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External beam radiotherapy for prostatic cancers: 2025 update.

Igor Latorzeff1, Alizée Camps-Maléa2, Christophe Hennequin3

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Cancer Radiotherapie : Journal De La Societe Francaise De Radiotherapie Oncologique
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Summary

Updated French Society of Radiation Oncology guidelines recommend image-guided intensity-modulated radiotherapy for prostate cancer. Techniques include standard, moderate, and extreme hypofractionation, with specific dose recommendations for each, alongside detailed postoperative irradiation strategies.

Keywords:
CancerProstateRadiotherapyRadiothérapie externeRecommandationsRecommendation

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • External radiotherapy is a primary treatment for localized and oligometastatic prostate cancer.
  • Evolving techniques necessitate updated clinical recommendations for optimal patient outcomes.

Purpose of the Study:

  • To present the updated recommendations of the Société française de radiothérapie oncologique (SFRO) for external radiotherapy in prostate cancer.
  • To detail irradiation techniques, fractionation schedules, and dosimetry for various risk groups and clinical scenarios.

Main Methods:

  • Review and synthesis of current evidence and expert consensus by the SFRO.
  • Detailed description of image-guided intensity-modulated radiotherapy (IMRT) techniques.
  • Specification of dose regimens for standard, moderate, and extreme hypofractionation, including stereotactic conditions.

Main Results:

  • Prostate image-guided IMRT is the recommended technique.
  • Standard fractionation: 74–80Gy in 2Gy fractions.
  • Moderate hypofractionation: 60Gy in 3Gy fractions over 4 weeks.
  • Extreme hypofractionation (stereotactic): 35–40Gy in five fractions for favorable/intermediate risk disease.
  • Detailed guidelines for postoperative irradiation, contouring, and dosimetry are provided.

Conclusions:

  • Updated SFRO guidelines provide a framework for advanced external radiotherapy in prostate cancer.
  • Hypofractionation techniques, including extreme hypofractionation, are established therapeutic standards.
  • Adherence to recommended techniques and dosimetry is crucial for effective treatment and minimizing toxicity.