Bone metastases from prostate cancer: Radiotherapy

Abstract

Radiotherapy is an effective treatment in patients with prostate cancer and metastatic bone disease. It has been in use for about a century, since radium has been found efficacious in the treatment of cancer. At the end of the 1960s, with the growth of high-energy radiation units, modern techniques of external beam irradiation (external beam radiation therapy (EBRT)) started to be routinely used. In subsequent years, technological evolution enabled the development of highly sophisticated treatment techniques, evolving from two-dimensional (2D) radiotherapy to three-dimensional conformal radiation therapy (3D-CRT) and, in the last two decades, to intensity-modulated radiation therapy (IMRT). IMRT main benefit is linked to the possibility to modulate the fluence of the beams, allowing an optimal dose distribution and enabling to irradiate structures with highly irregular shape close to critical organs [1, 2]. More recently, with the development of volumetric-modulated arc therapy (VMAT), an additional advantage in target volume coverage and normal tissue sparing has been reached, with a reduced treatment delivery time compared with IMRT [3, 4]. These techniques concur to improve tumor control and to reduce toxicity in the surrounding healthy tissues.