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Based on the recent guidelines, should prostate SBRT dose be no higher than 3625 cGy in 5 fractions?
The recently published executive summary from ASTRO/ASCO/AUA hypofractionated radiation therapy for localized prostate cancer states "Five-fraction prostate ultrahypofractionation at doses above 3625 cGy to the planning target volume is not suggested outside the setting of a clinical trial or multi-institutional registry due to risk of late toxicity. Strength of recommendation: Conditional; Quality of evidence: Moderate; Consensus: 100%." If your current practice is 4000 cGy in 5 fractions, for example, do you plan to change your regimen based on this publication?
Answer from: Radiation Oncologist at Academic Institution
In the absence of a randomized trial, it is difficult to definitively conclude that higher doses are definitely superior. In addition, it is very likely that the outcomes of SBRT for prostate cancer depends upon the risk group we are dealing with (low risk, favorable intermediate risk, and unfavorab...
Answer from: Radiation Oncologist at Academic Institution
I thought I'd update my answer since a lot has changed since 2018, but this is still a good question. The core of my previous answer is still correct, because of two important things:
There is a plethora of data at the 36.25 Gy/5 Fx dose that shows it to be effective and of low toxicity.
The 36.25...
Comments
Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
Yet, another great thread on theMednet. Since we a...
Yet, another great thread on theMednet. Since we a...
Radiation Oncologist at Quillen VA Medical Center
Although I’ve never published a prostate pap...
Although I’ve never published a prostate pap...
Very valid points. Everyone should remember that t...
Off of the above mentioned protocol, I have common...
It should be noted that note all SBRT is created e...
I have personally used the fractionation schemes o...
Thank you! Very practical and helpful comments @Da...