Conformal radiation therapy in prostate cancer - a review.
OBJECTIVE
Radiotherapy has progressed considerably over a century. It is mainly because of understanding of physical and biological principles. How to improve therapeutic ratio is major concern. Excellent dose conformality and homogeneity is possible due to recent advances in treatment techniques. But there are many areas of challenges in achieving increased tumor control and normal tissue effects. The aim of this review is to provide a brief update of the rapidly changing field of external radiotherapy and how it affects the clinical practice of treatment of prostate cancer.


METHODS
A literature Search has been undertaken, only relevant articles in the management of prostatic cancer that had appeared in peer viewed journals were considered. We have tried to discuss the levels of evidence available for various treatment techniques with photons and particles. American Society for Therapeutic Radiology and Oncology web site (www.astro.org) provided a large menu for this article. New brochures of information materials provided by various International medical companies also forms immense source of information. Materials from review articles and abstracts from world literature were also included.


RESULTS
The advances in imaging and computer visualization contribute greatly to radiotherapy planning by improving accuracy of treatment. It is possible to deposit a high conformal radiation dose within the tumor using highly targeted beam. Conformal radiation improved biochemical failures without an increased incidence of severe toxicity. Carefully conducted randomized studies are appropriate method for evaluating new treatment techniques and strategies. Proton therapy is an area of great therapeutic possibilities in the 21st century.


CONCLUSIONS
Great advancements are underway with IMRT and use of Particle therapies. We cannot have conservative approach to changing trends in treatment, no doubt, safety and efficacy of treatment is prime concern. Progress in technology is rapid and fundamental and this review will provide an update on what is happening in the changing field and how it affects our clinical practice.
Varghese
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Department of Radiation Oncology, Kuwait Cancer Control Centre, Salmiya, Kuwait. abrahamva9@hotmail.com
Juzer
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D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated