Emerging Technologies in Prostate Cancer Radiation Therapy: Improving the Therapeutic Window

Matthew C. Biagioli, MD, MS; Sarah E. Hoffe, MD

Disclosures

Cancer Control. 2010;17(4):223-32. 

In This Article

Conclusions

Significant technological advances have been made in the field of radiation oncology over the past 20 years. The development of more conformal treatments, initially with 3D CRT followed by IMRT, has resulted in reduced normal tissue toxicity and allowed for safe dose escalation up to 86.5 Gy. Currently, the optimal radiation dose needed for maximal tumor control remains unknown. However, multiple randomized trials have shown that doses of 76 Gy or greater are superior to the previous standard dose of 70 Gy. While recent reports suggest that different risk strata may require different doses with higher-risk cancers requiring higher doses, randomized trials are needed.

In the last decade, the development of better IGRT technologies have improved our understanding of day-to-day positional variations as well as variations that can occur during treatment delivery. Further adoption of IGRT techniques will likely result in a reduction of treatment toxicity and expansion in the ability to further escalate dose. Additionally, prostate brachytherapy represents a minimally invasive procedure that is an alternative to the typical 8-week course of EBRT. Both LDR and HDR IPB have better rectal sparing and, when combined with EBRT, may represent a superior form of therapy for intermediate- and high-risk patients, although further randomized trials are needed. Lastly, the recent introduction of SBRT for the treatment of low- to intermediate-risk prostate cancer presents an attractive alternative to standard radiation treatments. Further study is required to delineate long-term toxicity and efficacy before it can be accepted as another potential standard of care.

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