Skip to main content
SpringerLink
Log in

External Beam Radiotherapy for Advanced Prostate Cancer: Dose, Technique, and Fractionation

  • Chapter
  • First Online:
Management of Advanced Prostate Cancer

  • 814 Accesses

Abstract

Prostate cancer is generally considered to have a low α/β ratio. With this biological rationale and the development of radiation techniques, hypofractionation is now rapidly performed in radiation oncology field. Several prospective trials have been conducted to evaluate the moderate hypofractionation and demonstrated that moderate hypofractionation is not superior but equivalent to conventional fractionation regimen in terms of biochemical control. The data on extreme hypofractionation is still immature, but promising. Also, combined treatment with external beam radiotherapy and brachytherapy has demonstrated better biochemical control than that of external beam radiotherapy alone. In this chapter, we review the dose, technique, and fractionation scheme for the prostate cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zietman AL, Bae K, Slater JD, Shipley WU, Efstathiou JA, Coen JJ, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol. 2010;28(7):1106–11. https://doi.org/10.1200/jco.2009.25.8475.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dearnaley DP, Jovic G, Syndikus I, Khoo V, Cowan RA, Graham JD, et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2014;15(4):464–73.

    Article  PubMed  Google Scholar 

  3. Heemsbergen WD, Al-Mamgani A, Slot A, Dielwart MFH, Lebesque JV. Long-term results of the Dutch randomized prostate cancer trial: Impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol. 2014;110(1):104–9. https://doi.org/10.1016/j.radonc.2013.09.026.

    Article  PubMed  Google Scholar 

  4. Viani GA, Stefano EJ, Afonso SL. Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys. 2009;74(5):1405–18. https://doi.org/10.1016/j.ijrobp.2008.10.091.

    Article  PubMed  Google Scholar 

  5. Al-Mamgani A, Heemsbergen WD, Peeters STH, Lebesque JV. Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2009;73(3):685–91. https://doi.org/10.1016/j.ijrobp.2008.04.063.

    Article  PubMed  Google Scholar 

  6. Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X, et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84(1):125–9. https://doi.org/10.1016/j.ijrobp.2011.11.047.

    Article  PubMed  Google Scholar 

  7. Miralbell R, Roberts SA, Zubizarreta E, Hendry JH. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: α/β= 1.4 (0.9–2.2) Gy. Int J Radiat Oncol Biol Phys. 2012;82(1):e17–24.

    Article  PubMed  Google Scholar 

  8. Dasu A, Toma-Dasu I. Prostate alpha/beta revisited–an analysis of clinical results from 14 168 patients. Acta Oncol. 2012;51(8):963–74.

    Article  PubMed  Google Scholar 

  9. Arcangeli G, Saracino B, Arcangeli S, Gomellini S, Petrongari MG, Sanguineti G, et al. Moderate hypofractionation in high-risk, organ-confined prostate cancer: final results of a phase III randomized trial. J Clin Oncol. 2017;35:1891–7.

    Article  PubMed  Google Scholar 

  10. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, et al. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol. 2013;31(31):3860–8. https://doi.org/10.1200/jco.2013.51.1972.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hoffman KE, Voong KR, Levy LB, Pugh TJ, Choi S, Du W, et al. Randomized trial of hypofractionated dose-escalated intensity modulated radiation therapy versus conventionally fractionated intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2016;96(2):S32. https://doi.org/10.1016/j.ijrobp.2016.06.091.

    Article  Google Scholar 

  12. Incrocci L, Wortel RC, Alemayehu WG, Aluwini S, Schimmel E, Krol S, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2016;17(8):1061–9. https://doi.org/10.1016/S1470-2045(16)30070-5.

    Article  PubMed  Google Scholar 

  13. Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn PP, de Jager H, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol. 2016;17(4):464–74. https://doi.org/10.1016/S1470-2045(15)00567-7.

    Article  PubMed  Google Scholar 

  14. Catton CN, Lukka H, Gu C-S, Martin JM, Supiot S, Chung PWM, et al. Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol. 2017;35(17):1884–90. https://doi.org/10.1200/jco.2016.71.7397.

    Article  PubMed  Google Scholar 

  15. Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17(8):1047–60.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, et al. Randomized phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol. 2016;34(20):2325–32. https://doi.org/10.1200/JCO.2016.67.0448.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lieng H, Pintilie M, Bayley A, Berlin A, Bristow R, Chung P, et al. Long-term outcomes of a phase II trial of moderate hypofractionated image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer. Radiother Oncol. 2017;122(1):93–8. https://doi.org/10.1016/j.radonc.2016.10.017.

