Radiotherapy for Prostate Cancer: Difference between revisions

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== Hypofractionation ==

* '''Reduces the overall treatment course by delivering higher doses per fraction'''.

* '''The full dose of radiation is usually divided into a number of smaller doses called fractions'''

** '''The full dose of radiation is usually divided into a number of smaller doses called fractions'''

** Fractionated radiotherapy has been used since the early days of radiation, when it was found that cure could be achieved with less normal tissue injury when the radiation dose was split into many small fractions

*** Fractionated radiotherapy has been used since the early days of radiation, when it was found that cure could be achieved with less normal tissue injury when the radiation dose was split into many small fractions

* '''Hypofractionation (i.e. fewer fractions) reduces the overall treatment course by delivering higher doses per fraction'''

** Prostate cancer is believed to be acutely sensitive to the amount of radiation delivered at each treatment, such that providing a few treatments of high dose is more effective at producing cell kill than many fractions of 2 Gy. It is hypothesized that one could provide a lower total dose, thus lessening risk for normal organ injury, with similar prostate cancer control using higher than standard doses per fraction

* Prostate cancer is believed to be acutely sensitive to the amount of radiation delivered at each treatment, such that providing a few treatments of high dose is more effective at producing cell kill than many fractions of 2 Gy.

** ~~Safe treatment delivery requires accurate patient setup~~ and ~~conformal treatment planning~~.

**It is hypothesized that one could provide a lower total dose, thus lessening risk for normal organ injury, with similar prostate cancer control using higher than standard doses per fraction

* '''Doses in the range of 2.6 to 3.1 Gy have been delivered in phase III trials with low morbidity'''.

**Patient risk selection and biologically effective doses have resulted in excellent biochemical control reported up to 5 years, but it is not clear if moderate hypofractionation is more efficacious.

** ~~Patient risk selection~~ and ~~biologically effective doses have resulted in excellent biochemical control reported up to 5 years, but it is not clear if moderate hypofractionation is more efficacious~~.

*'''Doses in the range of 2.6 to 3.1 Gy have been delivered in phase III trials with low morbidity'''.

**Safe treatment delivery requires accurate patient setup and conformal treatment planning.

* '''Early studies of extreme fractionation (6.7 to 10 Gy) show good biochemical control rates but the duration of follow-up is limited.'''

== Heavy-particle therapy ==

* Another form of 3D-CRT

* Difficult to produce and control

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**** No clinical study has directly compared patient outcomes

***** Data suggest that proton therapy is safe and effective for prostate cancer treatment and likely results in cancer control and morbidity outcomes similar to that with IMRT.

~~== Radiation Therapy and Androgen Suppression Therapy ==~~

* '''See 2017 AUA Localized Prostate Cancer Guideline Notes and Management of Localized Disease Chapter Notes and Management of Locally Advanced Disease Chapter Notes'''

~~== Radiation Therapy after Prostatectomy ==~~

* '''See Management of Locally Advanced Prostate Cancer Chapter Notes''' and '''2019 AUA Guideline Notes on Radiation after Prostate Cancer Treatment'''

== Radiation therapy for palliation ==

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**** Epidural cord compressions arising from vertebral bodies accounts for the majority of spinal cord compressions; less frequently they are associated with soft-tissue masses involving the paravertebral region.

*** '''Diagnosis and Evaluation'''

**** '''Medical emergency; early diagnosis and therapy are critical'''

**** '''<span style="color:#ff0000">Medical emergency; early diagnosis and therapy are critical'''

***** '''Failure to diagnose and treat promptly can lead to significant morbidity, including paraplegia and autonomic dysfunction'''

**** '''History and Physical Exam'''

@@ Line 5: / Line 5: @@
 == Hypofractionation ==
-* '''Reduces the overall treatment course by delivering higher doses per fraction'''.
+* '''The full dose of radiation is usually divided into a number of smaller doses called fractions'''
-** '''The full dose of radiation is usually divided into a number of smaller doses called fractions'''
+** Fractionated radiotherapy has been used since the early days of radiation, when it was found that cure could be achieved with less normal tissue injury when the radiation dose was split into many small fractions
-*** Fractionated radiotherapy has been used since the early days of radiation, when it was found that cure could be achieved with less normal tissue injury when the radiation dose was split into many small fractions
+* '''Hypofractionation (i.e. fewer fractions) reduces the overall treatment course by delivering higher doses per fraction'''
-** Prostate cancer is believed to be acutely sensitive to the amount of radiation delivered at each treatment, such that providing a few treatments of high dose is more effective at producing cell kill than many fractions of 2 Gy. It is hypothesized that one could provide a lower total dose, thus lessening risk for normal organ injury, with similar prostate cancer control using higher than standard doses per fraction
+* Prostate cancer is believed to be acutely sensitive to the amount of radiation delivered at each treatment, such that providing a few treatments of high dose is more effective at producing cell kill than many fractions of 2 Gy.
-** Safe treatment delivery requires accurate patient setup and conformal treatment planning.
+**It is hypothesized that one could provide a lower total dose, thus lessening risk for normal organ injury, with similar prostate cancer control using higher than standard doses per fraction
-* '''Doses in the range of 2.6 to 3.1 Gy have been delivered in phase III trials with low morbidity'''.
+**Patient risk selection and biologically effective doses have resulted in excellent biochemical control reported up to 5 years, but it is not clear if moderate hypofractionation is more efficacious.
-** Patient risk selection and biologically effective doses have resulted in excellent biochemical control reported up to 5 years, but it is not clear if moderate hypofractionation is more efficacious.
+*'''Doses in the range of 2.6 to 3.1 Gy have been delivered in phase III trials with low morbidity'''.
+**Safe treatment delivery requires accurate patient setup and conformal treatment planning.
 * '''Early studies of extreme fractionation (6.7 to 10 Gy) show good biochemical control rates but the duration of follow-up is limited.'''
 == Heavy-particle therapy ==
 * Another form of 3D-CRT
 * Difficult to produce and control
@@ Line 34: / Line 34: @@
 **** No clinical study has directly compared patient outcomes
 ***** Data suggest that proton therapy is safe and effective for prostate cancer treatment and likely results in cancer control and morbidity outcomes similar to that with IMRT.
-== Radiation Therapy and Androgen Suppression Therapy ==
-* '''See 2017 AUA Localized Prostate Cancer Guideline Notes and Management of Localized Disease Chapter Notes and Management of Locally Advanced Disease Chapter Notes'''
-== Radiation Therapy after Prostatectomy ==
-* '''See Management of Locally Advanced Prostate Cancer Chapter Notes''' and '''2019 AUA Guideline Notes on Radiation after Prostate Cancer Treatment'''
 == Radiation therapy for palliation ==
@@ Line 63: / Line 55: @@
 **** Epidural cord compressions arising from vertebral bodies accounts for the majority of spinal cord compressions; less frequently they are associated with soft-tissue masses involving the paravertebral region.
 *** '''Diagnosis and Evaluation'''
-**** '''Medical emergency; early diagnosis and therapy are critical'''
+**** '''<span style="color:#ff0000">Medical emergency; early diagnosis and therapy are critical'''
 ***** '''Failure to diagnose and treat promptly can lead to significant morbidity, including paraplegia and autonomic dysfunction'''
 **** '''History and Physical Exam'''