Practice Changes and Geographic Reach of Postprostatectomy Radiation Therapy After NRG-GU003

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Abstract Objective: Moderately hypofractionated postprostatectomy radiation therapy (HYPORT) is an accepted practice supported by the landmark trial NRG-GU003 that established noninferiority compared to conventionally fractionated radiation therapy (COPORT) in terms of patient-reported toxicity. HYPORT is purported to increase access to postprostatectomy radiation therapy (PPRT) with fewer treatment visits and reduced burden to patients. We hypothesized the introduction of HYPORT at our institution in March 2024 increased the utilization of PPRT in the following year compared to the prior year. Methods: 86 consecutive patients who received COPORT or HYPORT from March 2023 to April 2025 at a single, multisite institution in California by multiple treating radiation oncologists were retrospectively analyzed. Demographic, disease, and treatment characteristics were collected. Subgroup analyses were stratified by treatment regimen and by RT initiation before vs after the March 2024 publication of NRG-GU003. Statistical tests included 2-sample t tests, Fisher exact tests, χ² tests, Mann-Whitney U tests, and regression analyses. Results: No significant differences in patient demographics aside from margin status were observed between patients treated before vs after March 2024. Patients treated after March 2024 were more likely to receive HYPORT regimens (2.2-2.6 Gy fractions) than those treated before March 2024 (71% vs 38%; P < .01). On multivariable logistic regression, treatment after March 2024 was associated with higher odds of HYPORT receipt after adjustment for facility, margin status, and age (OR 12.85; P < .001) and after additional adjustment for treating physician (OR 13.70; P < .001). Treated PPRT case volume was numerically higher after March 2024 (50 vs 36 patients), and patients treated with HYPORT traveled numerically greater distances than those treated with COPORT. Conclusion: Adoption of HYPORT at our institution was associated with a marked increase in the use of hypofractionated treatment regimens following publication of NRG-GU003. Although institutional PPRT case volume and travel distance were numerically greater after HYPORT implementation, these findings warrant confirmation in larger studies to determine whether shorter treatment regimens improve access to care.

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