Pelvic sufficiency.

Is 45-50 Gy sufficient to treat occult nodal disease in men with high risk prostate cancer? This small phase 2 study explored the feasibility of dose escalation to pelvic nodes during moderately hypofractionated prostate radiation. 27 men with a 25%+ risk of occult nodal metastases (using the Roach formula) received 70 Gy in 28 fractions to the prostate and proximal seminal vesicles and 56 Gy to pelvic nodes in the same 28 fractions. An important note on planning was that the CTV was prescribed 56 Gy in 28 fractions while 95% of the PTV was required to receive at least 50.4 Gy. Bladder and rectum goals were V45 < 45%, V55 < 25%, and V15 < 65%. The small bowel goal was V46.5 < 300 cc. There were 2 acute grade 3 events—one GU and one GI. The 5-year rate of late grade 1-2 GU and GI toxicity was 18% and 28%, and there were no late grade 3 events. | Hall, Pract Radiat Oncol 2021


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