Stereotactic Body Radiotherapy: Hitting Harder, Faster, and Smarter in High-Risk Prostate Cancer

Abstract

Stereotactic body radiotherapy (SBRT) is a technologically sophisticated form of radiotherapy that holds significant potential to effectively treat high-risk prostate cancer (HRPC). Prostate SBRT has been the subject of intense investigation in the context of low- and intermediate-risk disease, but less so for HRPC. However, emerging data are demonstrating its potential to safely and efficiently delivery curative doses of radiotherapy, both to the prostate and elective lymph nodes. SBRT theoretically hits harder through radiobiological dose escalation facilitated by ultra-hypofractionation (UHRT), faster with only five treatment fractions, and smarter by using targeted, focal dose escalation to maximally ablate the dominant intraprostatic lesion (while maximally protecting normal tissues). To achieve this, advanced imaging modalities like magnetic resonance imaging and prostate specific membrane antigen positron emmission tomography (PSMA-PET) are leveraged in combination with cutting-edge radiotherapy planning and delivery technology. In this focused narrative review, we discuss key evidence and upcoming clinical trials evaluating SBRT for HRPC with a focus on dose escalation, elective nodal irradiation, and focal boost.

Virtual HDR Boost for Prostate Cancer: Rebooting a Classic Treatment Using Modern Tech

“…This study will hopefully shed more light on the difference between SBRT vs. brachytherapy boost. Another future trial that will help discern the differences between brachytherapy and SBRT is the ASCENDE-SBRT trial [ 75 ]. This trial aims to randomize 710 unfavourable intermediate-risk and high-risk PC patients to either a schedule with whole pelvic radiotherapy + brachytherapy boost with 46 Gy in 23 fractions or an ultra-hypofractionated schedule of 25 Gy in 5 fractions administered to the whole pelvis + a vHDRB boost of 40 Gy in 5 fractions.…”

Stereotactic ablative radiotherapy for treating primary head and neck cancer and locoregional recurrence: A comprehensive review of the literature

“…In this context, the use of stereotactic ablative radiotherapy (SABR), an advanced radiation technique, has gained attention for its capacity to administer highly ablative doses over a limited number of fractions, while precisely sparing the surrounding healthy tissue [3] . SABR has now gained acceptance for various early-stage primary tumors, and oligometastases [4] , [5] , [6] . This approach yields commendable rates of tumor control and mitigate the toxicity to critical OARs, making it an appealing therapeutic option for HNC patients, particulary those who are elderly, inoperable, or experiencing recurrence [7] .…”

Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases

“…Use of highly conformal, high-dose-per-fraction stereotactic body radiotherapy (SBRT), (also known as stereotactic ablative radiotherapy: SABR) has grown over the past two decades for both primary [1] and metastatic cancers [2] , facilitated by incremental technological advancements [3] . This has led to adoption in less common anatomic sites, including lymph nodes [4] .…”