Electing small volumes.

If you’re itching to dive reeeal deep into the data and philosophy on whether or not to add elective pelvic nodal volumes to radiation treatments for prostate cancer, this review is for you. The authors land on erring towards not including elective nodes given it clearly adds toxicity while affording a very unclear meaningful benefit—despite over a thousand trial enrollees in pursuit of this result. While it remains a reasonable choice for the very select group meeting POP-RT inclusion, i.e. high-risk disease with no PSMA-evidence of distant mets, it very well may pan out that salvage nodal irradiation for the very few cases that prove to have nodal only recurrences is the most prudent path of all. | Zaorsky, Int J Radiat Oncol Biol Phys 2021