Prostate Cancer Radiotherapy

Chakrabarti et al. review and promote the adoption of hypofractionated and ultra-hypofractionated (SBRT) schedules for localized prostate cancer, citing radiobiological rationale and recent clinical trials ¹⁾.

While superficially related to radiosurgical approaches in neuro-oncology, this review provides no direct insights applicable to neurosurgical practice. It is narrowly focused on prostate cancer and rooted in a radiotherapy culture far removed from neurosurgical clinical decision-making.

The article's usefulness to a neurosurgeon is limited to generic conceptual validation of hypofractionation strategies — already well known in neuro-oncology.

The authors summarize trials like CHHiP, HYPO-RT-PC, and PACE-B, all widely disseminated. No new angle, critique, or hypothesis is introduced. This is academic repackaging, not a review.

*Verdict:* Redundant. We knew all this five years ago.

Despite citing radiobiological justification (low α/β), the article fails to:

• Address tumor heterogeneity.
• Discuss fractionation sensitivity at a molecular level.
• Extend these principles to other tumor types, such as gliomas or meningiomas.

*Translation:* Missed opportunity to bridge toward neuro-oncology.

Terms like “noninferiority,” “acceptable toxicity,” and “resource optimization” are used uncritically:

• No nuanced discussion of PROMs (Patient-Reported Outcome Measures).
• No mention of long-term cognitive, urinary, or sexual function deterioration.
• No counterarguments regarding overtreatment in low-risk disease.

This is marketing wrapped in medical terminology.

No effort is made to extrapolate lessons learned to brain tumors, skull base lesions, or spinal metastases — all areas where SBRT is also evolving.

*For neurosurgeons:* This is not a transferable model; it is organ-specific siloeing.

The article touts “efficiency” and “reduced burden” without exploring:

• The true economic cost of SBRT (planning, imaging, QA).
• Billing incentives behind fraction reduction.
• Access inequalities, especially in low-resource environments.

Efficiency without transparency is just cost-shifting.

A bland, consensus-driven voice with no dissent, no challenge, no clinical doubt. This is institutional publishing — not critical scholarship.

“Safe, effective, efficient” — the academic equivalent of elevator music.

This article has minimal relevance to neurosurgery beyond revalidating an already-known principle: fewer, larger doses can work — in some cancers, in some contexts. It does not inspire, educate, or challenge neurosurgical thinking.

Hypofractionation in neuro-oncology deserves its own mechanistic exploration — not a borrowed script from prostate cancer.

• A talking point in tumor boards when radiation oncologists push SBRT.
• A cautionary example of what academic theater looks like.
• A template of how not to write a cross-specialty impactful review.

Reviewed by: Neurosurgery Wiki Editorial Board Date: 2025-06-15