La Radioterapia Nel Trattamento Del Carcinoma Della Prostata: Indicazioni, Evoluzione Tecnologica e Approcci Integrati

Abstract

Prostate cancer is a heterogeneous, indolent or sometimes aggressive tumor. Treatment options are various and without proved superiority. Radiotherapy (RT) plays a key role in the disease history. Technological evolution with Intensity Modulate Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) allowed improvement, with significant results on local control and survival. Hypofractionation, Stereotactic Body RT (SBRT) and new brachytherapy approachs are still under investigation, with promising opportunities. Adjuvant vs salvage postoperative RT, hormone association, prophylactic pelvic irradiation are still under debate, but guidelines express overlapping indications. Multidisciplinary managements will be the future for care optimization, providing the best tool for holistic and informed patients’ choice.

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“…All these considerations are true for all cancer types, even for prostate cancer, the most common tumour in the male occidental population (250.000 new diagnoses in USA during 2012) [13]; with an expecting growing up prevalence in the following years (220.800 estimated new case in 2015) [14]. In this cancer type, more than in others, the therapeutic options are numerous, including surgery, with its different modalities, radiotherapy, with many techniques, dose and dose per fraction, hormone therapy alone or in association with other treatments, active surveillance, or others evolving therapies like cryosurgery or high intensity focused ultrasound (HIFU) [15]. So, with the heterogeneity of tumours and patients, the current speed of innovations and of new available options, the increasing numbers of published papers, it is very difficult to make a right choice for the single prostate cancer patient that we usually meet in our clinical practice.…”

Intensity‐modulated radiotherapy reduces toxicity with similar biochemical control compared with 3‐dimensional conformal radiotherapy for prostate cancer: A randomized clinical trial

“…Historically, radiation treatment has passed through different phases over time with considerable improvements in its quality . In the beginning, the conventional technique using bone marks to deliver the radiation dose to the target was widely used in clinical practice . Currently, RT using computed tomography/magnetic resonance imaging (CT/MRI) and sophisticated planning software to analyze the dose distribution to the target and organs at risk (OARs) are commonly used .…”

“…1,2 Currently, RT using computed tomography/magnetic resonance imaging (CT/MRI) and sophisticated planning software to analyze the dose distribution to the target and organs at risk (OARs) are commonly used. [1][2][3] This interaction between planning software and imaging permitted the development of 3-dimensional conformal RT (3DCRT) and intensity-modulated RT (IMRT). Today, these techniques are widely disseminated and available for daily use in many countries.…”

“…In the beginning, the conventional technique using bone marks to deliver the radiation dose to the target was widely used in clinical practice . Currently, RT using computed tomography/magnetic resonance imaging (CT/MRI) and sophisticated planning software to analyze the dose distribution to the target and organs at risk (OARs) are commonly used . This interaction between planning software and imaging permitted the development of 3‐dimensional conformal RT (3DCRT) and intensity‐modulated RT (IMRT).…”

Personalized Medicine in Prostate Cancer: Future Perspectives for Tailored Treatments

“…In this cancer type, more than in others, the therapeutic options are numerous, including surgery, with its different modalities, radiotherapy, with many techniques, dose and dose per fraction, hormone therapy alone or in association with other treatments, active surveillance, or others evolving therapies like cryosurgery or high intensity focused ultrasound (HIFU) [15]. So, with the heterogeneity of tumours and patients, the current speed of innovations and of new available options, the increasing numbers of published papers, it is very difficult to make a right choice for the single prostate cancer patient that we usually meet in our clinical practice.…”