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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| NRG-GU005 Trial Compares SBRT and Hypofractionated IMRT for Prostate Cancer |
| Rodney Ellis, MD |
| Rodney Ellis presents NRG-GU005 trial results, revealing nuanced findings in the comparison of SBRT versus moderate hypofractionation for intermediate-risk prostate cancer. |
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The 2025 American Society for Radiation Oncology (ASTRO) Annual Meeting |
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| Quality of Life Results from NRG-GU005: A Phase III Trial of SBRT vs. Hypofractionated IMRT for Localized Intermediate Risk Prostate Cancer |
| James Yu, MD, FASTRO, MHS |
| James Yu presented quality-of-life results from the NRG-GU005 phase III trial, which compared SBRT with hypofractionated IMRT in intermediate-risk prostate cancer. Patients treated with SBRT reported fewer declines in bowel and sexual function at 1 year, and less urinary incontinence decline at 2 years, with overall investigator-reported toxicities also favoring SBRT. These findings support SBRT as a safe, effective option with potential quality-of-life advantages over IMRT in this setting. |
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| Daily Online Adaptive Recontouring for Prostate Cancer Using 1.5 Tesla Magnetic Resonance Image Guidance (MRgRT) Improves Patient Reported Urinary Symptoms: A Prospective, International, Observational Cohort Study
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| William Hall, MD
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| William Hall presented results from the international MOMENTUM study (NCT04075305) showing that prostate cancer patients treated with daily MRI-guided adaptive recontouring (ATS) during SABR reported significantly fewer urinary symptoms compared to those treated without daily recontouring (ATP). No meaningful differences were seen in bowel or sexual function, highlighting urinary benefit as the primary advantage.
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| Long-Term Toxicity and Patient-Reported Quality of Life after Prostate IMRT with or without Biodegradable Balloon Rectal Spacer: Analysis of a Pivotal Randomized Trial
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| Daniel Song, MD
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| Daniel Song presented long-term results from a randomized phase III trial showing that use of a biodegradable balloon rectal spacer during prostate IMRT significantly reduced rectal and urinary toxicities while improving patient-reported bowel and sexual quality of life up to 48 months. Patients with spacers had notably lower rates of grade ≥2 rectal toxicity (5.9% vs 21.3%) and better preservation of urinary and sexual function.
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| A Randomized, Parallel Phase II Trial of Hypofractionated Proton Therapy or IMRT for Recurrent, Oligometastatic Prostate Cancer with Pelvic and/or Para-Aortic Lymph Node Involvement Following Primary Localized Treatment with Radiotherapy
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| Brian Davis, MD, PhD
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| Brian Davis reported results from a randomized phase II trial comparing hypofractionated proton therapy vs. IMRT for recurrent, oligometastatic prostate cancer with pelvic/para-aortic nodal involvement after prior radiotherapy. Moderate hypofractionation showed low rates of acute GU/GI toxicity, similar to conventional fractionation, with no grade ≥3 toxicities observed. Proton therapy reduced radiation exposure to abdominal organs versus IMRT, but this did not translate into significant clinical toxicity differences, supporting both as safe options for elective nodal radiation in this setting.
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| Hydrogel Spacer Quality Assurance (QA) in a Multi-Center Randomized Control Trial of Neurovascular-Sparing SAbR for Localized Prostate Cancer (PCa) |
| Neil Desai, MD |
| This multi-center phase II trial (POTEN-C) evaluated hydrogel spacer quality assurance in neurovascular-sparing SAbR for localized prostate cancer, aiming to preserve erectile function. Using MRI-based scoring, most patients achieved acceptable spacer quality, though infiltration rates were modestly higher than in single-center studies. Spacer quality correlated with rectal dose but not short-term toxicity, highlighting the importance of centralized QA and long-term follow-up for late toxicity and functional outcomes. |
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| Patient-Reported Outcomes in a Randomized Trial of 18F-Fluciclovine vs. 68Ga-PSMA-11 PET/CT- Guided Post-Prostatectomy Radiation with Simultaneous Integrated Boosts |
| Ashesh Jani, MD, MS, FASTRO |
| The EMPIRE-2 trial compared 18F-fluciclovine vs. 68Ga-PSMA PET/CT–guided post-prostatectomy radiotherapy with simultaneous integrated boosts and found no significant differences in patient-reported urinary, bowel, sexual, or vitality outcomes between the two imaging arms. Despite more frequent boost delivery in the fluciclovine group, boosts themselves were not associated with worse quality-of-life scores. |
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| The 67th American Society for Radiation Oncology (ASTRO) Annual Meeting |
| William Jackson, MD |
| William Jackson discussed six presentations on quality of life outcomes after prostate radiotherapy, emphasizing how modern techniques aim to reduce treatment burden while preserving patient well-being. Key findings showed that simultaneous integrated boosts, moderate hypofractionation, and SBRT are safe and do not compromise quality of life, while adaptive MRI-guided radiotherapy may improve urinary outcomes. |
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