Hypofractionated Salvage RT Not Superior for Prostate Recurrence, Adds GI Toxicity

In the phase 3 SHARE trial from South Korea, hypofractionated salvage radiotherapy (65 Gy in 26 fractions) did not improve 4-year biochemical progression-free survival compared with conventional salvage RT (66 Gy in 33 fractions) for biochemical recurrence after radical prostatectomy. Distant metastasis-free and prostate cancer–specific survival were similar between groups, while late GI toxicity was higher with hypofractionation (7.9% vs 0.7%), particularly without an endorectal balloon; quality of life was similar in both arms. Concurrent ADT and positive surgical margins were associated with better biochemical outcomes. The authors suggest hypofractionated RT could be a viable alternative given comparable outcomes, but longer follow-up and more data on balloon use are needed.