Clinical Protocol for IMRT and VMAT radiotherapy in localized prostate cancer: Practical implementation based on institutional guidelines

Background: Radiotherapy represents a cornerstone in the management of localized prostate cancer. The development of modern techniques such as intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and image-guided radiotherapy (IGRT) has significantly improved treatment precision while reducing irradiation of surrounding organs at risk. Standardization of treatment planning, target delineation, and dose constraints is essential to optimize tumor control and minimize treatment-related toxicity.

Objective: The aim of this work was to describe and standardize a radiotherapy protocol for the management of localized prostate cancer using modern techniques including IMRT/VMAT and daily image guidance.

Methods: This protocol defines therapeutic decision criteria, target volume delineation, treatment planning procedures, dose prescription, and organ-at-risk constraints for prostate radiotherapy. Risk stratification was based on NCCN classification and predictive nomograms for lymph node involvement [1,4–10]. Target volumes and organs at risk were delineated according to international consensus guidelines [2,3]. Treatment was delivered using IMRT or VMAT techniques with daily cone-beam CT (CBCT) verification. Both conventional and hypofractionated schedules were considered depending on clinical indications.

Results: The proposed protocol provides standardized recommendations for treatment planning, including clinical target volume definition, planning target volume margins, dose prescription strategies, and dose constraints for organs at risk. The integration of IMRT/VMAT techniques with IGRT and CBCT imaging allows improved target coverage while reducing radiation exposure to the rectum, bladder, and other pelvic structures. Hypofractionated schedules may also be safely implemented within this framework.

Conclusion: Modern prostate radiotherapy based on IMRT or VMAT combined with image guidance and standardized planning procedures enables highly conformal treatment delivery with improved therapeutic ratios. The implementation of such structured protocols may enhance treatment consistency, optimize dosimetric outcomes, and contribute to improved clinical results in patients with localized prostate cancer.