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Published on: February 6, 2019
[Image-guided radiotherapy in prostate cancer: concepts and implications]
G Créhange1, E Martin, S Supiot
1Département de radiothérapie, centre Georges-François-Leclerc, Dijon, France. gcrehange@cgfl.fr
Summary
Intensity modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) significantly reduce toxicity in prostate cancer treatment. Rigorous protocols are essential for effective image-guided radiotherapy (IGRT) to minimize side effects.
Area of Science:
- Radiation Oncology
- Medical Physics
- Oncology
Context:
- 3D conformational radiotherapy for prostate cancer is associated with significant digestive and urinary toxicity.
- Intensity modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) represent advanced techniques to mitigate these side effects.
- The combination of IG-IMRT has demonstrated a significant reduction in late genitourinary toxicity.
Purpose:
- To review the clinical benefits and technical considerations of IGRT and IMRT in prostate cancer treatment.
- To analyze literature data on dosimetric studies and clinical impact of IGRT protocols.
- To provide recommendations for IGRT repositioning protocols for radiation oncologists.
Summary:
- IMRT and IGRT significantly reduce digestive and urinary toxicity in prostate cancer patients compared to 3D conformational radiotherapy.
- At 10 years, minimal grade 2/3 digestive toxicity (3%) and moderate grade 2/3 urinary toxicity (16%) were reported with these advanced techniques.
- Effective IGRT requires rigorous adherence to protocols, including patient setup, repositioning techniques, imaging, margin definition, and treatment frequency.
Impact:
- IGRT and IMRT offer substantial clinical benefits by unequivocally reducing long-term digestive and urinary toxicity in prostate cancer survivors.
- The findings underscore the importance of meticulous protocol execution in IGRT to minimize repositioning uncertainties.
- Recommendations are provided for optimizing repositioning protocols based on established techniques like fiduciary markers, soft tissue matching, kV-CBCT, MV-CBCT, and 3D ultrasonography.
