Multidisciplinary Management of Prostate Cancer by Vincenzo Gentile Valeria Panebianco & Alessandro Sciarra

Author:Vincenzo Gentile, Valeria Panebianco & Alessandro Sciarra
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

7.7 External Beam Radiation Therapy

EBRT represents a well-established primary treatment options for clinically localized prostate cancer, considering that both modern RT and surgery resulted in equal cancer control.

In the last several decades, 3D-CRT has successfully replaced two-dimensional planning treatment, due to significant reduction in grade 3 or greater acute and late toxicity, and implementation of radiation total dose over 70 Gy [31]. Nowadays, the increasing availability of highly conformal irradiation techniques and advances in imaging technology, particularly RMN, are similarly affording new opportunities to optimize RT and diminish toxicity. The primary goal is to increase the dose gradient between target volume and surrounding areas, providing adequate coverage of the prostate and dose restriction to bladder and rectum. With the advent of IMRT, dose conformation and dose escalation have become possible. Of sure, benefit from IMRT requires meticulous delineation of target volume and organs at risk, accurate quality control in radiation planning and delivery, and limiting of interfraction and intrafraction variability—variability that can be reduce and minimize by daily prostate localization using IGRT [32].

EBRT Results

The role of radiation dose escalation is essential in tumor control, as supported by the growing evidence from clinical trials. Kuban et al. [29] randomized 301 patients with stage T1b to T3 prostate cancer to either 70 Gy or 78 Gy. The modest escalation dose improved freedom from biochemical and clinical progression (78 % vs. 59 %, p = 0.004), with the largest benefit in prostate cancer patients with PSA >10 ng/ml (78 % vs. 39 %, p = 0.001). In the Dutch trial [33] patients were randomly assigned to receive 68 Gy or 78 Gy and results showed better outcome in 78 Gy arm (54 % vs. 47 %, p = 0.04). In the MRC trial [34] patients were randomized to 64 Gy or 74 Gy and benefited from dose escalation (HR 0.67, 95 % CI 0.53–0.85, p = 0.0007) (Table 7.3 Table 7.3Studies reporting oncological results after external beam radiation therapy (EBRT) for clinically localized prostate cancer

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