    Article  PubMed  Google Scholar 

  18. Meier R, Beckman A, Henning G, Mohideen N, Woodhouse S, Cotrutz C et al. Five-year outcomes from a multi-center trial of stereotactic body radiotherapy for low-and intermediate-risk prostate cancer. 2016.

    Google Scholar 

  19. King CR, Freeman D, Kaplan I, Fuller D, Bolzicco G, Collins S, et al. Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials. Radiother Oncol. 2013;109(2):217–21.

    Article  PubMed  Google Scholar 

  20. Katz AJ, Kang J. Stereotactic body radiotherapy as treatment for organ confined low-and intermediate-risk prostate carcinoma, a 7-year study. Front Oncol. 2014;4:240.

    PubMed  PubMed Central  Google Scholar 

  21. Musunuru HB, Quon H, Davidson M, Cheung P, Zhang L, D'Alimonte L, et al. Dose-escalation of five-fraction SABR in prostate cancer: toxicity comparison of two prospective trials. Radiother Oncol. 2016;118(1):112–7. https://doi.org/10.1016/j.radonc.2015.12.020.

    Article  PubMed  Google Scholar 

  22. Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M, et al. Extreme hypofractionation versus conventionally fractionated radiotherapy for intermediate risk prostate cancer: early toxicity results from the scandinavian randomized phase III trial “HYPO-RT-PC”. Int J Radiat Oncol Biol Phys. 2016;96(5):938–9. https://doi.org/10.1016/j.ijrobp.2016.09.049.

    Article  Google Scholar 

  23. Quon HC, Ong A, Cheung P, Chu W, Chung HT, Vesprini D, et al. PATRIOT trial: randomized phase II study of prostate stereotactic body radiotherapy comparing 11 versus 29 days overall treatment time. J Clin Oncol. 2015;33(7_suppl):6. https://doi.org/10.1200/jco.2015.33.7_suppl.6.

    Article  Google Scholar 

  24. Grimm P, Billiet I, Bostwick D, Dicker AP, Frank S, Immerzeel J, et al. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU Int. 2012;109(Suppl 1):22–9. https://doi.org/10.1111/j.1464-410X.2011.10827.x.

    Article  PubMed  Google Scholar 

  25. Spratt DE, Zumsteg ZS, Ghadjar P, Kollmeier MA, Pei X, Cohen G, et al. Comparison of high-dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate-risk prostate cancer. BJU Int. 2014;114(3):360–7. https://doi.org/10.1111/bju.12514.

    Article  PubMed  Google Scholar 

  26. Morris WJ, Tyldesley S, Rodda S, Halperin R, Pai H, McKenzie M, et al. Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2017;98(2):275–85. https://doi.org/10.1016/j.ijrobp.2016.11.026.

    Article  PubMed  Google Scholar 

  27. Rodda S, Tyldesley S, Morris WJ, Keyes M, Halperin R, Pai H, et al. ASCENDE-RT: an analysis of treatment-related morbidity for a randomized trial comparing a low-dose-rate brachytherapy boost with a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2017;98(2):286–95. https://doi.org/10.1016/j.ijrobp.2017.01.008.

    Article  PubMed  Google Scholar 

  28. Fuller DB, Naitoh J, Lee C, Hardy S, Jin H. Virtual HDRSM CyberKnife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. Int J Radiat Oncol Biol Phys. 2008;70(5):1588–97. https://doi.org/10.1016/j.ijrobp.2007.11.067.

    Article  PubMed  Google Scholar 

  29. Spratt DE, Scala LM, Folkert M, Voros L, Cohen GN, Happersett L, et al. A comparative dosimetric analysis of virtual stereotactic body radiotherapy to high-dose-rate monotherapy for intermediate-risk prostate cancer. Brachytherapy. 2013;12(5):428–33. https://doi.org/10.1016/j.brachy.2013.03.003.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Depatment of Radiation Oncology, Asan Medical Center, Seoul, South Korea

    Yeon Joo Kim M.D. & Young Seok Kim M.D.

Authors
  1. Yeon Joo Kim M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Seok Kim M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young Seok Kim M.D. .

Editor information

Editors and Affiliations

  1. Department of Urology, Asan Medical Center, Seoul, Soul-t´ukpyolsi, Korea (Republic of)

    Choung Soo Kim

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kim, Y.J., Kim, Y.S. (2018). External Beam Radiotherapy for Advanced Prostate Cancer: Dose, Technique, and Fractionation. In: Kim, C. (eds) Management of Advanced Prostate Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-6943-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-6943-7_9

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-6942-0

  • Online ISBN: 978-981-10-6943-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation