Introduction: Kilovoltage CT-guided radiotherapy for prostate cancer patients with bilateral hip prostheses can be challenging due to metal artifacts. Case Presentation: To compensate for reduced tissue contrast and suppress metal artifacts, a 76-year-old NCCN very high-risk prostate cancer patient underwent megavoltage CT/MRI fusion image-guided radiotherapy with an endorectal balloon. The post-treatment course was uneventful. There were no recurrences or serious side effects 11 years after radiotherapy. Conclusions: Megavoltage CT/MRI-guided radiotherapy with endorectal balloon support may be a viable alternative for a prostate cancer patient with bilateral hip prostheses.
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