Will All Prostate Radiotherapy Be SBRT in 5 Years?

Abstract

Over the last 15 years there has been a move towards progressive hypofractionation for prostate cancer. It has been conclusively proven that moderate hypofractionation is non-inferior to longer regimens for treating the prostate alone and global standard of care has changed accordingly. Now observational, Phase II and now also Phase III studies are seeking to establish whether 5 fraction SBRT is equivalent to longer regiments. SBRT harnesses the power of precision radiotherapy to deliver high doses per fraction under careful image guidance, leveraging dose heterogeneity to maximise fall off around the prostate. 

Early clinical outcomes from observational and pooled Phase II studies are encouraging with low rates of toxicity and high rates of biochemical control. Phase III data, including from the HYPO-RT-PC and PACE trials, has already validated much of this data. 

Questions remain however; is SBRT right for all men with early prostate cancer? Can high risk prostate cancer be effectively treated in 5 fractions? Can pelvic nodal irradiation be safely treated in 5 fractions? How do we minimise toxicity?

The data supporting SBRT and the questions and controversies remaining will be discussed during this talk.