Abstract
There are radiobiological rationales supporting hypofractionated radiotherapy for prostate cancer. The recent advancements in treatment planning and delivery allow sophisticated radiation treatments to take advantage of the differences in radiobiology of prostate cancer and the surrounding normal tissues. The preliminary results from clinical studies indicate that abbreviated fractionation programs can result in successful treatment of localized prostate cancer without escalation of late toxicity.
Highlights
Prostate cancer is the most common cancer diagnosed in American men after non-melanomatous skin cancer
The radiobiological basis of hypofractionation for prostate cancer assumes that the prostate cancer cells respond to Prostate Cancer radiotherapy in a manner that can be mathematically modeled with a classic linear-quadratic equation: S = S0e−αD−βD2, (1)
It is noteworthy that the analyses that have yielded low α/β ratios for prostate cancer have sometimes involved comparisons of low dose rate brachytherapy with external beam radiotherapy, and assorted mathematical assumptions have been made [26,27,28,29] A comprehensive discussion of repair kinetics and other factors that influence the α/β estimates is beyond the scope of the present paper, and the reader is referred to some of the various studies related to this issue for additional discussion [10, 28, 30,31,32,33,34,35]
Summary
Prostate cancer is the most common cancer diagnosed in American men after non-melanomatous skin cancer. In most cases the prostate cancer is organ-confined at the time of initial diagnosis [2]. Either given as a seed implant or external beam radiation therapy, are the accepted standard options for treating the primary tumor itself, and androgen deprivation may be added selectively for certain cases with an intermediate or high risk of dissemination based on clinical and pathologic features evident at the time of diagnosis. Regarding the specific option of external beam radiotherapy, the current widely accepted standard regimen for organ-confined prostate cancer in the USA involves approximately eight weeks of fractionated treatments with a daily dose of 1.8–2.0 Gy to a total dose in the range of 70–80 Gy. At some centers the treatments, called fractions, are given over 9-10 weeks [3]. The scientific rationale for such “hypofractionated” treatment lies in the unique radiobiologic properties of prostate cancer
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