Mini pelvis?

Elective nodal irradiation for prostate cancer isn’t much more clear-cut than it is for breast cancer. Trials such as RTOG 9413 and SPPORT, in addition to observational trials, show an associated increase in acute and/or late GI toxicity. Here’s a trial that begs to differ. Patients with high-risk prostate cancer (and a >20% risk of nodal involvement) were randomized to prostate radiation (68 Gy in 25 fractions) +/- simultaneous treatment of the pelvic nodes (50 Gy in the same 25 fractions) along with 2 years of ADT. There was no significant difference in acute GI or GU toxicity on the RTOG scale. And while there was also no significant increase in late GI toxicity (4 → 7%), there was quite an increase in late GU toxicity (8 → 18%). As with many prostate cancer trials, this didn’t translate into any measurable detriment in patient-reported quality of life. TBL: In this trial, the higher volume of irradiated bladder with inclusion of nodes for men with high risk prostate cancer translated into higher late GU toxicity. | Murthy, Radiother Oncol 2020