China
Africa
Explore chapters and articles related to this topic
Brachytherapy Treatment Planning
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Margaret Bidmead, Dorothy Ingham, Peter Bownes, Chris D. Lee
Prostate brachytherapy has routinely targeted the whole prostate gland, either as monotherapy or combined with external-beam radiotherapy, as prostate cancer is typically known to be a multi-focal disease. Improvements in multi-parametric MRI and PET imaging, combined with transperineal template-guided mapping biopsies, have allowed better characterisation and delineation of the cancer distribution within the prostate. These developments have increased the interest in focal brachytherapy, with the aim to target areas of the prostate known to contain the cancer whilst reducing the dose to OARs and the remaining prostate gland. The objective for appropriately selected low-risk, low-volume focal disease is that it will be as effective as whole-gland treatments but with reduced treatment-related toxicity.
Prostate Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Malcolm Mason, Howard Kynaston
Radiotherapy has been used to treat primary prostate cancer since the pioneering work of Bagshaw, beginning in the 1960s. Most initial work, summarizing retrospective studies from this period, used external-beam radiotherapy (EBRT). More recently, prostate brachytherapy has become popular, with the potential to deliver very high doses of radiation to the prostate with an almost ideal dose distribution.
Current Role of Focal Therapy for Prostate Cancer
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
H. Abraham Chiang, George E. Haleblian
The largest published series of sub-total gland brachytherapy by Nguyen et al. includes 318 patients with low- to intermediate-risk disease. Notably, in this series sub-total gland ablation was performed by radiating the entire peripheral zone of the prostate, instead of hemi-gland or focal ablation. Hence, this technique does not fully conform to the idea of “focal therapy.” Nonetheless, as the largest series in sub-total prostate brachytherapy, the study provides valuable insight with regards to oncologic outcomes. After a median follow-up of 61 months, prostate cancer-free survival was 99.7% and 3.5% of patients were found to have clinically significant prostate cancer post-treatment (Nguyen et al. 2012). Functional outcomes were not investigated.
Prevalence and Risk Factors of QTc Prolongation in Prostate Cancer Patients Undergoing Brachytherapy
Published in Cancer Investigation, 2022
Simon Saad, Guila Delouya, Carole Lambert, Maroie Barkati, Charles Dariane, Mikhael Laskine, Daniel Taussky
The American Brachytherapy Society has stated that ADT should be used carefully in patients who undergo brachytherapy, due to a possible negative impact on overall survival. This is especially relevant in older patients who suffer from cardiovascular comorbidities (5). In a recent publication in brachytherapy patients, cardiovascular comorbidities were more common amongst intermediate risk prostate cancer patients than lower risk patients (22). A retrospective study reported that over a ten-year period in prostate brachytherapy patients, use of ADT in intermediate risk cases reduced overall survival and increased cardiovascular mortality (22). This study has to be interpreted with caution because patients on ADT were older and the analysis was not adjusted for age or comorbidities. The risks and benefits of ADT use is especially important to consider in patients with moderate to severe comorbidities. At least 1 study found that the overall mortality rate, especially cardiac related, was higher in patients who received a combination ADT and radiotherapy compared to patients who underwent radiotherapy alone (23).
Histopathological re-evaluations of biopsies in prostate cancer: a nationwide observational study
Published in Scandinavian Journal of Urology, 2020
B. W. H. van Santvoort, G. J. L. H. van Leenders, L. A. Kiemeney, I. M. van Oort, S. E. Wieringa, H. Jansen, R. W. M. Vernooij, C. A. Hulsbergen-van de Kaa, K. K. H. Aben
The concordance rate of the EAU risk classification in the current study (87.9%) was higher than reported by most other studies. For instance, the study by Camara-Lopes et al. [19] included 182 patients with PCa who were all referred to the same hospital before undergoing brachytherapy. This study was performed in daily clinical practice and reported a concordance rate of 68.1% (n = 124). A study by Thomas et al. [8] observed a management change in 14.8% (n = 196) of the patients who were treated in one of four centers with prostate brachytherapy between 1998 and 2005. A fair comparison of the results from these studies with our study is difficult because the other studies were confined to a specific group of patients with PCa who will likely have different cancer characteristics compared to the patient characteristics in our study. A study of Nguyen et al. [35] included all patients who were referred to a genitourinary oncology specialist after being diagnosed with PCa and reported a change in risk group in 14.2% (n = 92) of the patients, which follows well with our finding.
Prostate cancer high dose-rate brachytherapy: review of evidence and current perspectives
Published in Expert Review of Medical Devices, 2018
Sunil W. Dutta, Clayton E. Alonso, Bruce Libby, Timothy N. Showalter
Prostate brachytherapy, which involves placing a sealed radiation source directly into the prostate, has higher conformality than EBRT, potentially improving the therapeutic ratio [9]. For patients with high risk disease, the Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (ASCENDE-RT) trial demonstrated that patients who received low dose-rate (LDR) brachytherapy boost (compared to 78 Gy EBRT alone) were twice as likely to be free of biochemical failure, with an absolute estimated improvement of 21% with the use of brachytherapy by 9 years follow-up [10]. However, the ASCENDE-RT trial results also showed that patients who received LDR brachytherapy were at substantially higher risk of severe urinary toxicity, such as urethral stricture, potentially counterbalancing the gains in biochemical control [11]. As of a result of the improved cancer control outcomes from ASCENDE-RT and other clinical studies, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario issued joint guidelines in 2017 to recommend that all eligible patients with intermediate to high risk prostate cancer should be offered brachytherapy [12]. Similarly, the 2017 National Comprehensive Cancer Network (NCCN) guidelines list EBRT plus brachytherapy as a standard treatment option for intermediate to high risk prostate cancer [5].