Dose-Intensified Stereotactic Ablative Radiation for Localized Prostate Cancer

Lily Chen, Bhavani S. Gannavarapu, Neil B Desai, Michael R Folkert, Michael Dohopolski, Ang Gao, Chul Ahn, Jeffrey Cadeddu, Aditya Bagrodia, Solomon Woldu, Ganesh V. Raj, Claus Roehrborn, Yair Lotan, Robert D. Timmerman, Aurelie Garant, Raquibul Hannan

Research output: Contribution to journalArticlepeer-review


Purpose: Stereotactic ablative radiation (SAbR) has been increasingly used in prostate cancer (PCa) given its convenience and cost efficacy. Optimal doses remain poorly defined with limited prospective comparative trials and long-term safety/efficacy data at higher dose levels. We analyzed toxicity and outcomes for SAbR in men with localized PCa at escalated 45 Gy in 5 fractions. Methods and Materials: This study retrospectively analyzed men from 2015 to 2019 with PCa who received linear-accelerator-based SAbR to 45 Gy in 5 fractions, along with perirectal hydrogel spacer, fiducial placement, and MRI-based planning. Disease control outcomes were calculated from end of treatment. Minimally important difference (MID) assessing patient-reported quality of life was defined as greater than a one-half standard deviation increase in American Urological Association (AUA) symptom score after SAbR. Results: Two-hundred and forty-nine (249) low-, intermediate-, and high-risk PCa patients with median follow-up of 14.9 months for clinical toxicity were included. Acute urinary grade II toxicity occurred in 20.4% of patients. Acute grade II GI toxicity occurred in 7.3% of patients. For follow-up > 2 years (n = 69), late GU and GI grade ≥III toxicity occurred in 5.8% and 1.5% of patients, respectively. MID was evident in 31.8%, 23.4%, 35.8%, 37.0%, 33.3%, and 26.7% of patients at 3, 6, 12, 24, 36, and 48 months, respectively. The median follow-up for biochemical recurrence was 22.6 months with biochemical failure-free survival of 100% at 1 year (n = 226) and 98.7% for years 2 (n = 113) and 3 (n = 54). Conclusions: SAbR for PCa at 45 Gy in 5 fractions shows an encouraging safety profile. Prospective studies with longer follow-up are warranted to establish this dose regimen as standard of care for PCa.

Original languageEnglish (US)
Article number779182
JournalFrontiers in Oncology
StatePublished - Feb 21 2022


  • SBRT (stereotactic body radiation therapy)
  • dose-intense radiation therapy
  • gastrointestinal (GI)
  • genitourinary (GU)
  • prostate
  • prostate cancer
  • stereotactic ablative radiation (SAbR)
  • toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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