Fagundes is vice chair of Radiation Oncology, director of International Outreach, and a radiation oncologist at Baptist Health Herbert Wertheim Cancer Institute (WCI) in Miami, Florida.
Transcript:
CancerNetwork: For multidisciplinary tumor boards weighing intensity-modulated proton therapy against advanced photon-based modalities such as ultrahypofractionated stereotactic body radiotherapy (SBRT) or volumetric modulated arc therapy, what scenarios in intermediate- to very high–risk disease provide the strongest justification for prioritizing proton therapy?
Fagundes: Prioritizing proton therapy is most justified, or easiest to demonstrate, when we are treating the pelvic lymph nodes. Current practice guidelines determine that we have to include the lymph nodes up to the iliac bifurcation, which is usually at the L4 [or] L5 level. That includes a significant extent of the pelvis; virtually the entire pelvic nodal chain is included. Proton therapy will decrease [dosage] to the bowel and minimize adverse effects. That is the justification for using it.
SBRT, or stereotactic body radiotherapy, involves only 5 sessions, given every other day, for example. It is primarily recommended for low- and intermediate-risk prostate cancer, not for patients in whom we are treating the pelvic nodes. When you are treating pelvic nodes, doing 5 fractions is still a developing paradigm. We are primarily treating [patients with] low- and intermediate-risk disease in 5 sessions, not those who need pelvic lymph node treatment.
Reference
Fagundes MA, Hassan H, Rodrigues M-A, et al. Intensity modulated proton therapy (IMPT) for localized prostate cancer: disease control outcomes in intermediate to very-high risk patients. Presented at: 2026 ASTRO Annual Meeting; September 26-30, 2026; Boston, MA. Abstract PQA 06.
