Sophisticated prostate cancer external beam radiotherapy
Does it live up to the hype?

Arjun Sahgal, MD, FRCPC; Derek Hyde, PhD; Elizabeth Lui, MRT, CMD; Andrew Loblaw, BSc, MD, MSc, FRCPC, CIP

Advances in modern radiation delivery allow for higher doses of radiotherapy, leading to better prostate-specific antigen (PSA) control and a lower risk of side effects.

 

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Top-line summary
Radiation oncology has recently undergone a technologic revolution in treatment delivery. The aim is to improve cure rates while reducing toxicity in normal tissue, and this entails significantly more complex treatment. The progression from 2-dimensional to 3-dimensional treatment planning in external beam radiation therapy (EBRT) was the first major shift in technology, allowing for conformal radiation (i.e. treatment that follows the shape of the targeted area). Highly conformal intensity modulated radiation therapy (IMRT) is now used routinely, and leading centres employ image guidance to ensure that this more precise IMRT is on target. In prostate cancer, these technologies can deliver higher doses to tumours and result in improved cancer control, with fewer and milder side effects due to sparing of adjacent normal tissues such as the rectum and bladder. This report aims to provide an overview of current technologic capabilities in external beam radiation oncology with respect to prostate cancer treatment, including a review of benefits reported in published randomized controlled trials. In addition to EBRT, permanent seed implantation and high-dose rate brachytherapy are other options for this malignancy — the interested reader is directed to review articles on these topics.1,2
 
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