Comparison of intensity-modulated radiotherapy with the 5-field technique, helical tomotherapy and volumetric modulated arc therapy for localized prostate cancer

Abstract

The outcomes of three methods of intensity-modulated radiation therapy (IMRT) for localized prostate cancer were evaluated. Between 2010 and 2018, 308 D’Amico intermediate- or high-risk patients were treated with 2.2 Gy daily fractions to a total dose of 74.8 Gy in combination with hormonal therapy. Overall, 165 patients were treated with 5-field IMRT using a sliding window technique, 66 were then treated with helical tomotherapy and 77 were treated with volumetric modulated arc therapy (VMAT). The median age of patients was 71 years. The median follow-up period was 75 months. Five-year overall survival (OS) and biochemical or clinical failure-free survival (FFS) rates were 95.5 and 91.6% in the 5-field IMRT group, 95.1 and 90.3% in the tomotherapy group and 93.0 and 88.6% in the VMAT group, respectively, with no significant differences among the three groups. The 5-year cumulative incidence of late grade ≥2 genitourinary and gastrointestinal toxicities were 7.3 and 6.2%, respectively, for all patients. Late grade ≥2 gastrointestinal toxicities were less frequent in patients undergoing VMAT (0%) than in patients undergoing 5-field IMRT (7.3%) and those undergoing tomotherapy (11%) (P = 0.025), and this finding appeared to be correlated with the better rectal DVH parameters in patients undergoing VMAT. Other toxicities did not differ significantly among the three groups, although bladder dose-volume parameters were slightly worse in the tomotherapy group than in the other groups. Despite differences in the IMRT delivery methods, X-ray energies and daily registration methods, all modalities may be used as IMRT for localized prostate cancer.

Dosimetric and Radiobiological Comparison of Three- Dimensional Conformal Radiotherapy and Helical Tomotherapy in Whole Pelvic Radiotherapy of Prostate Cancer Patients

“…Clinical trial studies have demonstrated that modern radiotherapy techniques, including IMRT, VMAT, and HT, yield superior treatment outcomes for prostate cancer patients in terms of reduced rectal and bladder toxicities compared to the traditional 3D-CRT [33][34][35]. Techniques, such as HT, can produce a conformal dose distribution to the PTV, significantly reducing the irradiated volume of adjacent normal tissues.…”

Targeting the organelle for radiosensitization in cancer radiotherapy

“…Although many other innovative methods like RT combined with immunotherapy [29] made great progress in recent years, challenges like the unclear pathological mechanism for the occurrence of immune-related adverse effects [30] as well as inter-individual variability [31] remain. While different RT technologies like intensity-modulated RT, volumetric modulated arc therapy [32] and helical tomotherapy [33] enhance therapeutic effect, tumor heterogeneity and radioresistance hinder successful cancer treatment. Radiosensitizers, capable of precise radiation targeting and reducing normal tissue toxicity [34] , offer potential solutions to improve RT efficacy.…”