Evolution of advanced technologies in prostate cancer radiotherapy

Abstract

Conventional treatment options for clinically localized, low-risk prostate cancer include radical prostatectomy, external-beam radiotherapy (EBRT) and low-dose-rate brachytherapy. Advances in image-guided radiotherapy (IGRT) since the 1980s, the development of intensity-modulated radiotherapy (IMRT) during the 1990s and evidence from radiobiological models--which support the use of high doses per fraction--have developed alongside novel advanced radiotherapy modalities that include high-dose-rate brachytherapy (HDR-BT), stereotactic body radiotherapy (SBRT) and proton beam therapy. The relationship between the outcomes of and toxicities experienced by patients with prostate cancer treated with HDR-BT, SBRT and particle-beam therapy should provide urologists and oncologists an understanding of the continually evolving technology in prostate radiotherapy. On the basis of published evidence, conventionally fractionated EBRT with IMRT is considered the standard of care over conventional 3D conformal radiotherapy, whereas HDR-BT boost is an acceptable treatment option for selected patients with intermediate-risk and high-risk prostate cancer. SBRT and proton therapy should not be used for patients (regardless of disease risk group) outside the setting of a clinical trial. Finally, comparative effectiveness research should be conducted to provide a framework for evaluating advanced radiotherapy technologies by comparing the benefits and harms of available therapeutic options to optimize the risk:benefit ratio and improve cost effectiveness.

The evolution of proton beam therapy: Current and future status (Review)

“…Thus, long-term follow up is required to justify the increasing use of PBT for prostate cancer. It has been demonstrated that PBT is a safe and effective method for patients with localized prostate cancer (56)(57)(58)(59). However, it is necessary to further compare PBT with other treatment regimens for local prostate cancer to determine the optimal treatment regimen for different patients (60).…”

Pathological outcome for Chinese patients with low-risk prostate cancer eligible for active surveillance and undergoing radical prostatectomy: comparison of six different active surveillance protocols

“…treatments for low-risk prostate cancer include radical prostatectomy and radiotherapy, both of which are associated with significant morbidities. [5][6][7] In recent years, the concept of active surveillance (AS) has been adopted with the aim of monitoring clinically insignificant prostate cancer until disease progression, at which point radical prostatectomy or radiotherapy is considered. The ultimate objective is to delay or avoid the morbidities associated with radical treatments without compromising survival.…”

Proton beam therapy in Japan: current and future status

“…Zaorsky et al (27) reviewed the literature and concluded that PBT should not be used for patients, regardless of their disease, outside the setting of a clinical trial. At present, for prostate cancer, the ASTRO policy for PBT recommends well-designed registries and studies with sizable comparative cohorts to accelerate data collection.…”