Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know? (original) (raw)
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Current Approaches in Prostate Cancer Radiotherapy
Grand Journal of Urology, 2021
Prostate cancer is one of the most common tumor in males. Radical prostatectomy, radiotherapy and watchful waiting are the main treatment options in localized disease. Radiotherapy together with hormonotherapy is accepted as the standard of care in patients with advanced stages. Surgery or radiotherapy has comparable local control and survival outcomes in localized disease. During recent years a significant reduction in the rate of serious side effects has been achieved due to the development of modern radiotherapy techniques. With the use of these techniques such as Intensity-modulated radiotherapy (IMRT), Image-guided radiotherapy (IGRT), Stereotactic body radiotherapy (SBRT), high doses can be given safely and the rates of serious short - or long-term side effects have not exceeded 1 percent. Modern radiotherapy techniques allow dose escalation for the target volume, and due to its achievement of sharp dose gradient around the target volume and enable to increase radiation doses ...
Evolution of advanced technologies in prostate cancer radiotherapy
Nature Reviews Urology
Conventional treatment options for clinically localized, low-risk prostate cancer include radical prostatectomy, external-beam radiotherapy (EBRT) and low-dose-rate brachytherapy. Advances in image-guided radiotherapy (IGRT) since the 1980s, the development of intensity-modulated radiotherapy (IMRT) during the 1990s and evidence from radiobiological models-which support the use of high doses per fraction-have developed alongside novel advanced radiotherapy modalities that include high-dose-rate brachytherapy (HDR-BT), stereotactic body radiotherapy (SBRT) and proton beam therapy. The relationship between the outcomes of and toxicities experienced by patients with prostate cancer treated with HDR-BT, SBRT and particle-beam therapy should provide urologists and oncologists an understanding of the continually evolving technology in prostate radiotherapy. On the basis of published evidence, conventionally fractionated EBRT with IMRT is considered the standard of care over conventional 3...
Brachytherapy- State Of The Art Radiotherapy In Prostate Cancer
BJU international, 2015
Contemporary treatment options for prostate cancer are considered to have comparable efficacy. Therefore other differences such as treatment related toxicities, impact on quality of life, convenience, treatment time, and cost become important considerations in influencing treatment choice. The goal of brachytherapy is to achieve high precision, targeted radiotherapy utilising advanced computerised treatment planning and image guided delivery systems to achieve tailored ablative tumour dose to the prostate whilst sparing surrounding organs at risk to minimise potential toxicities. This article is protected by copyright. All rights reserved.
Radiotherapy Technique for the Prostate Cancer Treatment: A Short Communication
Open Journal of Research, 2015
Prostate cancer is the one of the most commonly diagnosed cancer among men throughout the world. In the recent days, prostate cancer can be managed by several options such as surgery, chemotherapy, radiotherapy, etc. Radiotherapy is considered as one of the popular options to treat prostate cancer due to excellent survival rate and fewer side effects. The field of radiotherapy is evolving since the days of 3-dimensional conformal radiotherapy (3DCRT), and it is now possible to treat the caner using more advanced techniques such as intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), proton therapy, and carbon therapy. This letter addresses some of the major radiotherapy techniques available for the cancer treatment.
International Journal of Radiation Oncology*Biology*Physics, 2014
Five rival treatment techniques for localized prostate cancer with excellent local control and moderate side effects were dosimetrically compared: intensitymodulated photon, proton, and carbon ion therapy, as well as low-dose-rate and high-dose-rate brachytherapy. All assumed total doses and fractionation schemes are clinically used. For comparison, dose distributions were radiobiologically converted to the same fractionation scheme. Brachytherapy techniques were Purpose: To assess the dosimetric differences among volumetric modulated arc therapy (VMAT), scanned proton therapy (intensity-modulated proton therapy, IMPT), scanned carbon-ion therapy (intensity-modulated carbon-ion therapy, IMIT), and low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy (BT) treatment of localized prostate cancer. Methods and Materials: Ten patients were considered for this planning study. For external beam radiation therapy (EBRT), planning target volume was created by adding a margin of 5 mm (lateral/anterioreposterior) and 8 mm (superioreinferior) to the clinical target volume. Bladder wall (BW), rectal wall (RW), femoral heads, urethra, and pelvic tissue were considered as organs at risk. For VMAT and IMPT, 78 Gy(relative biological effectiveness, RBE)/2 Gy were prescribed. The IMIT was based on 66 Gy(RBE)/20 fractions. The clinical target volume planning aims for HDR-BT (192 Ir) and LDR-BT (125 I) were D 90% !34 Gy in 8.5 Gy per fraction and D 90% !145 Gy. Both physical and RBE-weighted dose distributions for protons and carbon-ions were converted to dose distributions based on 2-Gy(IsoE) fractions. From these dose distributions various dose and doseevolume parameters were extracted. Results: Rectal wall exposure 30-70 Gy(IsoE) was reduced for IMIT, LDR-BT, and HDR-BT when compared with VMAT and IMPT. The high-dose region of the BW doseevolume histogram above 50 Gy(IsoE) of IMPT resembled the VMAT shape, whereas all other techniques showed a significantly lower high-dose region. For all 3 EBRT techniques similar urethra D mean around 74 Gy(IsoE) were obtained. The LDR-BT results were approximately 30 Gy(IsoE) higher, HDR-BT 10 Gy(IsoE) lower. Normal tissue and femoral head sparing was best with BT. Conclusion: Despite the different EBRT prescription and fractionation schemes, the high-dose regions of BW and RW expressed in Gy(IsoE) were on the same order of magnitude.
