In light of the recent data indicating increased late grade 3 to 5 toxicities (LTOX3) after hypofractionated salvage radiation therapy, will you continue to offer these regimes to patients?   

Prior Literature: Prior non-randomized studies seem to suggest excess toxicity with hypofractionated PORT (e.g., Cozzarini et al., PMID 24985964, Tandberg et al., PMID 29559284). In part for this reason, a phase III, randomized controlled non-inferiority trial, NRG-GU003, was conducted (Buyyounouski...

I think future radiation oncology physician-historians will cite this as yet another debacle of COVID. Trying to use hypofractionation and unlearn the lessons of decades of radiotherapy experience with fractionation and late effects, from the 1960s-2010s, seems now to have led to disasters which man...

This was not a randomized trial, so we cannot be sure of the impact of hypofractionation. But the increase in late grade ≥3 toxicity from 2 years to 13.5 years of median follow-up is dramatic and should give us pause. It is also a warning that we need very long-term toxicity outcomes data in more...

It does bring up the issue of longer follow-up for late effects, total dose delivered 65 Gy in 26 fractions (do we need such a high dose for BCR with no visible target?), and CTV delineation (RTOG atlas treats a lot more bladder than some recent recurrence patterns seen on PSMA).