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Intervention protocol 08

Optimization of external beam radiotherapy for prostate cancer

Objectives The aim of this study is to optimise the selection of patients for curative radiotherapy for prostate cancer and to improve the planning and delivery of treatment.
Study outline (intervention) The project consist of three parts, indicated in italics: 1. Improved selection of patients for radiation therapy: a) A part of the initial diagnostic biopsy is used for microarray analysis in 200 patients. In hormone-treated patients a biopsy is obtained when gold seeds are inserted before radiotherapy, and differences between the genetic profiles obtained before and after endocrine therapy are analysed. The genetic profiles are also analyzed in relation to the outcome and side effects of treatment. This part is pending support from other sources. 2. Treatment delivery: a) Dynamic arc therapy and proton therapy will be compared to a plan for standard intensity modulated radiotherapy (IMRT). Patients will be treated with marker based arc therapy if the treatment plan is equal to or better than conventional IMRT. Acute and long-term side effects will be assessed. b) Phase I/II study regional lymph node irradiation with integrated boost using IMRT technique. Choline-PET will be used for planning. The dose to rectum and bladder is assessed by repetitive cone beam CT (CBCT) during the treatment period. Acute and long-term side effects will be assessed. c) Phase III study of the influence of diet intervention in prostate motility. The variation of prostate position, rectal volume and dose to rectum is assessed by repetitive CBCT during the treatment period. Acute and long-term side effects will be assessed. 3. Fractionation: a) Scandinavian phase III study of hypofractionated radiotherapy with 6.1 Gy x 7 compared to conventional dose therapy for localised prostate cancer. The dose to rectum and bladder is assessed by repetitive CBCT during the treatment period.
Expected impact The projects will have direct impact on the treatment of prostate cancer. After PET/CT staging patients with regional or distant metastases can avoid treatment. Arc therapy and proton beam therapy harbours a potential for more effective treatment of the cancer disease without increased side effects. Hypofractionation may improve cost-effectiveness of therapy without increased side effects.
Linkages with work packages WP 1, 2, 3, 4, 5, 6, 7.