Over the past decades, both hypofractionation and (focal) dose escalation have been studied in trials for prostate cancer (PCa) radiotherapy. Several studies have demonstrated a benefit of dose escalation in terms of improved biochemical progression-free survival (bPFS). Whole-gland dose escalation, however, is associated with an increased risk of side effects. The concept of isotolerated focal boosting was tested in the phase III FLAME trial and showed improved bPFS survival in patients with intermediate- and (mainly) high-risk PCa, without significantly increasing side effects. Following this publication, a steady increase in the number of patients treated with focal boosting of the intraprostatic tumour(s) is anticipated. Thus, the current ESTRO recommendation has been developed to provide practical suggestions for the implementation of focal boosting of the intraprostatic tumour(s). We here present an overview of the existing literature and, based on evaluation of the current evidence and expert opinion, we formulate a set of practical 'how-to' recommendations to support the integration of focal boosting of the intraprostatic tumour(s) using either external beam radiotherapy or brachytherapy into routine clinical practice.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2026 Jul 03 [Epub]
T Willigenburg, C Draulans, F J Pos, T M Seibert, I Syndikus, A Henry, A Mitchell, M Buijs, B A Jereczek-Fossa, S K B Spohn, T Pommer, B R Pieters, A C Tree, J R N van der Voort van Zyp
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, AZ Sint-Maarten Hospital, Mechelen, Belgium., Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, the Netherlands., Department of Radiation Medicine & Applied Sciences, University of California San Diego, San Diego, CA, United States; Department of Radiology, University of California San Diego, La Jolla, CA, United States; Department of Urology, University of California San Diego, La Jolla, CA, United States; Department of Bioengineering, Jacobs School of Engineering, University of California San Diego, La Jolla, CA, United States., The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom., Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, United Kingdom., Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom., InHolland Haarlem, University of Applied Sciences, Haarlem, the Netherlands., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy., German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre, Freiburg, Germany; Department of Radiation Oncology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden., Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands., The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom., Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: .