Abstract
Simple SummaryRadiation therapy is a standard of care treatment option for men with localized prostate cancer. Over the years, various radiation delivery modalities have contributed to the increased precision of radiation, employing radiobiological insights to shorten the overall treatment time with hypofractionation, while improving oncological control without increasing toxicities. Here, we discuss and compare two ablative radiation modalities, stereotactic body radiation therapy (SBRT) and high-dose-rate brachytherapy (HDRBT), in terms of oncological control, dose/fractionation and toxicities in men with localized prostate cancer. This review will highlight the levels of evidence available to support either modality as a monotherapy, will summarize safety and efficacy, help clinicians gain a deeper understanding of the safety and efficacy profiles of these two modalities, and highlight ongoing research efforts to address many unanswered questions regarding ablative prostate radiation.Prostate cancer (PCa) is the most common noncutaneous solid organ malignancy among men worldwide. Radiation therapy is a standard of care treatment option that has historically been delivered in the form of small daily doses of radiation over the span of multiple weeks. PCa appears to have a unique sensitivity to higher doses of radiation per fraction, rendering it susceptible to abbreviated forms of treatment. Stereotactic body radiation therapy (SBRT) and high-dose-rate brachytherapy (HDRBT) are both modern radiation modalities that allow the precise delivery of ablative doses of radiation to the prostate while maximally sparing sensitive surrounding normal structures. In this review, we highlight the evidence regarding the radiobiology, oncological outcomes, toxicity and dose/fractionation schemes of SBRT and HDRBT monotherapy in men with low-and intermediate-risk PCa.
Highlights
Most patients diagnosed with prostate cancer (PCa) in the developed world present with clinically localized disease, and the majority have low- or intermediate-risk disease as defined by the NationalComprehensive Cancer Network (NCCN) [1]
Current evidence suggests that high-dose-rate brachytherapy (HDRBT) affords better tolerability with similar oncological control compared to LDRBT
While no randomized trials have compared HDRBT monotherapy directly to External beam radiotherapy (EBRT) alone, the use of brachytherapy in general as a monotherapy for intermediate risk disease is supported by the Radiotherapy Therapy Oncology Group (RTOG) 0232 trial, which has been presented in abstract form [55]
Summary
Most patients diagnosed with prostate cancer (PCa) in the developed world present with clinically localized disease, and the majority have low- or intermediate-risk disease as defined by the National. Considerable data suggest that PCa has a low alpha/beta ratio ranging from 1.5 to 3.1 [2], implying a preferential response to higher doses per fraction compared to most other tumors and normal tissues [3]. This has motivated multiple clinical trials investigating higher dose-per-fraction regimens. We will comprehensively review the safety and efficacy profiles of SBRT and HDRBT for localized prostate cancer, beginning with a brief discussion of the unique radiobiological features of ablative radiotherapy.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
