Ebrt Therapy For Prostate Cancer

Which Type Of Radiation Therapy Is Right For You

It can be confusing to know which radiation treatment approach is your best choice. Were here to help. When recommending one approach or another, our team of radiation oncologists will consider a number of factors, including the aggressiveness of your tumor, how advanced your disease is, and your own preferences.

It can be helpful to know about different radiation treatment scenarios that occur based on the types of conditions we commonly see. Here are a few.

Localized prostate cancer refers to a tumor that is clearly confined within the prostate. Radiation therapy options for men with early-stage, localized prostate cancer include:

• low-dose-rate brachytherapy
• IG-IMRT
• stereotactic radiosurgery

For men with locally advanced prostate cancer which means the cancer has spread outside the prostate to nearby tissues options may include:

• LDR brachytherapy combined with a short course of daily IG-IMRT
• IG-IMRT combined with hormone therapy
• High-dose-rate brachytherapy combined with a short course of daily IG-IMRT

Together with your radiation oncologist, we can help you figure out which of these approaches is best for you.

Often, when a tumor is more advanced or aggressive, men receive hormone therapy before radiation therapy begins and continue it throughout the course of their treatment. Some receive hormone therapy after radiation therapy finishes as well. Hormone therapy reduces the level of testosterone throughout the body .

How Long Does External Beam Radiation Therapy Last

EBRT treatments are typically outpatient procedures. The length of your treatment depends on many factors, including your type and stage of cancer. EBRT may be administered over a period of weeks. Patients typically receive treatment once a day for five days in a row, generally Monday through Friday. The actual treatments last only a few minutes, but each session requires time to set up equipment and ensure the patient is in the correct position for treatment.

Diarrhea Flatulence Or Painful Defecation

These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

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What Is External Beam Radiation Therapy

Using a special X-ray machine called a linear accelerator, EBRT delivers high-energy rays to tumors. The machine delivers radiation from any angle and shapes radiation beams to the contour of the tumor. The machine moves around the body without touching the patient, aiming radiation at the cancer. Some types of focused EBRT target a tumor with higher, more precise doses of radiation, while reducing damage to healthy tissue and nearby organs. As a result, modern EBRT may help reduce the risk of side effects associated with traditional radiation treatment.

What should I expect during my external beam radiation therapy?

Every patients experience during EBRT varies depending on the type of cancer, the size and location of the tumor and the type of therapy being used. But there are some general rules and expectations most patients should consider. For instance:

Swelling Bruising Or Tenderness Of The Scrotum

Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.

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Tomotherapy And Hypofractionated Radiotherapy

The radiotherapeutic approach to carcinoma has been relatively consistent for more than 3 decades. Although refinements in existing treatment technique have allowed higher doses of radiation treatment to be offered to patients with limited disease, there are 2 unique forms of external beam radiotherapy that have garnered increasing interest over the past few years.

The first of these is helical radiotherapy using a computed tomography -like gantry and a rotating radiation beam that passes through the target area of interest. This modality, termed tomotherapy, has been used in the management of primary central nervous system tumors and viscera-based malignancies. Although the CT-like gantry generates megavoltage radiation, its design allows ready acquisition of CT-like images, which have been successfully used in optimizing patient positioning on a daily basis.

The second distinct modality is hypofractionated radiotherapy. In this form of therapy, radiation is delivered from an accelerator however, the equipment is mounted to a computer-guided robotic arm. Because the machine is capable of treating the target at angles that are not possible with conventional rotation-based equipment, it yields the theoretical advantage of conforming the dose more closely to the target organs shape.

Possible Side Effects Of Radiation Treatment

There are possible side effects associated with radiation therapy. Some people may not experience any side effects. Others may experience mild or bothersome side effects.

Some side effects may only last a short period of time, and others may last longer or forever. Side effects may occur at the time of treatment or could develop months after treatment.

Most side effects are manageable by your radiation team and last only a short time. Before starting treatment, your doctor will discuss possible side effects and their duration.

Because we use advanced targeting technology, the probability of side effects is lower.

Possible side effects include:

Bowel Issues Because radiation treatment is so close to the rectum, it could cause irritation. This irritation could cause soreness, blood in your stool, or rectal leakage. Most of the time these issues are temporary, but in rare cases, normal bowel function does not return. Because patients use a rectal balloon during each treatment, the likelihood of rectal issues is lower.

Urinary Issues Radiation can cause irritation to the bladder. This can cause urinary frequency, urgency and a burning sensation. If these problems occur, they generally go away after time.

Keeping your activity level up will result in less fatigue and feeling better.

Keeping your activity level up will result in less fatigue and you will feel better overall.

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When Is Radiation Therapy Used

There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:

• As the first treatment of cancer, which is still confined to the prostate gland.
• It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
• After the reoccurrence of cancer in the area, it was before surgery.
• To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.

What Happens After Radiotherapy

After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:

• check how your cancer has responded to treatment
• help you deal with any side effects of treatment
• give you a chance to raise any concerns or ask any questions.

Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have

follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.

PSA test

The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.

After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.

Treatment options after radiotherapy

Looking after yourself after radiotherapy

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Specific Foods To Eat During Ebr Prostate Therapy

Foods During EBR Prostate Therapy

QUESTION: Very little info on specific foods/recipes to eat during the 44 sessions of EBR. After 9 sessions, my husband is having stomach issues and urinary problems.

