Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024;14(6):522-540
Date
07/18/2024Pubmed ID
39019208Pubmed Central ID
PMC11531394DOI
10.1016/j.prro.2024.06.006Scopus ID
2-s2.0-85200402815 (requires institutional sign-in at Scopus site)Abstract
PURPOSE: To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition.
METHODS: Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer.
RESULTS: Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes.
CONCLUSION: Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
Author List
Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WAAuthor
William Adrian Hall MD Professor in the Radiation Oncology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
HumansMagnetic Resonance Imaging
Male
Positron-Emission Tomography
Prostatic Neoplasms
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted