Effective dose fractionation schemes of radiotherapy for prostate cancer

TL;DR

This study explores adaptive radiotherapy dose fractionation strategies for prostate cancer, demonstrating that tailored dosing schedules can significantly reduce tumor volume, especially when accounting for tumor heterogeneity and treatment schedules.

Contribution

The paper introduces a dynamical system model for personalized radiotherapy, showing how adaptive dosing strategies can improve treatment efficacy for heterogeneous prostate tumors.

Findings

Longer intervals with higher doses reduce tumor volume more effectively.

Weekend dose compensation improves treatment outcomes.

Adaptive dosing plans can be tailored to tumor properties and clinic schedules.

Abstract

Radiation therapy has remained as one of the main cancer treatment modalities and a highly cost-effective single modality treatment of cancer care. Typical regimens for fractionated external beam radiotherapy comprise a constant dose administered on weekdays, and no radiation on weekends. However, every patient has a tumor with distinct properties depending on intra-tumor heterogeneity, aggressiveness, and interactive properties with other cells that may make it more resistant or sensitive to radiation treatment. Accordingly, the concept of personalized cancer treatment is emerging to specialize each patient treatment case to the unique properties of the tumor. In this paper, we examine adaptive radiation treatment strategies for heterogeneous tumors using a dynamical system model that consists of radiation-resistant and parental cell populations with unique interactive properties. We study different adaptive dosage strategies for PC3 and DU145 prostate cancer cell lines. We show that stronger doses of radiation given in longer time intervals, while keeping the overall dosage the same, reduce final tumor volume by more than half in PC3 cell lines, but by only five percent in DU145 cell lines. In addition, we tested an adaptive dosing schedule by administering a stronger dosage on Friday to compensate for the treatment-off period during the weekend, which was effective in decreasing the final tumor volume of both cell lines. This result creates interesting possibilities for new radiotherapy strategies at clinics that cannot provide treatment on weekends. Finally, we propose a dosage plan incorporating our findings.