Gagliardo Gaetano, Serra Marcello, Ametrano Gianluca, Galiero Marco, Arrichiello Cecilia, Borzillo Valentina, Buonanno Francesca, d'Alesio Valentina, Di Franco Rossella, Muto Paolo
Post Graduate School in Medical Physics, University of Naples Federico II, Naples, Italy.
Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
Radiol Med. 2025 Sep 11. doi: 10.1007/s11547-025-02046-3.
Prostate cancer (PCa) remains one of the most frequently diagnosed malignancies in men globally, ranking second in prevalence, with increasing incidence anticipated due to aging populations. Radiotherapy has emerged as a cornerstone treatment for localized PCa with stereotactic body radiation therapy (SBRT), and it offers a promising approach by delivering highly conformal high-dose radiation in fewer fractions. This study compares the dosimetric outcomes of three SBRT techniques-CyberKnife (CK), Volumetric Modulated Arc Therapy with flattening filter-free mode (VMAT FFF), and Helical Tomotherapy Radixact (HT)-for localized PCa. The investigation evaluates dose distribution characteristics, sparing of organs at risk (OARs), and treatment delivery efficiency. Two patient groups with low-to-intermediate-risk localized PCa treated at the Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale were included. Treatment plans for CK, VMAT FFF, and HT were retrospectively generated and analyzed using dosimetric metrics such as Conformity Index (CI), Homogeneity Index (HI), Gradient Index, and dose-volume constraints for OARs. Results revealed comparable target coverage across all techniques, with CK demonstrating superior dose conformity and VMAT FFF achieving shorter treatment times. HT and VMAT FFF are effective alternatives, particularly for centers without access to CK systems, though CK offered advantages in challenging anatomical scenarios. Findings emphasize the feasibility of VMAT FFF and HT as viable options for expanding SBRT accessibility, enabling high-quality treatment delivery in diverse clinical settings.
前列腺癌（PCa）仍是全球男性中最常被诊断出的恶性肿瘤之一，患病率排名第二，预计随着人口老龄化发病率还会上升。放射治疗已成为局部前列腺癌立体定向体部放射治疗（SBRT）的基石性治疗方法，它通过在较少的分次中给予高度适形的高剂量辐射提供了一种有前景的方法。本研究比较了三种SBRT技术——射波刀（CK）、无均整器模式的容积调强弧形治疗（VMAT FFF）和螺旋断层放射治疗Radixact（HT）——用于局部前列腺癌的剂量学结果。该研究评估了剂量分布特征、危及器官（OARs）的保护以及治疗实施效率。纳入了在国立肿瘤研究所-IRCCS帕斯卡尔基金会接受低至中危局部前列腺癌治疗的两组患者。使用诸如适形指数（CI）、均匀性指数（HI）、梯度指数以及OARs的剂量-体积限制等剂量学指标，对CK、VMAT FFF和HT的治疗计划进行回顾性生成和分析。结果显示所有技术的靶区覆盖相当，CK表现出更好的剂量适形性，VMAT FFF实现了更短的治疗时间。HT和VMAT FFF是有效的替代方案，特别是对于没有CK系统的中心，尽管在具有挑战性的解剖学情况下CK具有优势。研究结果强调了VMAT FFF和HT作为扩大SBRT可及性的可行选择的可行性，能够在不同临床环境中提供高质量的治疗。
