Put this on your RADAR.

The TROG RADAR trial initially reported in 2014 was pretty complex. It used a 2x2 design to randomize patients receiving definitive radiation therapy for locally advanced prostate cancer to 6 versus 18 months of androgen deprivation (ADT) with or without 18 months of zoledronic acid. As we know, 18 months was better than 6 months of ADT for men with high-risk disease. But alas, another layer of complexity was that the study era spanned the transition from old-school conformal radiation (i.e., three fixed beams) to the more complex intensity modulated radiation (IMRT). IMRT--much like mortgage backed securities and collateral debt obligations--was widely adopted in the late 90s and early 2000s because it was smarter, sexier, and just intuitively made sense. The TROG trialists now report how radiation techniques influenced tumor control. To the chagrin of RVU talliers everywhere, patients treated with more complex techniques experienced significantly more disease progression. The authors hypothesize this resulted from smaller, more conformal target volumes and steeper dose fall-offs without the necessary set-up and dose calculation certainties. This may be something to figure out before we get too fancy.