Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer

Abstract

Prostate cancer (PCa) is the most common male malignancy and the second cause of cancer death in the United States (US) with expected 248,530 new cases and 34,130 deaths in 2021 (Siegel et al., 2021). Following the 2012 update of the US Preventive Task Force against routine prostate specific antigen (PSA) screening (Moyer, 2012), there has been an increase in the proportion of higher risk localized cases especially in those >75 years at diagnosis (Hu et al., 2016).According to the National Cancer Comprehensive Network (NCCN) guidelines the majority of PCa patients of intermediate and high-risk with long life expectancy will end up receiving either radical prostatectomy (RP), or definitive radiotherapy (RT) with or without androgen deprivation therapy (ADT) (National Comprehensive Cancer Network, 2019). Men with higher risk PCa

The role of image-guided radiotherapy in prostate cancer: A systematic review and meta-analysis

“…After further exclusion, 26 articles were eligible for inclusion, but 6 of them were excluded due to the inappropriate form of outcomes [17] , [37] , [38] , [39] , [40] , [41] and 2 were excluded because of the same cohort of patients [42] , [43] . Ultimately, 18 studies that met the eligibility criteria were finally selected, including 3 RCTs, [19] , [23] , [44] 4 PCSs [45] , [46] , [47] , [48] and 11 RCSs [18] , [21] , [22] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] . A PRISMA flow diagram depicting the study identification and selection is shown in Fig.…”

Using a Further Planning MRI after Neoadjuvant Androgen Deprivation Therapy Significantly Reduces the Radiation Exposure of Organs at Risk in External Beam Radiotherapy of Prostate Cancer

“…It is known from several studies [ 33 , 34 , 35 , 36 ] that even a small decrease in mean dose and especially relief in the high dose range is associated with a significantly lower rate of proctitis and cystitis, even if these data were not yet clearly reproducible in the patient reported outcome [ 37 ]. The clinical relevance of the present results is thus demonstrated.…”

Cone-beam CT delta-radiomics to predict genitourinary toxicities and international prostate symptom of prostate cancer patients: a pilot study

“…Definitive radiotherapy (RT), a primary intervention for intermediate and high-risk PCa, aims to limit treatment-related side effects and preserve patient quality of life (QOL) while delivering curative dose to the prostate 3 – 6 . Efforts to minimize toxicity to nearby organs at risk (OAR), mainly gastrointestinal and genitourinary (GU) tissues, have established intensity-modulated radiotherapy (IMRT) as the standard external beam technique for RT of PCa 7 – 10 . Modern image-guided RT (IGRT) with linac-mounted cone-beam CT (CBCT) improves the therapeutic index through enhanced visualization of the prostate prior to daily treatment, allowing for reduction of planning target volume (PTV) margins and sparing of adjacent OAR 6 , 7 , 11 , 12 .…”

“…Efforts to minimize toxicity to nearby organs at risk (OAR), mainly gastrointestinal and genitourinary (GU) tissues, have established intensity-modulated radiotherapy (IMRT) as the standard external beam technique for RT of PCa 7 – 10 . Modern image-guided RT (IGRT) with linac-mounted cone-beam CT (CBCT) improves the therapeutic index through enhanced visualization of the prostate prior to daily treatment, allowing for reduction of planning target volume (PTV) margins and sparing of adjacent OAR 6 , 7 , 11 , 12 . Despite innovations in RT techniques, modalities and fractionation, overall patient QOL suffers compared to men without PCa in part due to RT-related side effects 13 .…”