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HYDRA (MARCAP): moderate-hypofx at isodose = CFRT for PFS with no toxicity penalty; dose-escalated hypofx adds late G2+ GI (OR 1.48) for no PFS gain.
Prostate carried the day, and the theme was dose, not efficacy: moderate hypofx at isodose matches conventional RT while dose-escalation only buys late GI (HYDRA), and SBRT toxicity in UIR is constraint-driven, not intrinsic to 5fx. In breast, SUPREMO's null tested chest-wall RT alone (RNI prohibited), not full nodal PMRT; node-pos LRR still fell (HR 0.51).
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- ASTRO 2024: SBRT for Unfavorable Intermediate-Risk Prostate CancerEducational round-up on SBRT (5fx) for unfavorable intermediate-risk prostate; late grade ≥3 GU/GI ~2.0%/1.1%, toxicity driven by dose and urethral constraints, not SBRT itself.
- HYDRA (MARCAP)PFS equal for isodose (HR 0.92) and dose-escalated MHFRT (HR 0.94) vs CFRT, but dose-escalated adds late G2+ GI toxicity (OR 1.48).
- SUPREMOCritique: the null tested chest-wall RT alone (RNI prohibited; SCV 12%, IMN <2%), not comprehensive PMRT; node-pos LRR still fell 4.8%→3.3% (HR 0.51).
- ARS Appropriate Use Criteria: Intraprostatic RecurrencePSMA-PET + mpMRI staging, mandatory biopsy, then curative-intent salvage reirradiation (≤6 fractions) preferred over ADT alone for local intraprostatic radiorecurrence.
- HYDRA (MARCAP Consortium)No PFS difference for isodose or dose-escalated MHFRT vs CFRT (HR 0.92, 0.94); only dose-escalated adds late G≥2 GI toxicity (OR 1.48).
- 10-yr SBRT for Prostate Cancer (Meier et al.)10-yr RFS 90% (94% LR, 86% IR); late G3 GI/GU 1.4%/1.5%, no G4-5, after 40Gy/5fx prostate SBRT, no ADT.
- NRG-GU005Co-primary DFS superiority for SBRT not met (HR 1.38, p=0.13); bowel QoL favored SBRT (35% vs 44% MCID, p=0.034).
- SUPREMO10-yr OS 81.4% vs 81.9% (HR 1.04, p=0.80): no survival benefit from post-mastectomy chest-wall RT in intermediate-risk disease.
- EORTC 22033-26033/NCIC-CTG/TROG/MRC-CTUNo PFS/OS difference between RT (28×1.8 Gy) and dose-dense TMZ monotherapy in high-risk WHO grade 2 glioma; molecular subtype drives outcome.
- ARTOmOS NR vs 50mo, HR 0.55 (0.33-0.92) p=0.021 adding SBRT to all mets over abiraterone+ADT in oligomet CRPC.
- BART2-yr locoregional FFS 87.1% vs 76.0% (HR 0.43, p=0.04) favoring adjuvant RT post-cystectomy; OS not significant.
- ENZARAD (ANZUP 1303)Primary MFS endpoint negative (HR 0.88, p=0.34); enzalutamide benefit concentrated in cN1 (HR 0.43) and planned-pelvic-RT (HR 0.47) subgroups.