Professional paper
https://doi.org/10.20471/acc.2022.61.s3.8
Recent Advances in Radiotherapy Modalities for Prostate Cancer
Jure Murgić
orcid.org/0000-0001-8152-0494
; Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
Ana Fröbe
; Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
Melvin Lee Kiang Chua
orcid.org/0000-0002-1648-1473
; Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology and Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore; Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
Abstract
Radiotherapy is the attractive treatment option for prostate cancer and has a clear
role in all stages of the disease. Over the last decade, advances in technology, imaging capabilities, and
improved radiobiological understanding have deeply transformed radiotherapy for prostate cancer,
allowing dose escalation and wide adoption of hypofractionation. Furthermore, the integration of
magnetic resonance imaging (MRI) and improved physical precision of dose delivery have given an
impetus to additionally target intraprostatic tumor lesions, previously agnostic to conventional radiotherapy
target definition concept. The emerging data from randomized clinical trials and observation
research show that ultra-hypofractionation is a safe approach while further follow-up is needed to
assess its efficacy compared to standard fractionation. There is an ongoing uncertainty surrounding
true alpha/beta ratio for prostate cancer since hypofractionation has so far failed to yield theoretically
envisioned superior biochemical control outcomes. Finally, recently published randomized trial settled
ongoing controversy regarding the role of elective pelvic lymph node radiotherapy in patients with
high-risk prostate cancer, showing clear benefit when pelvic nodes were treated to 50 Gy. The role of
partial gland dose escalation/tumor boosting is evolving, and more data is needed to adopt this approach
in routine clinical care. Going forward, molecular imaging will be crucial to assess biology of
the disease, predict a response potentially, and optimally personalize radiotherapy treatment decisions.
In this narrative review, we critically analyzed the published literature and provided practical summary
of recent prostate radiotherapy advances for busy clinicians.
Keywords
Prostate Cancer; Radiotherapy; Hypofractionation; Stereotactic Body Radiotherapy; Dose Escalation; Clinical Trials
Hrčak ID:
286368
URI
Publication date:
1.10.2022.
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