ACR Appropriateness Criteria for external beam radiation therapy treatment planning for clinically localized prostate cancer, part II of II

Abstract

PurposeTo present the most updated American College of Radiology (ACR) Appropriateness Criteria formed by an expert panel on the appropriate delivery of external beam radiation to manage stage T1 and T2 prostate cancer (in the definitive setting and post-prostatectomy) and to provide clinical variants with expert recommendations based on accompanying Appropriateness Criteria for target volumes and treatment planning.Methods and materialsThe ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a panel of multidisciplinary experts. The guideline development and revision process includes an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In instances in which evidence is lacking or equivocal, expert opinion may supplement available evidence to recommend imaging or treatment.ResultsThe panel summarizes the most recent and relevant literature on the topic, including organ motion and localization methods, image guidance, and delivery techniques (eg, 3-dimensional conformal intensity modulation). The panel presents 7 clinical variants, including (1) a standard case and cases with (2) a distended rectum, (3) a large-volume prostate, (4) bilateral hip implants, (5) inflammatory bowel disease, (6) prior prostatectomy, and (7) a pannus extending into the radiation field. Each case outlines the appropriate techniques for simulation, treatment planning, image guidance, dose, and fractionation. Numerical rating and commentary is given for each treatment approach in each variant.ConclusionsExternal beam radiation is a key component of the curative management of T1 and T2 prostate cancer. By combining the most recent medical literature, these Appropriateness Criteria can aid clinicians in determining the appropriate treatment delivery and personalized approaches for individual patients.

Information Needs of Black Prostate Cancer Patients Receiving Treatment Within the South African Public Healthcare System

“…The treatments, and in particular radiation treatments, create another set of information needs. The radiation therapist is primarily responsible for providing this information from a patient-centred perspective [ 32 ]. Patients need to be warned about potential side effects of the radiation treatments and an explanation of the symptoms that they might be experiencing [ 33 ].…”

Dose shadowing and prosthesis involvement for megavoltage photon In vivo diode dosimetry

“…For instance, the treatment of prostate cancer using hypofractionated radiotherapy is an emerging form of external beam radiotherapy which is an attractive option for low-risk patients who might not be candidates for brachytherapy or who find a 7–8-week course of daily conventional treatment (fractionated doses of 1.8–2 Gy daily fractions) prohibitive because of logistics or costs. [293031]…”

“…Hypofractionated treatment regimens usually deliver radiation doses ranging from 3.5 to 15 Gy per fraction in ≤5 daily fractions. [3031] Furthermore, a common and relevant use of IVD with diodes is the control or monitoring of total body irradiation (TBI) which requires detectors at the entrance and exit ports of the irradiation. [283233] TBI with external megavoltage photon beams may use parallel-opposed AP/PA or lateral fields.…”

“Après Mois, Le Déluge”: Preparing for the Coming Data Flood in the MRI-Guided Radiotherapy Era

“…Nevertheless, MR-only workflow introduces unique BMI considerations. For example, prostate RT plans are more precise with setup to intraprostatic gold or titanium fiducial implants (48), but these are visualized as signal void on conventional MRI sequences and poorly differentiated from calcifications. Maspero et al (49) reported that 3/48 fiducial implants were imprecisely and inaccurately identified by five radiation technologists when visualized only on MRI.…”