The evolving role of external beam radiotherapy in localized prostate cancer |
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| Affiliation: | 1. The Champalimaud Centre for the Unknown, Lisbon, Portugal;2. Medical Sciences Division, University of Oxford, Oxford, United Kingdom;3. Memorial Sloan Kettering Cancer Center, New York, New York;1. Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy;2. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy;3. European Institute of Oncology, IRCSS, Milan Italy;1. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC;2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC;3. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC |
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| Abstract: | Primary organ-confined prostate cancer is curable with external-beam radiotherapy. However, prostate cancer expresses a unique radiobiological phenotype, and its ablation requires doses at the high-end range of clinical radiotherapy. At this dose level, normal tissue radiosensitivity restricts the application of curative treatment, and mandates the use of the most advanced high-precision treatment delivery techniques to spare critical organs at risk. The efficacy and tolerance of dose-escalated conventional fractionated radiotherapy and of the biological equivalent doses of moderate and extreme hypofractionation are reviewed. Current studies indicate that novel risk-adapted techniques to spare normal organs at risk are still required to deploy high-biological equivalent dose extreme hypofractionation, while affording preservation of quality of life and cost-effectiveness. |
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