International Journal of Radiation Oncology Biology Physics, 2006
) brachytherapy boost. Methods: From November 1991 to April 2003, 197 patients were treated for intermediate-and high-risk disease features. All patients had prostate-specific antigen >10 ng/ml, Gleason score >7, or clinical stage >T2b, and all received pelvic EBRT (46 Gy) while receiving either two or three HDR boost treatments. HDR dose fractionation increased progressively and was divided into two dose levels. The mean prostate biologic equivalency dose was 88.2 Gy for the low-dose group and 116.8 Gy for the high-dose group (␣/ ؍ 1.2). Clinical failure was either local failure or distant metastasis; clinical event-free survival (cEFS) was defined as patients who lived free of clinical failure. Results: Median follow-up was 4.9 years. The 5-year rates were as follows: biologic failure (BF), 18.6%, clinical failure (CF), 9.8%, cEFS 84.8%, cause-specific survival (CSS), 98.3%, and overall survival (OS), 92.9%. Five-year biochemical failure (68.7% vs. 86%, p < 0.001), CF (6.1% vs. 15.6%, p ؍ 0.04), cEFS (75.5% vs. 91.7%, p ؍ 0.003), CSS (95.4% vs. 100%, p ؍ 0.02), and OS (86.2% vs. 97.8%, p ؍ 0.002) were significantly better for the high-dose group. Multivariate analysis showed that high-dose group (p ؍ 0.01, HR 0.35) and Gleason score (p ؍ 0.01, HR 1.84) were significant variables for cEFS. Multivariate analysis showed that high-dose group (p ؍ 0.01, HR 0.14) and age (p ؍ 0.03, HR 1.09 per year) were significant variables for overall survival. Conclusion: There is a strong dose-response relationship for intermediate-to high-risk prostate cancer patients. Improved locoregional control with higher radiation doses alone can significantly decrease biochemical and clinical failures.
Stereotactic ablative body radiotherapy in patients with prostate cancer
Translational Andrology and Urology, 2018
Prostate is the most common non-cutaneous cancer diagnosed among men in North America. Fortunately most prostate cancers are screen detected and non-metastatic on diagnosis. Treatment options for men with localized prostate cancer include surgery ± postoperative radiation or radiation ± androgen deprivation therapy (ADT). Brachytherapy ± external beam radiation treatment (EBRT) appears to have superior long-term disease control over EBRT alone likely because of higher biologic effective dose delivered. Stereotactic ablative body radiation (SABR) is a novel, non-invasive, high-precision EBRT technique that allows safe delivery of biologic doses similar to brachytherapy with similar or lower side effects [measured using toxicity or quality of life (QOL) scales]. Efficacy for SABR appears to be similar to brachytherapy including positive biopsy rates 2-3 years post treatment, biochemical failure (BF) rates out to 10-year and incidence of metastases. SABR dose escalation reduces biopsy positivity and prostate-specific antigen (PSA) nadirs but increases genitourinary (GU) and gastrointestinal (GI) toxicity-no effect on BF has been realized yet. The overall treatment time (OTT) varies in many protocols. Phase 2 randomized data shows that QOL is better in the acute setting with a weekly course of treatment compared to an every other day treatment regimen with no difference in late setting. Follow-up data are immature and likely underpowered to determine efficacy differences. SABR is cheaper and uses less resource than any other radiation technique. Given the healthcare resource challenges (including financial resources), SABR would be a welcomed addition if studies show non-inferiority to other radiation techniques. For patients with de novo or metastatic disease on relapse, there is much enthusiasm regarding the use of SABR in the setting of oligometastatic prostate cancer. SABR appears to be feasible to deliver, well tolerated and may delay the next line of therapy. However, until adequately powered randomized studies confirm a benefit, such an approach cannot be considered standard of care treatment at this time. Enrollment of eligible prostate cancer patients onto SABR clinical trials should be encouraged.
Cancer Treatment Reviews, 2013
Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Stereotactic body radiation therapy (SBRT) is touted as a superior type of external beam radiation therapy (EBRT) for the treatment of various tumors. SBRT developed from the theory that high doses of radiation from brachytherapy implant seeds could be recapitulated from advanced technology of radiation treatment planning and delivery. Moreover, SBRT has been theorized to be advantageous compared to other RT techniques because it has a treatment course shorter than that of conventionally fractionated EBRT (a single session, five days per week, for about two weeks vs. eight weeks), is non-invasive, is more effective at killing tumor cells, and is less likely to cause damage to normal tissue. In areas of the US and Europe where there is limited access to RT centers, SBRT is frequently being used to treat prostate cancer, even though long-term data about its efficacy and safety are not well established. We review the impetus behind SBRT and the current clinical evidence supporting its use for prostate cancer, thus providing oncologists and primary care physicians with an understanding of the continually evolving field of prostate radiation therapy. Studies of SBRT provide encouraging results of biochemical control and late toxicity. However, they are limited by a number of factors, including short follow-up, exclusion of intermediate-and high-risk patients, and relatively small number of patients treated. Currently, SBRT regimens should only be used in the context of clinical trials.