigating Setup Error Differences between Conventional and Ultra‐Hypofractionated Whole Pelvis Radiation Therapy: A Secondary Analysis from the HOPE Randomized Clinical Trial
Abstract
Abstract Introduction The multi‐institutional HOPE trial (NCT04197141) compared conventional (25 fractions over 5 weeks) to ultra‐hypofractionated (5 fractions over 1.5 weeks) whole pelvis radiotherapy for unfavorable intermediate and high/very high‐risk prostate cancer patients treated with brachytherapy boost. Within this randomized controlled trial, we investigated setup errors for clinical target volumes corresponding to the prostate (CTVp) and nodes (CTVn). Methods Fifty‐four patients treated within a single institution were analyzed, with 28 treated on the ultra‐hypofractionated arm and 26 on the conventional fractionation arm. Prior to treatment, three fiducial markers were implanted into the prostate for daily cone‐beam computed tomography (CBCT) matching. All plans were delivered using volumetric modulated arc therapy with a uniform 6‐mm PTV margin. For all treatment fractions, average fiducial matching errors were measured for CTVp, while errors to CTVn were determined based on the difference between the treatment position and an automatic match to bone. Asymmetric PTV margins to account for prostatic and nodal setup errors were calculated using the van Herk formalism. Results Median (interquartile range [IQR]) 3D errors for CTVp were 1.4 (0.8–2.5) mm for conventional versus 1.2 (0.7–1.9) mm for the ultra‐hypofractionatated arms (p = 0.013), while for CTVn they were 2.8 (1.6–4.2) mm and 2.9 (2.2–4.4) mm, respectively (p = 0.07). Between arms, statistically…
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Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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