Seminars in Oncology
Volume 30, Issue 5 , Pages 596-615 , October 2003

Technological advances in external-beam radiation therapy for the treatment of localized prostate cancer

  • Steven A Leibel

      Affiliations

    • Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • Corresponding Author InformationAddress reprint requests to Steven A. Leibel, MD, Chairman, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
    • ,
  • Zvi Fuks

      Affiliations

    • Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Michael J Zelefsky

      Affiliations

    • Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Margie Hunt

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Chandra M Burman

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Gikas S Mageras

      Affiliations

    • Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Chen-Shou Chui

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Andrew Jackson

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Howard I Amols

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • C.Clifton Ling

      Affiliations

    • Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

References 

  1. Del Regato J. Radiotherapy in the conservative treatment of operable and locally inoperable carcinoma of the prostate. Radiology. 1967;88:761–766
  2. Bagshaw MA, Kaplan HS, Sagerman RH. Linear accelerator supervoltage therapy (VII. Carcinoma of the prostate). Radiology. 1967;85:121–129
  3. Ray GR, Cassady JR, Bagshaw MA. Definitive radiation therapy of carcinoma of the prostate. Radiology. 1973;106:407–418
  4. Shipley WU, Thames HD, Sandler HM, et al.  Radiation therapy for clinically localized prostate cancer (A multi-institutional pooled analysis). JAMA. 1999;28:1598–1604
  5. Zagars GK, Pollack A, Smith LG. Conventional external-beam radiation therapy alone or with androgen ablation for clinical stage III (T3, Nx/N0, M0) adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1999;44:809–819
  6. Leibel SA, Fuks Z, Zelefsky MJ, et al.  Prostate cancer (Three-dimensional conformal and intensity modulated radiation therapy). PPO Updates. 2000;14:1–9
  7. Leibel SA, Fuks Z, Zelefsky MJ, et al.  Treatment of prostate cancer (External-beam radiotherapy). In:  DeVita VT,  Hellman S,  Rosenberg SA editor. Progress in Oncology 2001. Sudbury, MA: Jones & Bartlett; 2001;p. 313–334
  8. Leibel SA, Fuks Z, Zelefsky MJ, et al.  Intensity-modulated radiotherapy. Cancer J. 2002;8:164–176
  9. Zelefsky MJ, Fuks Z, Hunt M, et al.  High-dose intensity modulated radiotherapy for prostate cancer (Early toxicity and biochemical outcome in 772 patients). Int J Radiat Oncol Biol Phys. 2002;53:1111–1116
  10. Leibel SA, Zelefsky MJ, Kutcher GJ, et al.  The biological basis and clinical application of three-dimensional conformal external beam radiation therapy in carcinoma of the prostate. Semin Oncol. 1994;21:580–597
  11. Horowitz EM, Hanks GE. External beam radiation for prostate cancer. CA Cancer J Clin. 2000;50:349–375
  12. Pollack A, Zagars GK. Androgen ablation in addition to radiation therapy for prostate cancer (Is there a true benefit?). Semin Radiat Oncol. 1998;8:95–106
  13. Bagshaw MA. Definitive megavoltage radiation therapy in carcinoma of the prostate. In:  Fletcher GH editors. Textbook of Radiotherapy. (ed 2). Philadelphia, PA: Lea & Febiger; 1973;p. 752–767
  14. Bagshaw MA. External radiation therapy of carcinoma of the prostate. Cancer. 1980;45:1912–1921
  15. Ten Haken RK, Perez-Tamayo C, Tesser RJ, et al.  Boost treatment of the prostate using shaped fixed beams. Int J Radiat Oncol Biol Phys. 1989;16:193–200
  16. Epstein BE, Hanks GE. Radiation therapy techniques and dose selection in the treatment of prostate cancer. Semin Radiat Oncol. 1993;3:179–186
  17. Hanks GE, Krall JM, Hanlon AL, et al.  Patterns of care and RTOG studies in prostate cancer (Long-term survival, hazard rate observations, and possibilities of cure). Int J Radiat Oncol Biol Phys. 1994;28:39–45
  18. Crook JM, Malone S, Bahadur Y, et al.  Postradiotherapy prostate biopsies (What do they really mean? Results for 498 patients). Int J Radiat Oncol Biol Phys. 2000;48:355–367
  19. Laverdière J, Gomez JL, Cusan L, et al.  Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys. 1997;37:247–252
  20. Hanks GE, Martz KL, Diamond JJ. The effect of dose on local control of prostate cancer. Int J Radiat Oncol Biol Phys. 1988;15:1299–1305
  21. Valicenti R, Lu J, Pilepich M, et al.  Survival advantage from higher-dose radiation therapy for clinically localized prostate cancer treated on the Radiation Therapy Oncology Group Trials. J Clin Oncol. 2000;18:2740–2746
  22. Leibel SA, Hanks GE, Kramer S. Patterns of care outcomes studies (Results of the national practice in adenocarcinoma of the prostate). Int J Radiat Oncol Biol Phys. 1984;10:401–409
  23. Smit WGJM, Helle PA, Van Putte WLJ, et al.  Late radiation damage in prostate cancer patients treated by high dose external radiotherapy in relation to rectal dose. Int J Radiat Oncol Biol Phys. 1990;18:23–29
  24. Fuks Z, Leibel SA, Kutcher GE, et al.  Three dimensional conformal treatment (A new frontier in radiation therapy). In:  DeVita VT,  Hellman S,  Rosenberg SA editor. Important Advances in Oncology. Philadelphia, PA: Lippincott; 1991;p. 151–172
  25. Munro TR, Gilbert CW. The relation between tumour lethal doses and the radiosensitivity of tumour cells. Br J Radiol. 1961;34:246–259
  26. Thames HD, Schultheiss TE, Hendry JH, et al.  Can modest escalations of dose be detected as increased tumor control. Int J Radiat Oncol Biol Phys. 1994;22:241–246
  27. Bentzen SM. Radiobiological considerations in the design of clinical trials. Radiother Oncol. 1994;32:1–11
  28. Levegrün S, Jackson A, Zelefsky MJ, et al.  Risk group dependence of dose-response for biopsy outcome after three-dimensional conformal radiation therapy for prostate cancer. Radiother Oncol. 2002;63:11–26
  29. Withers HR, Tayler JM, Maciejewski B. Treatment volume and tissue tolerance. Int J Radiat Oncol Biol Phys. 1988;14:751–759
  30. Jackson A, Skwarchuk MW, Zelefsky MJ, et al.  Late rectal bleeding after conformal radiotherapy of prostate cancer (II) (Volume effects and dose volume histograms). Int J Radiat Oncol Biol Phys. 2001;49:685–698
  31. ICRU Report No. 50 (Prescribing, Recording and Reporting Photon Beam Therapy). Bethesda, MD: International Commission on Radiation Units and Measurements; 1993;
  32. Pollack A, Zagars GK, Starkschall G, et al.  Prostate cancer radiation dose response (Results of the M.D. Anderson phase III randomized trial). Int J Radiat Oncol Biol Phys. 2002;53:1097–1105
  33. Huang EH, Pollack A, Levy L, et al.  Late rectal toxicity (Dose-volume effects of conformal radiotherapy for prostate cancer). Int J Radiat Oncol Biol Phys. 2002;54:1314–1321
  34. Hanks GE, Hanlon AL, Epstein B, et al.  Dose response in prostate cancer with 8–12 years’ follow-up. Int J Radiat Oncol Biol Phys. 2002;54:427–435
  35. Lyons JA, Kupelian PA, Mohan DA, et al.  Importance of high radiation doses (72 or greater) in the treatment of stage T1-T3 adenocarcinoma of the prostate. Urology. 2000;55:85–90
  36. Perez CA, Michalski JM, Purdy JA, et al.  Three-dimensional conformal or standard irradiation in localized carcinoma of prostate (Preliminary results of a nonrandomized comparison). Int J Radiat Oncol Biol Phys. 2000;47:629–637
  37. Fiveash JB, Hanks G, Roach M, et al.  3D conformal radiation therapy (3DCRT) for high grade prostate cancer (A multi-institutional review). Int J Radiat Oncol Biol Phys. 2000;47:335–342
  38. Zelefsky MJ, Fuks Z, Hunt M, et al.  High-dose radiation delivered by intensity modulated radiation therapy (IMRT) improves the outcome of localized prostate cancer. J Urol. 2001;166:876–881
  39. Mohan R, Barest G, Brewster LJ, et al.  A comprehensive three-dimensional radiation treatment planning system. Int J Radiat Oncol Biol Phys. 1988;15:481–495
  40. Verhey LJ. Comparison of three-dimensional conformal radiation therapy and intensity modulated radiation therapy systems. Semin Radiat Oncol. 1999;9:78–98
  41. Ling CC, Burman CM, Chui CS, et al.  Conformal radiation treatment of prostate cancer using inversely planned intensity-modulated photon beams produced with dynamic multileaf collimation. Int J Radiat Oncol Biol Phys. 1996;35:721–730
  42. Burman CM, Chui CS, Kutcher GJ, et al.  Planning, delivery, and quality assurance of intensity-modulated radiotherapy using dynamic multileaf collimator (A strategy for large-scale implementation for the treatment of carcinoma of the prostate). Int J Radiat Oncol Biol Phys. 1997;39:863–873
  43. Spirou SV, Chui C-S. Generation of arbitrary fluence profiles by dynamic jaws or multileaf collimators. Med Phys. 1994;21:1031–1041
  44. Fraas BA, Kessler ML, McShan DL, et al.  Optimization and clinical use of multisegment intensity-modulated radiation therapy for high-dose conformal therapy. Semin Radiat Oncol. 1999;9:60–77
  45. Carol MP. Peacock (A system for planning and rotational delivery of intensity modulated fields). Int J Imaging Syst Technol. 1995;6:56–61
  46. Leibel SA, Zelefsky MJ, Kutcher GJ, et al.  Three-dimensional conformal radiation therapy in localized carcinoma of the prostate (Interim report of a phase I dose-escalation study). J Urol. 1994;152:1792–1798
  47. Zelefsky MJ, Happersett L, Leibel SA, et al.  The effect of treatment positioning on normal tissue dose in patients with prostate cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 1994;37:13–19
  48. Leibel SA, Kutcher GJ, Mohan R, et al.  Three-dimensional conformal radiation therapy at the Memorial Sloan-Kettering Cancer Center. Semin Radiat Oncol. 1992;2:274–289
  49. Zelefsky MJ, Leibel SA, Burman CM, et al.  Neoadjuvant hormonal therapy improves the therapeutic ratio in patients with bulky prostatic cancer treated with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys. 1994;29:755–761
  50. Mohan R. Three-dimensional radiation treatment planning. Australas Phys Eng Sci Med. 1989;12:73–91
  51. Photon Treatment Planning Collaborative Working Group . Three-dimensional dose calculations for radiation treatment planning. Int J Radiat Oncol Biol Phys. 1991;21:25–36
  52. Mageras GS, Podmaniczky KC, Mohan R. A model for computer-controlled delivery of 3D conformal treatments. Med Phys. 1992;19:945–953
  53. Spirou SV, Chui C-S. A gradient inverse planning algorithm with dose-volume constraints. Med Phys. 1998;25:321–333
  54. Zelefsky MJ, Fuks Z, Happersett L, et al.  Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol. 2000;55:241–249
  55. Zelefsky MJ, Leibel SA, Gaudin PB, et al.  Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys. 1998;41:491–500
  56. Lawton CA, Won M, Pilepich MV, et al.  Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate (Analysis of RTOG studies 7506 and 7706). Int J Radiat Oncol Biol Phys. 1991;21:935–939
  57. American Society for Therapeutic Radiology and Oncology Consensus Panel . Consensus statement (Guidelines for PSA following radiation therapy). Int J Radiat Oncol Biol Phys. 1997;37:1035–1041
  58. Hanks GE, Hanlon AL, Pinover WH, et al.  Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy. Cancer J Sci Am. 1999;5:152–158
  59. Kupelian PA, Elshaikh M, Reddy CA, et al.  Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era (A large scale single-institution experience with radical prostatectomy and external-beam radiotherapy). J Clin Oncol. 2002;20:3376–3385
  60. Pollack A, Zagars GK. External beam radiotherapy dose-response of prostate cancer. Int J Radiat Oncol Biol Phys. 1997;39:1011–1018
  61. Brundage M, Lukka H, Crook J, et al.  The use of conformal radiotherapy and the selection of radiation dose in T1 and T2 low or intermediate risk prostate cancer—A systematic review. Radiother Oncol. 2002;64:239–250
  62. Goldenberg SL, Bruchovsky N. Androgen withdrawal therapy (New perspective in the treatment of prostate cancer). In:  Raghavan D,  Scher HI,  Leibel SA editor. Principles and Practice of Genitourinary Oncology. Philadelphia, PA: Lippincott-Raven; 1997;p. 583–591
  63. Zeitman AL, Prince EA, Nakfoor BM, et al.  Androgen deprivation and radiation therapy (Sequencing studies using the Shionogi in vivo tumor system). Int J Radiat Oncol Biol Phys. 1997;38:1067–1070
  64. Zeitman AL, Nakfoor BM, Prince EA, et al.  The effect of androgen deprivation and radiation therapy on an androgen-sensitive murine tumor (An in vitro and in vivo study). Cancer J Sci Am. 1997;3:31–36
  65. Joon DL, Hasegawa M, Sikes C, et al.  Supraadditive apoptotic response of R3327-G rat prostate tumors to androgen ablation and radiation. Int J Radiat Oncol Biol Phys. 1997;38:1071–1077
  66. Pollack A, Ashoori F, Sikes C, et al.  The early supra-additive apoptotic response of R3327-G prostate tumors to androgen ablation and radiation is not sustained with multiple fractions. Int J Radiat Oncol Biol Phys. 2000;46:153–158
  67. Pollack A, Salem N, Ashoori F, et al.  Lack of prostate cancer radiosensitization by androgen deprivation. Int J Radiat Oncol Biol Phys. 2001;51:1002–1007
  68. Granfors T, Yomic R, Bergh A, et al.  After radiotherapy testosterone stimulation is unable to increase growth in the Dunning R3327-PAP prostate tumour. Urol Res. 1999;27:357–361
  69. Forman JD, Kumar R, Haas G, et al.  Neoadjuvant hormonal downsizing of localized carcinoma of the prostate (Effects on the volume of normal tissue irradiation). Cancer Invest. 1995;13:8–15
  70. Yang FE, Chen GT, Ray P, et al.  The potential for normal tissue dose reduction with neoadjuvant hormonal therapy in conformal treatment planning for stage C prostate cancer. Int J Radiat Oncol Biol Phys. 1995;33:1009–1017
  71. Pilepich MV, Winter K, John M, et al.  Phase III Radiation Therapy Oncology Group (RTOG) Trial 86–10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2001;50:1243–1252
  72. Lawton C, Winter K, Murray K, et al.  Updated results of the phase III Radiation Therapy Oncology Group (RTOG) Trial 85–31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2001;49:937–946
  73. Hanks GE, Lu JD, Machtay M, et al.  RTOG Protocol 92–02 (A phase III trial of the use of long term androgen suppression following neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate). Int J Radiat Oncol Biol Phys. 2000;48:112; (suppl, abstr)
  74. Bolla M, Collette L, Blank L, et al.  Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study) (A phase III randomized trial). Lancet. 2002;360:103–108
  75. Horwitz EM, Winter K, Hanks GE, et al.  Subset analysis of RTOG 85–31 and 86–10 indicates an advantage for long-term vs. short-term adjuvant hormones for patients with locally advanced nonmetastatic prostate cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2001;49:947–956
  76. Aihara M, Wheeler TM, Ohori M, et al.  Heterogeneity of prostate cancer in radical prostatectomy specimens. Urology. 1994;43:60–66
  77. Ling CC, Humm J, Larson S, et al.  Towards multidimensional radiotherapy (MD-CRT) (Biological imaging and biological conformality). Int J Radiat Oncol Biol Phys. 2000;47:551–556
  78. Kurhanewicz J, Vigneron DB, Hricak H, et al.  Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7-cm3) spatial resolution. Radiology. 1996;198:795–805
  79. Wefer AE, Hricak H, Vigneron DB, et al.  Sextant localization of prostate cancer (Comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology). J Urol. 2000;164:400–404
  80. Zakian KL, Sircar K, Kleinman S, et al.  Correlation of proton MR spectroscopic imaging with Gleason score based on step section radical prostatectomy. Radiology. 2002;225:628; (suppl, abstr)
  81. Pickett B, Vigneault E, Kurhanewicz J, et al.  Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. Int J Radiat Oncol Biol Phys. 1999;43:921–929
  82. Xia P, Pickett B, Vigneault E, et al.  Forward or inversely planned segmental multileaf collimator IMRT and sequential tomotherapy to treat multiple dominant intraprostatic lesions of prostate cancer to 90 Gy. Int J Radiat Oncol Biol Phys. 2001;51:244–254
  83. Roach M, Lu J, Pilepich MV, et al.  Predicting long-term survival, and the need for hormonal therapy (A meta-analysis of RTOG prostate cancer trials). Int J Radiat Oncol Biol Phys. 2000;47:617–627
  84. D’Amico AV, Schultz D, Loffredo M, et al.  Biochemical outcome following external beam radiation therapy with or without androgen suppression therapy for clinically localized prostate cancer. JAMA. 2000;284:1280–1283
  85. Zelefsky MJ, Kelly WK, Scher HI, et al.  Results of a phase II study using estramustine phosphate and vinblastine in combination with high-dose three-dimensional conformal radiotherapy for patients with locally advanced prostate cancer. J Clin Oncol. 2000;18:1936–1941
  86. Vavassori V, Cozzarini C, Bianchi C, et al.  Androgen deprivation and late rectal bleeding after radiotherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys. 2002;54:109; (suppl, abstr)

☆ Supported in part by Grant No. CA 59017 from the National Cancer Institute, Department of Health and Human Services, Bethesda, MD.

PII: S0093-7754(03)00354-3

doi: 10.1016/S0093-7754(03)00354-3

Seminars in Oncology
Volume 30, Issue 5 , Pages 596-615 , October 2003

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