**7. New radiation techniques**

The biological effect of ionizing radiation to cancer cells and normal tissues it based on the fact that the cancer cells are more susceptible to radiation because the lack of normal repair mechanism. Hypofractionated radiotherapy can reduce the duration of treatment since larger dose is given per day and the cumulative dose is adjusted to a lower dose. The randomized trials that compared hypofractionation with conventional RT did not have long enough follow-up and used to low total dose for current standards. But the investigation is still on. The extreme form of hypofractionation is stereotactic body radiotherapy (radiosurgery). This method uses only few fractions but with very high doses applied to a target volume in a very precise fashion. Although these techniques are attractive for theoretical advantage in radiobiology, the risk of late toxicity is considerable.

Another possible radiotherapy approach to enhance radiotherapeutic ratio for prostate cancer is to utilize charged particles such as protons and carbon ions. The clinical benefit is still unclear but the optimism is based upon the fact that charged particles deposit most of their energy at a given depth followed by a dose fall-of with almost no dose deposition beyond the point of maximal dose called Bragg peak which can lead to increased normal tissue sparing. For proton therapy, a dosimetric analysis did not show a significant improvement in conformity to spare normal tissues over photon IMRT. Clinical outcome and toxicity is also similar. Carbon ion has the same dose distribution as proton beams with Bragg peak and following dose fall-of. But the relative biological effectiveness of carbon ion is four times higher than protons and photons that can lead to improved local tumor control without causing more toxicity. However these technologies are still developing and results are yet to be seen. (Choe & Liauw, 2010)

### **8. Conclusion**

Radiotherapy is widely used as curative treatment modality for many cases of prostate cancer. There is a diverse array of radiotherapeutic strategies that can be effectively used to treat both organ-confined and locally advanced disease, alone or in combination with androgen-deprivation therapy. In recent decades it has undergone significant clinical and technological advances that aim to optimize cancer control outcomes while minimizing treatment morbidity.

#### **9. References**

190 Prostate Cancer – Diagnostic and Therapeutic Advances

localized bony metastases radiotherapy is applied through simple fields (two opposed fields, single direct field etc). A higher daily dose of 2.5 Gy or 3 Gy is given. Single dose of 8 Gy (single shoot), 20 Gy in 5 fractions or 30Gy in 10 fractions are considered to have the

Half-body irradiation is performed when there are many disseminated bony metastases and probably as many occult. The dose of 8 Gy is applied to lower half, and 6 Gy to upper half of the body. If we treat the whole body, the gap between irradiation of upper and lower half of

On the other hand, for patients with extensive locoregional prostate cancer, radiotherapy can be applied to pelvis with a total dose of 50-60Gy in order to reduce pain, hemathuria,

The biological effect of ionizing radiation to cancer cells and normal tissues it based on the fact that the cancer cells are more susceptible to radiation because the lack of normal repair mechanism. Hypofractionated radiotherapy can reduce the duration of treatment since larger dose is given per day and the cumulative dose is adjusted to a lower dose. The randomized trials that compared hypofractionation with conventional RT did not have long enough follow-up and used to low total dose for current standards. But the investigation is still on. The extreme form of hypofractionation is stereotactic body radiotherapy (radiosurgery). This method uses only few fractions but with very high doses applied to a target volume in a very precise fashion. Although these techniques are attractive for theoretical advantage in radiobiology, the risk of late toxicity is

Another possible radiotherapy approach to enhance radiotherapeutic ratio for prostate cancer is to utilize charged particles such as protons and carbon ions. The clinical benefit is still unclear but the optimism is based upon the fact that charged particles deposit most of their energy at a given depth followed by a dose fall-of with almost no dose deposition beyond the point of maximal dose called Bragg peak which can lead to increased normal tissue sparing. For proton therapy, a dosimetric analysis did not show a significant improvement in conformity to spare normal tissues over photon IMRT. Clinical outcome and toxicity is also similar. Carbon ion has the same dose distribution as proton beams with Bragg peak and following dose fall-of. But the relative biological effectiveness of carbon ion is four times higher than protons and photons that can lead to improved local tumor control without causing more toxicity. However these technologies are still developing and results

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same results regarding pain relief and survival.

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**7. New radiation techniques** 

are yet to be seen. (Choe & Liauw, 2010)

considerable.

**8. Conclusion** 

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**9** 

*United Kingdom* 

**Combination of Immunotherapy & Radiotherapy** 

There are around 35,000 new cases of prostate carcinoma (PCa) in the UK per annum, making it the most common solid malignancy. Approximately 10,000 men die of PCa each year in the UK (http://infocancerresearchukorg/cancerstats/). Disease incidence is increasing partly due to earlier detection and the increasing age of the population. Environmental causes especially dietary factors have been postulated but this is still an area of research. At presentation ~60% of patients have localised, ~30% locally advanced and

Radical radiotherapy (RT) can be used as part of curative therapy for both localised and locally advanced disease but has no proven role in the metastatic setting. Recently, radiation has been shown to cause immunogenic tumour cell death and to modify immunosuppression in the tumour environment. Importantly, reduction of tumour burden by RT, in an ablative setting, has been shown to depend largely on T cell responses (Lee et al., 2009). Combination of ionising radiation (IR) and immunological approaches in preclinical models of PCa has also proved to be synergistic. Immunotherapy offers a unique cotreatment that enables the patients' own immune cells to contribute to the success of RT. Immunological memory, developing as the result of the combination treatment, may provide long-term protection from tumour recurrence. There are however very few clinical trials addressing how immunotherapy and RT can be best combined for clinical efficiency.

There are four major treatment approaches for localised prostate cancer: active surveillance, radical prostatectomy, external beam radiotherapy (EBRT) and low-dose rate (LDR) brachytherapy. RT is conventionally delivered with photons with delivery systems that have developed considerably over the past decade, leading to lower toxicity and allowing safe dose escalation. Higher doses have been demonstrated to improve tumour control outcomes in several large Phase III trials (Viani et al., 2009). Present trials are evaluating the role of intensity modulated radiotherapy (IMRT), hypofractionation (treatment in ~4 weeks) and improved imaging during treatment with image-guided radiotherapy (IGRT) (Khoo & Dearnaley, 2008). Further developments in EBRT delivery systems allow highly targeted treatment in 5-7 fractions, called stereotactic body radiotherapy (SBRT), although tumour

control outcomes are not yet known (King et al., 2011; Madsen et al., 2007).

**1. Introduction** 

10% metastatic disease.

**2. Radiotherapy of prostate cancer** 

**for the Treatment of Prostate Cancer** 

*Department of Oncology, School of Medicine, Cardiff University, Cardiff* 

Zsuzsanna Tabi, Lisa K. Spary and John Staffurth

Yoshioka, Y., Konishi, K., Oh, R-J. et al. (2006). High-dose-rate brachytherapy without external beam irradiation for locally advanced prostate cancer. *Radiotherapy and Oncology*, vol. 80, pp. (62-68)
