Next level.

If you’re not reading theMednet by now, you should be. Including this great discussion by Dr. Zelefsky and others on the topic of appropriate extreme hypofractionation dosing for prostate cancer. The latest data comes from 5 year follow-up of the MSKCC dose-escalation trial. Dose was escalated up to 40 Gy in 5 fractions to the entire prostate + 5 mm (3 mm posterior) margins using Calypso beacons. Only 1 of 136 enrollees had a late grade 3 toxicity. While grade 2 toxicity increased with dose, the rate of biochemical failure and positive post-treatment biopsy went way down. TBL: Even with extreme hypofractionation, prostate cancer continues to exhibit a dose response with no apparent threshold. | Zelefsky, Int J Radiat Oncol Biol Phys 2019