High five.

Whatever you choose to call it—SBRT, SABR, extreme hypofractionation—stereotactic radiation therapy for prostate cancer is becoming increasingly popular. But the use of extreme hypofractionation (our favorite) has been largely used for patients with lower-risk disease. In the SATURN trial, patients with high-risk disease (T3+, GS 8+ or PSA 20+) were treated with 5-fraction radiation directed at the prostate plus the seminal vesicles and pelvic nodes. The prostate received 40 Gy in 5 while the nodal CTV and seminal vesicles received 25 Gy in 5. Importantly, the PTVs for each of these were prescribed lower doses. The primary endpoints of GU and GI toxicity were encouraging with no patients experiencing as much as a grade 3 toxicity. TBL: Treating pelvic nodes with extreme hypofractionation appears feasible without major increases in toxicity. | Musunuru, Int J Radiat Oncol Biol Phys 2018