Hashim U. Ahmed, Professor and Chair of Urology at Imperial College London and Consultant Urological Surgeon at Imperial College Healthcare NHS Trust, shared by Rishabh Jain, Medical Consultant at Renova Hospital (RHL), on X;
“Presumably SBRT for localised favourable intermediate PCa will be rolled back following this RCT of 698 patients randomised in 136 international centres; designed and powered a priori as superiority of cancer control for SBRT over MH-IMRT, but wasn’t?”
Quoting Rishabh Jain:
5 fractions vs 20–28 fractions in intermediate-risk prostate cancer:
NRG-GU005
Phase 3 RCT, 698 patients:
SBRT 36.25 Gy/5 fx vs MH-IMRT 60 Gy/20 fx or 70 Gy/28 fx.
Key results
- 3-y DFS: 88.6% vs 92.1% with SBRT vs MH-IMRT
- SBRT was not superior for DFS
- Biochemical failure was higher with SBRT
Bowel QoL decline at 2 y: 34.9% vs 43.8%, favoring SBRT
- Grade 3–4 GU toxicity: 0.6% vs 2.5%, favoring SBRT
Why it matters
SBRT offers major convenience and somewhat better QoL/toxicity, but this modest-dose 5 – fraction regimen did not improve cancer control. The DFS difference was not statistically significant after covariate adjustment, but PSA failure was higher with SBRT.
Clinical verdict:
PROMISING FOR CONVENIENCE, BUT DO NOT ASSUME EQUIVALENT DOSE INTENSITY.”
Title: Stereotactic Body Radiotherapy vs Moderately Hypofractionated IMRT for Localized Intermediate-Risk Prostate Cancer: A Randomized Clinical Trial
Authors: Rodney J. Ellis, Stephanie L. Pugh, James B. Yu, Felix Y. Feng, Andre A. Konski, Robert L. Grubb III, Robert E. Wallace, David J. Gladstone, Cynthia Ménard, Joseph A. Miccio, Arthur J. Frazier, J. Daniel Pennington, Jeff M. Michalski, Daniel E. Spratt,
Alvaro Martinez, Scott C. Morgan, Alina Mihai, Abhishek Ashok Solanki, Asim Amjad, Michael W. Straza, Guila Delouya, Thomas M. Schroeder, David T. Marshall, Nirav Kapadia, Akshar N. Patel, Terrence P. Cescon, Ali El-Gayed, Harold A. Yoon, Rebecca Paulus, Howard M. Sandler, NRG-GU005 Collaborative Authors
