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World J Clin Oncol. Oct 10, 2017; 8(5): 389-397
Published online Oct 10, 2017. doi: 10.5306/wjco.v8.i5.389
Stereotactic radiotherapy for prostate cancer: A review and future directions
Yusef A Syed, Ami K Patel-Yadav, Charlotte Rivers, Anurag K Singh
Yusef A Syed, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30342, United States
Ami K Patel-Yadav, Charlotte Rivers, Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
Anurag K Singh, Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
Author contributions: Syed YA drafted the manuscript and compiled the tables; Patel-Yadav AK contributed technical oversight and edited the manuscript; Rivers C assisted in editing the manuscript; Singh AK developed the concept and led the editing process.
Conflict-of-interest statement: There are no conflicts of interest for any of the above listed authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Anurag K Singh, Professor, Department of Radiation Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States. anurag.singh@roswellpark.org
Telephone: +1-716-8451180 Fax: +1-716-8457616
Received: February 20, 2017
Peer-review started: February 23, 2017
First decision: June 14, 2017
Revised: July 12, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: October 10, 2017
Abstract

Prostate cancer affects over 200000 men annually in the United States alone. The role of conventionally fractionated external beam radiation therapy (RT) is well established as a treatment option for eligible prostate cancer patients; however, the use of stereotactic body radiotherapy (SBRT) in this setting is less well defined. Within the past decade, there have been a number of studies investigating the feasibility of SBRT as a potential treatment option for prostate cancer patients. SBRT has been well studied in other disease sites, and the shortened treatment course would allow for greater convenience for patients. There may also be implications for toxicity as well as disease control. In this review we present a number of prospective and retrospective trials of SBRT in the treatment of prostate cancer. We focus on factors such as biochemical progression-free survival, prostate specific antigen (PSA) response, and toxicity in order to compare SBRT to established treatment modalities. We also discuss future steps that the clinical community can take to further explore this new treatment approach. We conclude that initial studies examining the use of SBRT in the treatment of prostate cancer have demonstrated impressive rates of biochemical recurrence-free survival and PSA response, while maintaining a relatively favorable acute toxicity profile, though long-term follow-up is needed.

Keywords: Stereotactic body radiotherapy, Prostate cancer, Radiation therapy, Hypofractionation, Toxicity, Stereotactic ablative radiotherapy

Core tip: Initial studies examining the use of stereotactic body radiotherapy (SBRT) in the treatment of prostate cancer have demonstrated impressive rates of biochemical recurrence-free survival and prostate specific antigen response, while maintaining a relatively favorable acute toxicity profile. Here we review a number of recent prospective and retrospective studies to evaluate the efficacy and toxicity of SBRT in the treatment of low, intermediate, and high-grade prostate cancer.