scholarly journals Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

2020 ◽  
Author(s):  
Ilias Sachpazidis ◽  
Panayiotis Mavroidis ◽  
Constantinos Zamboglou ◽  
Christina Marie Klein ◽  
Anca-Ligia Grosu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Radiation Treatment ◽  
Prostate Gland ◽  
Multivariate Logistic Regression Model ◽  
Biochemical Relapse ◽  
Linear Quadratic ◽  
Tumour Control ◽  
Tumour Control Probability

Abstract Purpose: To evaluate the applicability and estimate the radiobiological parameters of linear-quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV). The TCP describes the dose–response of prostate after definitive radiotherapy (RT). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI-GTV based on multivariate logistic regression model. Methods: The study included 129 intermediate and high-risk prostate cancer patients (cN0 and cM0), who were treated with image-guided intensity modulated radiotherapy (IMRT) +/- androgen deprivation therapy with a median follow-up period of 81.4 months (range: 42.0 - 149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI-GTV was delineated retrospectively based on a pre-treatment multi-parametric MR imaging (mpMRI), which was co-registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality. Furthermore, we also fitted the clinical data to TCP model for the two considered targets for the 5-year follow-up after radiation treatment, where our cohort was composed of a total number of 108 patients, of which 19 were biochemical relapse (BR) patients.Results: For the median follow-up period of 81.4 months (range: 42.0 - 149.0) months, our results indicated an appropriate α/β=1.3 Gy for prostate gland and α/β=2.9 Gy for mpMRI-GTV. Only for prostate gland, EQD2 and gEUD2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear-quadratic Poisson TCP model for prostate gland and α/β=1.3 Gy were D50=66.8 Gy with 95%CI [64.6 Gy, 69.0 Gy], and γ=3.8 with 95%CI [2.6, 5.2]. For mpMRI-GTV and α/β=2.9 Gy, D50 was 68.1 Gy with 95%CI [66.1 Gy, 70.0 Gy], and γ=4.5 with 95%CI [3.0, 6.1]. Finally, for the 5-year follow-up after the radiation treatment, our results for the prostate gland were: D50=64.6Gy [61.6Gy, 67.4Gy], γ=3.1 [2.0, 4.4], α/β=2.2Gy (95%CI was undefined). For the mpMRI-GTV, the optimizer was unable to deliver any reasonable results for the expected clinical D50 and α/β. The results for the mpMRI-GTV were D50=50.1Gy [44.6Gy, 56.0Gy], γ=0.8 [0.5, 1.2], α/β=0.0Gy (95%CI was undefined). For a follow-up time of 5 years and a fixed α/β=1.6Gy, the TCP fitting results for prostate gland were D50=63.9Gy [60.8Gy, 67.0Gy], γ=2.9 [1.9, 4.1], and for mpMRI-GTV D50=56.3Gy [51.6Gy, 61.1Gy], γ=1.3 [0.8, 1.9].Conclusion: The linear-quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI-GTV. This is compatible with the results of the comparison of the dose distributions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD2Gy. Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences. The failure to identify any benefit for considering mpMRI-GTV as the target responsible for the clinical response is confirmed when considering a fixed α/β=1.6Gy, a fixed follow-up time for biochemical response at 5 years or Gleason score differentiation.

scholarly journals Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ilias Sachpazidis ◽  
Panayiotis Mavroidis ◽  
Constantinos Zamboglou ◽  
Christina Marie Klein ◽  
Anca-Ligia Grosu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Radiation Treatment ◽  
Prostate Gland ◽  
Multivariate Logistic Regression Model ◽  
Biochemical Relapse ◽  
Linear Quadratic ◽  
Tumour Control ◽  
Tumour Control Probability

Abstract Purpose To evaluate the applicability and estimate the radiobiological parameters of linear-quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV). The TCP describes the dose–response of prostate after definitive radiotherapy (RT). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI-GTV based on multivariate logistic regression model. Methods The study included 129 intermediate and high-risk prostate cancer patients (cN0 and cM0), who were treated with image-guided intensity modulated radiotherapy (IMRT) ± androgen deprivation therapy with a median follow-up period of 81.4 months (range 42.0–149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI-GTV was delineated retrospectively based on a pre-treatment multi-parametric MR imaging (mpMRI), which was co-registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality. Furthermore, we also fitted the clinical data to TCP model for the two considered targets for the 5-year follow-up after radiation treatment, where our cohort was composed of a total number of 108 patients, of which 19 were biochemical relapse (BR) patients. Results For the median follow-up period of 81.4 months (range 42.0–149.0) months, our results indicated an appropriate α/β = 1.3 Gy for prostate gland and α/β = 2.9 Gy for mpMRI-GTV. Only for prostate gland, EQD2 and gEUD2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear-quadratic Poisson TCP model for prostate gland and α/β = 1.3 Gy were D50 = 66.8 Gy with 95% CI [64.6 Gy, 69.0 Gy], and γ = 3.8 with 95% CI [2.6, 5.2]. For mpMRI-GTV and α/β = 2.9 Gy, D50 was 68.1 Gy with 95% CI [66.1 Gy, 70.0 Gy], and γ = 4.5 with 95% CI [3.0, 6.1]. Finally, for the 5-year follow-up after the radiation treatment, our results for the prostate gland were: D50 = 64.6 Gy [61.6 Gy, 67.4 Gy], γ = 3.1 [2.0, 4.4], α/β = 2.2 Gy (95% CI was undefined). For the mpMRI-GTV, the optimizer was unable to deliver any reasonable results for the expected clinical D50 and α/β. The results for the mpMRI-GTV were D50 = 50.1 Gy [44.6 Gy, 56.0 Gy], γ = 0.8 [0.5, 1.2], α/β = 0.0 Gy (95% CI was undefined). For a follow-up time of 5 years and a fixed α/β = 1.6 Gy, the TCP fitting results for prostate gland were D50 = 63.9 Gy [60.8 Gy, 67.0 Gy], γ = 2.9 [1.9, 4.1], and for mpMRI-GTV D50 = 56.3 Gy [51.6 Gy, 61.1 Gy], γ = 1.3 [0.8, 1.9]. Conclusion The linear-quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI-GTV. This is compatible with the results of the comparison of the dose distributions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD2Gy. Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences. The failure to identify any benefit for considering mpMRI-GTV as the target responsible for the clinical response is confirmed when considering a fixed α/β = 1.6 Gy, a fixed follow-up time for biochemical response at 5 years or Gleason score differentiation.

scholarly journals Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

2020 ◽  
Author(s):  
Ilias Sachpazidis ◽  
Panayiotis Mavroidis ◽  
Constantinos Zamboglou ◽  
Christina Marie Klein ◽  
Anca-Ligia Grosu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Model ◽  
Radiation Treatment ◽  
Prostate Gland ◽  
Biochemical Relapse ◽  
Linear Quadratic ◽  
Tumour Control ◽  
Tumour Control Probability ◽  
Multivariate Logistic Model

Abstract Purpose: To evaluate the applicability and estimate the radiobiological parameters of linear-quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV). The TCP describes the dose–response of prostate after definitive radiotherapy (RT). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI-GTV based on multivariate logistic regression model.Methods: The study included 129 intermediate and high-risk prostate cancer patients (cN0 and cM0), who were treated with image-guided intensity modulated radiotherapy (IMRT) +/- androgen deprivation therapy with a median follow-up period of 81.4 months (range: 42.0 - 149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI-GTV was delineated retrospectively based on a pre-treatment multi-parametric MR imaging (mpMRI), which was co-registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality. Furthermore, we also fitted the clinical data to TCP model for the two considered targets for the 5-year follow-up after radiation treatment, where our cohort was composed of a total number of 108 patients, of which 19 were biochemical relapse (BR) patients. Results: For the median follow-up period of 81.4 months (range: 42.0 - 149.0) months, our results indicated an appropriate α/β = 1.3 Gy for prostate gland and α/β = 2.9 Gy for mpMRI-GTV. Only for prostate gland, EQD2 and gEUD2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear-quadratic Poisson TCP model for prostate gland and α/β = 1.3 Gy were D50 = 66.8 Gy with 95%CI [64.6 Gy, 69.0 Gy], and γ = 3.81 with 95%CI [2.58, 5.20]. For mpMRI-GTV and α/β = 2.9 Gy, D50 was 68.1 Gy with 95%CI [66.1 Gy, 70.0 Gy], and γ = 4.45 with 95%CI [3.00, 6.12]. The fitness of the model was better for prostate gland. For the multivariate logistic model, the gEUD2Gy for prostate gland showed a very high significant predictive value (p = 0.001), whereas regarding mpMRI-GTV only its volume showed a significance (p = 0.01). Finally, for the 5-year follow-up after the radiation treatment, our results for the prostate gland were: D50=64.6Gy [61.6Gy, 67.4Gy], γ=3.08 [2.03, 4.35], α/β=2.2Gy (95%CI was undefined). For the mpMRI-GTV, the optimizer was unable to deliver any reasonable results for the expected clinical D50 and α/β. The results for the mpMRI-GTV were: D50=50.1Gy [44.6Gy, 56.0Gy], γ=0.84 [0.53, 1.21], α/β=0.0Gy (95%CI was undefined). Conclusion: The linear-quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI-GTV. This is compatible with the results of the comparison of the dose distributions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD 2Gy . Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences.

scholarly journals Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

2020 ◽  
Author(s):  
Ilias Sachpazidis ◽  
Panayiotis Mavroidis ◽  
Constantinos Zamboglou ◽  
Christina Marie Klein ◽  
Anca-Ligia Grosu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Logistic Model ◽  
External Beam Radiotherapy ◽  
Prostate Gland ◽  
Biochemical Relapse ◽  
Linear Quadratic ◽  
Tumour Control ◽  
Tumour Control Probability ◽  
Multivariate Logistic Model

Abstract Purpose: To evaluate the applicability and estimate the radiobiological parameters of linear-quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV). The TCP describes the dose–response of prostate after definitive radiotherapy (RT). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI-GTV based on multivariate logistic regression model.Methods: The study included 129 intermediate and high-risk prostate cancer patients (cN0 and cM0), who were treated with image-guided intensity modulated radiotherapy (IMRT) +/- androgen deprivation therapy with a median follow-up period of 81.4 months (range: 42.0 - 149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI-GTV was delineated retrospectively based on a pre-treatment multi-parametric MR imaging (mpMRI), which was co-registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality.Results: Our results indicated an appropriate α/β = 1.3 Gy for prostate gland and α/β = 2.9 Gy for mpMRI-GTV. Only for prostate gland, EQD2 and gEUD 2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear-quadratic Poisson TCP model for prostate gland and α/β = 1.3 Gy were D 50 = 66.8 Gy with 95%CI [64.6 Gy, 69.0 Gy], and γ = 3.81 with 95%CI [2.58, 5.20]. For mpMRI-GTV and α/β = 2.9 Gy, D 50 was 68.1 Gy with 95%CI [66.1 Gy, 70.0 Gy], and γ = 4.45 with 95%CI [3.00, 6.12]. The fitness of the model was better for prostate gland. For the multivariate logistic model, the gEUD 2Gy for prostate gland showed a very high significant predictive value ( p = 0.001), whereas regarding mpMRI-GTV only its volume showed a significance ( p = 0.01).Conclusion: The linear-quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI-GTV. This is compatible with the results of the comparison of the dose distributions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD 2Gy . Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences.

The impact of pretreatment MRI on genitourinary and gastrointestinal toxicity after radiation therapy in patients with localized prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 119-119
Author(s):  
Kyle Kilinski ◽  
Arash Naghavi ◽  
Yazan Asad Abuodeh ◽  
Michelle Echevarria ◽  
Kosj Yamoah
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Radiation Treatment ◽  
Comparison Cohort ◽  
Planning Treatment ◽  
Gi Toxicity ◽  
Localized Disease ◽  
Pre Treatment ◽  
The Impact

