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Should rectal spacing only be considered routinely for patients who are at elevated risk of rectal toxicity?

At 2023 ASTRO, PACE-B reported very low 5-year RTOG grade 2+ rectal toxicity with SBRT (1/363) and conventionally or moderately fractionated radiotherapy (1/348).
4 Answers
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Radiation Oncology · Virginia Commonwealth University Medical Center
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I think some caution needs to be injected here (pun intended) before people decide to make a change in practice based on unpublished data. Let me remind everyone that the devil is in the details of the treatment technique, dose constraints, dose-fractionation schedule, treatment delivery technique, ...

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Radiation Oncology · Michigan Healthcare Professionals, PC
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PACE-B (NCT01584258) is a phenomenal study that gives us great information about cure rates and toxicity with SBRT for prostate cancer.

To give what appears to be a grade 2 toxicity (placement of spacer), to reduce grade 2 toxicity seems to be an odd clinical decision, especially when the rates of g...

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Radiation Oncology · Kansas City VA Medical Center
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I'm glad to see the discussion started on this subject. In my opinion, there is no role for Space OAR in prostate radiotherapy other than creating financial toxicity to patients in addition to the inherent toxicity of the procedure in itself. We have to be honest with ourselves about how often grade...

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Radiation Oncology · Northern Nevada Radiation Oncology
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We have level I evidence supporting decreased rectal toxicity and decreased rates of erectile dysfunction and as we know, our bladder DVHs improve. Being "honest" with ourselves by looking back at our patients is full of bias and misinformation. Many patients quite like their Radiation Oncologist an...

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