# Impact of Adaptive Radiation Therapy on Toxicity in Prostate Cancer: A Scoping Review

## TL;DR

This review examines how adaptive radiation therapy affects side effects in prostate cancer patients, finding that toxicity rates are low and comparable across different treatment types.

## Contribution

The study provides a comprehensive evaluation of toxicity in adaptive radiation therapy for prostate cancer, comparing different techniques and image guidance modalities.

## Key findings

- Acute and late toxicity rates for adaptive radiation therapy in prostate cancer are generally low, with no grade 3 gastrointestinal or genitourinary toxicities reported.
- The choice of image guidance modality does not significantly affect toxicity, but commercial adaptive systems may reduce side effects further.
- Adaptive conventional fractionated radiation therapy and stereotactic body radiation therapy show comparable toxicity rates.

## Abstract

Background/Objectives: Existing literature reviews have not focused on the acute and late toxicities of non-magnetic resonance imaging (MRI)-guided adaptive radiation therapy (ART), compared the impacts of non-MRI-guided versus MRI-guided ART, or evaluated the effectiveness of adaptive conventional fractionated radiation therapy (CFRT) and stereotactic body radiation therapy (SBRT) in relation to toxicity in prostate cancer (PCa). The purpose of this scoping review was to systematically identify original articles and evaluate the impact of ART on toxicity in PCa in a comprehensive manner. Methods: A literature search was conducted using electronic databases on 17 June 2025, identifying 27 eligible papers. Results: The overall median toxicities of ART in PCa were 15.0% (acute grade 1 gastrointestinal (GI)), 1.0% (acute grade 2 GI), 0.0% (acute grade 3 GI), 47.1% (acute grade 1 genitourinary (GU)), 9.6% (acute grade 2 GU), 0.0% (acute grade 3 GU), 10.0% (late grade 1 GI), 2.0% (late grade 2 GI), 0.0% (late grade 3 GI), 29.7% (late grade 1 GU), 5.0% (late grade 2 GU), and 0.0% (late grade 3 GU). The choice of image guidance modality for ART does not appear to substantially influence toxicity; however, dedicated commercial ART systems may contribute to reducing toxicity to lower levels in PCa. Furthermore, the toxicity rates of adaptive CFRT and SBRT were comparable. Conclusions: Adaptive CFRT may be considered when SBRT is unsuitable for certain patients, without increasing the risk of side effects. However, further research is warranted to evaluate dedicated commercial cone-beam computed tomography (CT)- and CT-guided ART systems.