60-year-old man with stage IVA (cT2a, cN1, cM0) high risk prostate cancer (grade group 4, iPSA 37.6).
TECHNIQUE: Patient received neoadjuvant, concurrent, and adjuvant ADT for 2 years. Proximity of small bowel to the right external iliac node required sacrifice of coverage in order to meet small bowel constraints.
DOSE: Patient was treated with whole pelvis radiation to 50.4 Gy in 28 fractions with an SIB to the prostate (and SV) for definitive dose of 70Gy in 28 fractions. Involved nodes were also treated with an SIB to 60 Gy in 28 fractions.
ADT: Patients with node positive disease should receive neoadjuvant, concurrent, and/or adjuvant ADT for 18-36 months (FROGG guidelines). ADT + abiraterone may also be considered per the STAMPEDE trial (James NEJM 2017).
Case contributed by University of Cincinnati Medical Center
Per NRG Oncology 2021 Updated Consensus
70 Gy in 28 fx OARS: (NRG 2021 Consensus)
Questions? Feedback? Report here