Target | Target Dose Range (Gy EQD2) | Fractionated RT (Gy EQD2) |
HDR/LDR Brachytherapy Boost (Gy EQD2) | SABR (Gy EQD2) |
---|---|---|---|---|
Prostate tumor < 50% of prostate volume |
(78–168) |
(78–113) e.g. 77Gy/35 fractions with concomitant boost to 95Gy/35 fractions [21] |
(115–140) intraprostatic boost optional at time of brachytherapy, (125% - GTV) |
(92–168) e.g. 35Gy/5 fractions with concomitant boost to 50Gy/5 fractions [22] |
Involved pelvic or adjacent PA LNs (up to T12/L1) | (60–86) |
(60–74) concomitant integrated or sequential boost (aim as high as possible within dose range while respecting OARs) |
na |
(65–86) 30–35/5# Concomitant boost |
Prostate bed GTV | (70–74) |
(70–74) sequential boost only |
na | na |
Bone metastasis | (66–110) |
(66–74) concomitant if adjacent to pelvic RT fields |
na |
(66–110) 30-40Gy/5# 24Gy/2# (spine only) |
Remote LNs | (66–110) | na | na |
(66–110) 30-40Gy/5# |
Lung mets (peripheral) | (190) | na | na |
(190) 48Gy/4# |
Lung mets (central) | (86–168) | na | na |
(86–168) 35-50Gy/5# |
Liver metastasis | (66 or more) | na | na |
(66 or more) 30-60Gy/3–5# |
For gross disease that has achieved a complete radiographic response to hormone therapy (e.g. enlarged lymph nodes), the original area of the disease should be treated to an EQD2 of 42-56Gy
In general for stereotactic radiotherapy of metastases, a dose of 35 Gy in 5 fractions delivered in a conformal fashion and with dose homogeneity is an effective and safe dose for the majority of non-spine tumour targets. For spine metastases, a dose of 24 Gy in 2 fractions is highly recommended
Radiation therapy details including OAR constraints are available in Appendix