open access

Vol 8, No 3 (2003)
Published online: 2003-01-01
Submitted: 2003-09-22
Get Citation

Radiotherapy for locally advanced prostate Cancer: dogmas and dilemmas

Bogusław Maciejewski, Zbigniew Petrovich, Dariusz Lange, Andrzej Borówka
DOI: 10.1016/S1507-1367(03)70998-5
·
Rep Pract Oncol Radiother 2003;8(3):97-110.

open access

Vol 8, No 3 (2003)
Published online: 2003-01-01
Submitted: 2003-09-22

Abstract

Several well documented clinical trials and retrospective studies on radiotherapy for locally advanced prostate cancer are reviewed showing that almost all conventional, 5-day-a-week, 2 Gy fraction regimes produce the “plateau effect” (further increase in total dose above some level does not improve local tumour control), although a few studies identified radiation dose as an important predictor for the treatment outcome. This suggests that conventional radiotherapy for locally advanced prostate cancer has limited efficacy. Dissimilar patient population in each of the reports under review makes conclusions uncertain because the analysis does not make it possible to separate the impact of clinical and histological predictors on the treatment outcome from the effect of the radiation dose. The advent of conformal 3D IMRT permits safe delivery of dose escalated radiotherapy. Advantages and traps of 3D-CRT-IMRT therapy are presented and discussed. Evidence of low α/β value of about 1.5 Gy for prostate cancer cases suggests that these tumours have unusual sensitivity to a change in dose per fraction which opens up a new perspective for radical hypofractionated 3D-CRT and/or 3D-high dose rate brachytherapy and various fractionation regimes. Hyperthermia combined with 3D-CRT is discussed as an interesting treatment option.

Abstract

Several well documented clinical trials and retrospective studies on radiotherapy for locally advanced prostate cancer are reviewed showing that almost all conventional, 5-day-a-week, 2 Gy fraction regimes produce the “plateau effect” (further increase in total dose above some level does not improve local tumour control), although a few studies identified radiation dose as an important predictor for the treatment outcome. This suggests that conventional radiotherapy for locally advanced prostate cancer has limited efficacy. Dissimilar patient population in each of the reports under review makes conclusions uncertain because the analysis does not make it possible to separate the impact of clinical and histological predictors on the treatment outcome from the effect of the radiation dose. The advent of conformal 3D IMRT permits safe delivery of dose escalated radiotherapy. Advantages and traps of 3D-CRT-IMRT therapy are presented and discussed. Evidence of low α/β value of about 1.5 Gy for prostate cancer cases suggests that these tumours have unusual sensitivity to a change in dose per fraction which opens up a new perspective for radical hypofractionated 3D-CRT and/or 3D-high dose rate brachytherapy and various fractionation regimes. Hyperthermia combined with 3D-CRT is discussed as an interesting treatment option.

Get Citation
About this article
Title

Radiotherapy for locally advanced prostate Cancer: dogmas and dilemmas

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 8, No 3 (2003)

Pages

97-110

Published online

2003-01-01

DOI

10.1016/S1507-1367(03)70998-5

Bibliographic record

Rep Pract Oncol Radiother 2003;8(3):97-110.

Authors

Bogusław Maciejewski
Zbigniew Petrovich
Dariusz Lange
Andrzej Borówka

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl