Onkológia 2/2023

Stereotactic ultrahypofractionated radiotherapy of prostate cancer

External beam radiotherapy is an effective curative modality of non-metastatic prostate cancer. Prostate cancer radiobiology points at high sensitivity to fractionation what has led to the use of ultrahypofractionation, in which case the total dose is delivered in a few, usually in 5 fractions, contrary to 35 – 40 fractions in conventional fractionation. Stereotactic body radiotherapy (SBRT) is characterised by a steep dose fallout and the use of image guidenance what allows significant reduction of adjacent health tissues irradiation. Clinical implementation of prostate cancer ultrahypofractionated radiotherapy is supported by medical evidence. Ideally, this intervention is executed by the means of stereotactic technology with prostate imaging before each fraction or during the course of each irradiation. Availability of molecular imaging with more sensitive disease localisation at biochemical recurrence has led to increased interest in stereotactic radiotherapy as a salvage modality in locally recurrent prostate cancer after primary radiotherapy, or in the case of oligorecurrent metastatic involvement. Published evidence of effectivity and safety of prostate SBRT, practical recommendations for radiotherapy planning and delivery and some clinical experience is presented.

Keywords: prostate cancer, stereotactic body radiotherapy, utrahypofractionation