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Volume 8, Number 3, 2003

Radiotherapy for locally advanced prostate cancer: dogmas and dilemmas

Maciejewski B, Petrovich Z, Lange D, Borówka A.


Several well documented clinical trials and retrospective studies on radiotherapy for locally advanced prostate cancer are reviewed showing that almost all conventional, 5-day-a-week, 2 Gy fraction regimes produce the “plateau effect” (further increase in total dose above some level does not improve local tumour control), although a few studies identified radiation dose as an important predictor for the treatment outcome. This suggests that conventional radiotherapy for locally advanced prostate cancer has limited efficacy. Dissimilar patient population in each of the reports under review makes conclusions uncertain because the analysis does make it possible to separate the impact of clinical and histological predictors on the treatment outcome from the effect of the radiation dose. The advent of conformal 3D IMRT permits safe delivery of dose escalated radiotherapy. Advantages and traps of 3D-CRT-IMRT therapy are presented and discussed. Evidence of low  value of about 1.5 Gy for prostate cancer cases suggests that these tumours have unusual sensitivity to a change in dose per fraction which opens up a new perspective for radical hypofractionated 3D-CRT and/or 3D-high dose rate brachytherapy and various fractionation regimes. Hyperthermia combined with 3D-CRT is discussed as an interesting treatment option.

Signature: Rep Pract Oncol Radiother, 2003; 8(3) : 97-110


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