AUA 2016: What’s Next for Radiation Therapy in Low to Favorable/Intermediate Risk? - Session Highlights

San Diego, California ( Mack Roach, III MD, FACR gave a broad over-view of development within radiation oncology with a focus on low to intermediate risk prostate cancer.

He discussed RTOG9910 trial which illustrated no change in overall-survival, disease-specific survival or biochemical failure when intermediate risk patients were randomized to 4 months or 9 months duration of neoadjuvant ADT with XRT. He concluded that there is currently no reason to use ADT beyond 4 months in any patients with intermediate risk prostate cancer. Low-risk patients should get no ADT.

He then discussed RTOG0126 trial comparing 79.2Gy vs 70.2 Gy in intermediate risk prostate cancer patients. The study did not show any difference in overall or cancer-specific survival but improved biochemical control rate with higher dose.

Dr. Roach III then discussed an increased interest in SBRT as compared to IMRT. SBRT utilization is predicted to increase over next decade. SBRT is associated with more toxicity currently than IMRT but is shown to be less expensive with equivocal cancer outcomes. Therefore, further work is being done to minimize toxicity.

He then discussed proton-beam therapy, which is also projected to increase in utility. Although the cost is high with proton beam therapy currently, further work needs to be done to decrease the number of fractionations, which may make it financially feasible.

Dr. Roach III concludes with the following points:
- No ADT in the vast majority of low risk disease
- No more than 4 months in intermediate risk disesase
- SBRT is likely to grow
- Proton therapy is likely to grow if hypofractionation is achieved.
- MRI maybe helpful in patient selection


Presented By: Mack Roach, III MD, FACR


Written By: Mohammed Haseebuddin, MD; Fox Chase Cancer Center, Philadelphia, PA at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA

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