Who has time for five-fraction prostate ultra-hypofractionation when they could do the whole shebang over two fractions? This is Israeli phase 2 trial enrolled 20 patients with mostly favorable intermediate risk prostate cancer with prostates <80 cc. Everyone had a hydrogel spacer and fiducials placed with 3T-MRI T2 sequences for planning. Simultaneous integrated boosts were delivered to up to three targets: 1-2 cm of proximal seminal vesicles (23 Gy), the entire prostate (27 Gy), and an optional gross tumor boost (30 Gy, received by 50%) with a 2-mm radial planning margin delivered over only 2 fractions. At a median follow-up of 8 months, there were no grade 3+ GU or GI toxicities suggesting the safety of this regimen, though it remains unclear how this incrementally improves disease outcomes over more well-established 5-fraction ultra-hypofractionated courses. | Fredman, Int J Radiat Oncol biol Phys 2024