119 Background: MRI has several advantages relative to other imaging modalities in evaluating, diagnosing, and planning treatment for prostate cancer yet it is rarely ordered for localized disease. While the diagnostic abilities have been studied, little has been done to associate clinical outcomes with prostate cancer patients who received MRI. We evaluated the effect of pre-treatment MRI on genitourinary (GU) and gastrointestinal (GI) toxicity in prostate cancer patients who received definitive radiation treatment. Methods: We retrospectively analyzed prostate cancer patients who underwent definitive radiation treatment at our facility between January 01, 1999 and July 31, 2014. All patients who underwent MRI of the pelvis or prostate within 5 years prior to treatment were included in the MRI cohort. The American Urological Symptom Score (AUA) and Rectal Assessment Scale (RAS) were used to measure GU and GI toxicity, respectively. We compared the toxicity profile of patients in our MRI cohort to a comparable cohort of patients who did not receive pre-treatment MRI. Results: 1085 patients (211 with MRI) were analyzed. Median follow-up was 30 months. Mean increase from baseline in AUA scores at 6 months was 3.58 for the MRI cohort and 5.04 for the comparison cohort (p = 0.017). RAS scores were not significantly different between the MRI and comparison cohorts at 6 months (mean increase: 0.62 vs. 0.77, p = 0.662). AUA scores returned to baseline after 6 months in the MRI cohort and after 12 months in the comparison cohort. RAS scores returned to baseline after 12 months in the MRI cohort but never returned to baseline in the comparison cohort. Biochemical failure rates were not significantly different between the MRI cohort and comparison cohort (86.3% vs. 91.1%, p = 0.083). Conclusions: Pre-treatment MRI was associated with significantly less GU and GI toxicity. These results may be influenced by more advanced disease and higher use of hormonal therapy in the MRI cohort. Future prospective studies in a risk-matched cohort are required to validate these findings.

scholarly journals Prostate cancer with low burden skeletal disease at diagnosis: outcome of concomitant radiotherapy on primary tumor and metastases

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190353 ◽  
Author(s):  
Chiara Lucrezia Deantoni ◽  
Andrei Fodor ◽  
Cesare Cozzarini ◽  
Claudio Fiorino ◽  
Chiara Brombin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Clinical Relapse ◽  
Biochemical Relapse ◽  
Relapse Free Survival ◽  
Free Survival

Objective: To evaluate toxicity and clinical outcome in synchronous bone only oligometastatic (≤2 lesions) prostate cancer patients, simultaneously irradiated to prostate/prostatic bed, lymph nodes and bone metastases. Methods: From 2/2009 to 6/2015, 39 bone only prostate cancer patients underwent radiotherapy (RT) at “radical” doses to bone metastases (median 2 Gy equivalent dose, EQD2>40Gy, α/β = 1,5), nodes, and prostate/prostatic bed, within the same RT course, in association with androgen deprivation therapy (ADT). Biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were evaluated. Results: After a median follow-up of 46.5 (1.2–103.6) months, 5 patients died from disease progression, 10 experienced biochemical relapse, 19, still in ADT, presented undetectable prostate-specific antigen (PSA) at the last follow-up. Five patients who discontinued ADT after a median of 34 months (5.8–41) are free from biochemical relapse. The 4 year Kaplan–Meier estimates of biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were 53.3%, 65.7%, 73.4% and 82.4% respectively. No Grade > 2 acute events and only two severe late urinary events were recorded, not due to the concomitant treatment of primary and metastatic disease. Conclusion: Our results suggest that “radical” and synchronous irradiation of primitive tumor and metastatic disease may be a valid approach in synchronous bone only prostate cancer patients, showing mild toxicity profile and promising survival results. Advances in knowledge: To the best of our knowledge, this is the first analysis of clinical outcome in synchronous bone-only metastasis (neither nodal nor visceral) patients at diagnosis, treated with radical RT to all disease, associated to ADT.

Long-term efficacy of stereotactic body radiotherapy for localized prostate cancer: A multi-institutional pooled analysis.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 9-9 ◽  
Author(s):  
Patrick Kupelian ◽  
Alan J. Katz ◽  
Debra Freeman ◽  
Irving D. Kaplan ◽  
Donald B. Fuller ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
High Risk ◽  
Cancer Patients ◽  
Gleason Score ◽  
Stereotactic Body Radiotherapy ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Biochemical Relapse

