Conformal vs conventional technique: a comparison of sequelae-acute symptoms, late complications and cancer control

The technology of conformal 3D radiation treatments provides for improved protection of normal tissue and improved targeting of the radiation beams. There is clear evidence at equivalent total dose that symptoms during treatment are fewer with conformal treatment. There is clear evidence that higher doses can be delivered with conformal technique, resulting in fewer late complications than is possible with conventional treatment. There is clear evidence that higher doses can be delivered with conformal technique, resulting in fewer late complications than is possible with conventional treatment. There is evidence that improved biochemical control of cancer (bNED) is obtained with conformal technique, presumed to be due to improved targeting. This is further supported by an improved 12 month PSA response, again probably due to improved targeting. Patients with pretreatment PSA > 10 ng/ml require radiation doses above that which can be safely delivered by conventional technology to obtain maximum bNED survival. Multivariate analysis shows that dose is a significant independent variable for bNED survival for these high PSA patients. There are now dose responses for Grade 2 and Grade 3,4 gastrointestinal complications with techniques that include or specially protect the anterior rectal mucosa. We can now optimize the treatment of prostate cancer patients by understanding the dose/responses for cancer control and late morbidity. Conformal 3D treatment wins the comparison with conventional technique on all counts