In light of the recent data indicating increased late grade 3 to 5 toxicities 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...

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 tr...

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).