ACR Appropriateness Criteria ® on External Beam Radiation Therapy Treatment Planning for Clinically Localized Prostate Cancer
Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110-1032, USA.International journal of radiation oncology, biology, physics (Impact Factor: 4.26). 05/2009; 74(3):667-72. DOI: 10.1016/j.ijrobp.2008.12.073
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ABSTRACT: The 5-year follow up data from a study on localized prostate cancer has shown high rates of bladder, lung, and rectal cancers in men treated with external beam radiotherapy compared with radical prostatectomy. at 10 years of follow-up, only excess lung cancer risk was significant, and the authors conclude that increased secondary malignancy risk with radiation should be included in initial treatment decisions and counseling. in my opinion, younger men subjected to radiation might suffer more in the long-term than if they had undergone surgery.
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ABSTRACT: Intensity-modulated radiotherapy (IMRT) offers dosimetric benefit for irregularly shaped treatment volumes compared to three-dimensional conformal approaches. Some groups advocate IMRT as the standard of care for prostate radiotherapy. For clinicians, assessment of an IMRT plan can introduce new opportunities and challenges. Although a standard IMRT plan may be deemed acceptable by meeting pre-set dose constraints, further optimisation may yield a superior treatment plan by further reducing dose to critical structures or improving target volume homogeneity. The aim of this article is to present aspects of IMRT planning relevant to clinicians to aid in plan critiquing.
Chapter: Prostate[Show abstract] [Hide abstract]
ABSTRACT: Given the high global incidence of prostate cancer, it represents one of the most common diseases treated in radiation oncology and urological clinics. It also represents a disease where technological innovations are often introduced and evaluated before they are advanced to other disease sites. In this chapter we describe an array of acceptable methods for the curative treatment of prostate cancer, from conventional radiation therapy techniques, intensity modulated radiation therapy, stereotactic body radiation therapy, brachytherapy, and proton therapy. The choice of modalities used in any given clinical situation is often determined by its technical availability, as no “level one” evidence exists to demonstrate clinical outcome superiority of one technique to another. We also discuss the definitive management of patients with brachytherapy and the post-operative management of patients who have adverse pathologic factors or have failed radical prostatectomy. Discussions on appropriate immobilization and localization techniques are provided. Finally, prescription methods and normal organ dose constraints for the various techniques of radiation therapy are given.
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