ANSWER

As you probably know, the radiation is killing the cancer cells in the prostate. At the same time, this radiation is affecting the normal cells of the prostate, bladder and other organs situated nearby the prostate. The radiation of the EBRT is not killing them, but is destroying their metabolism, by damaging specific enzymes. For that reason, the organism needs a lot of energy provided by the carbs.

Besides this, for the synthesis of new enzymes and other important molecules, the organism needs a lot of amino acids provided by the proteins.

Furthermore, the radiation is also causing the formation of free radicals, which are able to damage the molecules in the normal cells. Vitamins from group B, vitamin C and vitamin A are acting as antioxidants, i.e., they have the ability to neutralize the free radicals and to prevent the destruction of those enzymes. Just boost your husband with vitamins pills, but not the effervescent one, because they are containing only the water-soluble vitamin C and vitamins from group B.

Besides this, it is good for your husband to cook him chicken meat. For example, chicken with potatoes or with rice. The chicken does contain a lot of proteins and the potatoes a lot of carbs.

What Are The Different Types Of External Beam Radiation Therapy

Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a CT scan to map your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.

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Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

Radiotherapy And Androgen Ablation

Data from the Radiation Therapy Oncology Group have shown a clear improvement in biochemical control of disease when patients receive a combination of radiotherapy and androgen-suppressive treatment. The results of several phase III clinical trials suggest that the true benefit of combining radiotherapy with androgen blockade may lie in the potentially synergistic effects of the 2 treatments.

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What Are The Side Effects Of External Beam Radiation Therapy

As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:

• Skin irritation
• Erectile dysfunction
• Secondary malignancy

If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.

Recently, the FDA approved the use of Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.

What Are The Side Effects Of External Beam Radiotherapy

Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease.

Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover so side effects may only last a few weeks or months. But some side effects can start months or years after treatment. These can sometimes become long-term problems. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.

If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy. Read more about the side effects of hormone therapy and how you can manage them.

If youre having radiotherapy as a second treatment, and you still have side effects from your first treatment, then radiotherapy can make those side effects worse or last longer. It may also cause other side effects. The most common side effects of radiotherapy are described here.

Short-term side effects of radiotherapy

Urinary problems

Radiotherapy can irritate the lining of the bladder and the urethra, which is the tube men urinate and ejaculate through. This can cause urinary problems, such as:

Bowel problems

Tiredness and fatigue

Problems with ejaculation

Skin irritation and hair loss

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However, if youre okay with waiting for the PSA nadir, and if you dont mind getting treatment over the course of a few weeks instead of in one operation, then radiation may be ideal for you.

What are my options?

Conventional external-beam radiation therapy is given in little doses, a few minutes a day, five days a week, for seven or eight weeks. These small doses minimize the injury risk for the healthy tissue near the tumor. Scientists measure radiation in units called Gy . Most men get a minimum total dose of 75.6 Gy, but could get as much as 81 Gy this works out to 2 Gy or less per day.

The treatment itself is painless just like getting an x-ray at the dentists office. But one big challenge with getting repeated treatments is making sure youre always in the exact same position, so the radiation can hit the target the way its supposed to. Thus, you will be custom-fitted with your own pelvic immobilization device, which will not only keep you from fidgeting, but will make sure youre not slightly higher and to the right on the table one day, and slightly lower and to the left the next.

When you get fitted for your device, you will have a CT scan, so doctors can get a 3D look at your prostate. Then, when you get the radiation, you wont just get it from one side, but from multiple directions, and each beam of radiation will be individually shaped to target the cancer and a 5- to 10-millimeter margin of healthy tissue around the prostate.

How Can I Reduce Skin Reactions

• Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Do not rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
• Try not to scratch or rub the treated area.
• Do not apply any ointment, cream, lotion, or powder to the treated area unless your radiation oncologist or nurse has prescribed it.
• Do not wear tight-fitting clothing or clothes made from harsh fabrics such as wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers such as cotton.
• Do not apply medical tape or bandages to the treated area.
• Do not expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
• Do not expose the treated area to direct sunlight, as sun exposure may intensify your skin reaction and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.

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A Conversation With Scott Morgan Md Msc Frcpc And Howard M Sandler Md Fasco Fastro

External-beam radiation therapy is a standard treatment option for men with localized prostate cancer and confers long-term prostate cancer control outcomes equal to radical prostatectomy. Technologic advances in imaging and computing during the past 20 years have led to a number of innovations in prostate EBRT, which together have allowed for more precise delivery of escalated doses of radiation to the prostate. More recently, several clinical trials investigating hypofractionated EBRTcourses of treatment in which fewer, larger-dose fractions of radiation are deliveredhave been completed.

With the results of these trials emerging, three oncology organizations created a task force to develop a guideline offering recommendations on the use of hypofractionated EBRT. The American Society for Radiation Oncology , ASCO, and the American Urological Association worked together to conduct a systematic literature review on which the recommendations are based. The guideline was recently published in the Journal of Clinical Oncology.1

Scott Morgan, MD, MSc, FRCPC

Howard M. Sandler, MD, FASCO, FASTRO

Moderate Hypofractionation vs Ultrahypofractionation

How do you differentiate between moderate hypofractionation and ultrahypofractionation as treatment techniques?

Guideline Takeaways

What are the key takeaways of the guideline?

How will the practice-changing recommendations benefit patients most?

Clinical Implications

REFERENCES

Originally published in ASCO Daily News