Adaptive Salvage Radiation Therapy for Stage IIIB Prostate Adenocarcinoma Status Post-prostatectomy

The prostate and post-prostatectomy surgical bed can shift in anatomical position due to changes in the bladder and rectum size. This mobility of the prostate and prostatic bed, along with that of the bladder and rectum, poses a challenge in devising a single radiation therapy plan capable of delivering the desired dose to each organ across all treatment fractions. Adaptive radiation therapy (ART) represents a significant advancement in cancer treatment. The Ethos^TM ART system (Varian Medical Systems, Inc., Palo Alto, CA) streamlines the adaptive therapy workflow, enabling the efficient creation of superior radiation treatment plans based on anatomical orientation at the time of treatment. This case report aims to discuss how the online ART workflow was utilized in a 72-year-old male with recurrent prostate cancer post-prostatectomy. Our results demonstrated the advantage of having the flexibility to choose between scheduled and adapted plans based on daily images, providing improved radiotherapy plan quality for prostate cancer treatment post-prostatectomy.