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Radiation Oncology • Genitourinary Cancers
When you do recommend conventional fractionation over moderate hypofractionation for prostate cancer?
Do you prefer to treat patients with factors such as large prostate volume, significant comorbidities, anticoagulation use, history of TURP, or high AUA/IPSS score with conventional fractionation?
Answer from: Radiation Oncologist at Academic Institution
I am routinely using 2.5-3 Gy in patients with low, intermediate, and some high risk patients so I guess I am an early adopter (or a cavalier nutjob). The exclusion criteria from the two published non-inferiority trials of moderate hypofractionation that are relevant to this question are quoted more...
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Answer from: Radiation Oncologist at Academic Institution
At Fox Chase, the overwhelming majority of our prostate patients who are treated with IMRT are treated with some form of hypofractionation (moderate hypofx or SbRT). Based on our own phase III randomized prospective trial (long-term results were published in 2020 - Avkshtol et al. PMID 32119599) as ...
Answer from: Radiation Oncologist at Community Practice
I concur with @W. Robert Lee's response. We will wait for the RTOG 0415. At the Scripps proton therapy center, we have been treating most of our prostate patients using the 70 Gy in 28 fractions with simulteous boost to the DIL (seen on MRI) to 78 Gy using Intensity Modulated Proton Therapy. The onl...
Answer from: Radiation Oncologist at Community Practice
I had measured some unexpectedly fortuitous and significant lowering of the IPSS in IPSS>20 patients undergoing 81 Gy/45 fx IG-IMRT (the "old" popular MSKCC regimen). In my experience, 79 of 81 IPSS>20 patients had a stable or (much) lower IPSS after 1.8 Gy daily fractional doses. ( @W. Robert...