Prostate IMRT: Promises and Problems

Introduction Prostate is one of the treatment sites that is well suited for IMRT. For localized prostate cancer radiation therapy it is one of the effective modalities. However, radiation induced complications such as, urinary incontinence, rectal bleeding are some of the side effects. With traditional treatment techniques such as 4-field box or bi-lateral arc, doses in the range of 60-70Gy can be delivered. To deliver higher doses, up to 75.6Gy, 3-dimensional conformal radiation therapy has been used successfully [1]. However, there are indications that the use of higher doses can lead to better outcomes [2-4]. To test the hypothesis, our institution (MSKCC) has been involved in a dose escalation trial [5]. Within this study doses at 81Gy and 86.4Gy have been successfully delivered, without exceeding concomitant normal tissue complication. It has been possible with the use of IMRT. In this presentation we will discuss our experience in the use of IMRT for the treatment of localized prostate cancer and some of the clinical outcome; rationale for using IMRT; problem in defining the target and normal tissues; dose-volume criteria for evaluating treatment plans.