9 Background: The purpose of this study is to report biochemical relapse-free survival (bRFS) rates for a group of localized prostate cancer patients from a pooled multi-institutional dataset with at least 5 years follow-up after stereotactic body radiotherapy (SBRT). Methods: The outcome data from 1101 patients treated with SBRT between 2003 and 2011 were pooled from 8 institutions. A subset of 135 cases had a minimum 5 years follow-up. All 135 cases had clinical stage T1 or T2A disease. The distribution by Gleason score (GS) was <6 in 80% and 7 in 20%. The median pretreatment PSA (iPSA) level was 5.1 ng/ml (range: 0.1-27.8). The distribution by risk was 77% low, 21% intermediate, and 2% high risk. The median dose was 36.25 Gy (35-40 Gy range) delivered either with 4 or 5 fractions. The prescribed dose groups were as follows: 35 Gy in 42%, 36.25 Gy in 47%, and >38 Gy in 11%. Androgen deprivation therapy was given to 21% of patients. Biochemical relapse, defined as a rise > 2 ng/ml above nadir, was determined in a total of 4 failures. Results: The median follow-up for all 135 cases was 60 months (range 60 to 72). For all patients, the bRFS rate at 5 years was 97%. The 5-year actuarial bRFS rates for GS < 6, and Gleason score 7 were 98%, and 92%, respectively (p=0.15). The 5-year actuarial bRFS rates for low versus intermediate/high-risk patients were 99% and 93%, respectively (p=0.11). The 5-year actuarial bRFS rates for patients receiving 35 Gy versus >36.25 Gy were 93% and 100%. No difference in bRFS was observed with the use of androgen deprivation (p=0.78). Multivariate analysis showed only GS to be an independent predictor of relapse (p=0.03); iPSA (p=0.10) and radiation dose (0.97) were not. Conclusions: In a relatively large cohort of localized prostate cancer patients treated with SBRT, long follow-up period (>5 years), excellent efficacy was demonstrated with 97% of patients being free from relapse. For low and intermediate risk cases, these results compare favorably with other modalities with similar follow-up periods. Although a trend for worse outcome was seen with total radiation doses of 35 Gy, this was not confirmed on multivariate analysis.

scholarly journals Derivation of the Tumour Control Probability (TCP) from a Cell Cycle Model

2006 ◽  
Vol 7 (2-3) ◽  
pp. 121-141 ◽  
Author(s):  
A. Dawson ◽  
T. Hillen
Keyword(s):  
Cell Cycle ◽  
Radiation Treatment ◽  
Malignant Cell ◽  
Time Dependent ◽  
Death Process ◽  
Linear Quadratic ◽  
Tumour Control ◽  
Tumour Control Probability ◽  
A Cell ◽  
General Time

In this paper, a model for the radiation treatment of cancer which includes the effects of the cell cycle is derived from first principles. A malignant cell population is divided into two compartments based on radiation sensitivities. The active compartment includes the four phases of the cell cycle, while the quiescent compartment consists of theG0state. Analysis of this active-quiescent radiation model confirms the classical interpretation of the linear quadratic (LQ) model, which is that a larger α/β ratio corresponds to a fast cell cycle, while a smaller ratio corresponds to a slow cell cycle. Additionally, we find that a large α/β ratio indicates the existence of a significant quiescent phase. The active-quiescent model is extended as a nonlinear birth–death process in order to derive an explicit time dependent expression for the tumour control probability (TCP). This work extends the TCP formula from Zaider and Minerbo and it enables the TCP to be calculated for general time dependent treatment schedules.

scholarly journals Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

2021 ◽  
Vol 17 (3) ◽  
pp. 64-77
Author(s):  
R. V. Novikov ◽  
S. N. Novikov
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Radiation Treatment ◽  
Prostate Gland ◽  
Research Work ◽  
Clinical Problem ◽  
Radiation Toxicity ◽  
Normal Tissues ◽  
Clinical Scenarios ◽  
Leading Position

The basic principles of the treatment of prostate cancer patients have underwent significant revisions in recent years. Modern radiotherapy techniques, which have demonstrated high efficacy and safety in long-term randomized trials, are beginning to take a leading position in the treatment of prostate cancer in an overwhelming number of clinical scenarios (National Comprehensive Cancer Network, 2021). Despite the obvious successes of radiation oncology, a number of important problems remain unresolved, first of all - the need to reduce the rates of radiation complications. The topographical anatomy of the prostate gland determines the main profiles of post-radiation damage: rectal and genitourinary radiation toxicity. The previous five years have been marked by a significant intensification of research work abroad aimed at clinical testing of a number of biopolymer compositions and products for use as spacers between irradiated structures and normal tissues. The experience has made it possible for the first time to consider the possibility of using spacers in radiotherapy treatment of prostate cancer in the modern recommendations of the European Association of Urology (2021). The analysis of the national literature shows a complete lack of publications on the possibilities of optimizing the radiation treatment of prostate cancer through the use of specers. The purpose of this work was the need to highlight this important and perspective clinical problem.

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