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Hdr Radiation Therapy Prostate Cancer

Stereotactic Body Radiation Therapy

HDR Brachytherapy for Prostate Cancer

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.

The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

Future Directions For High Dose Rate Prostate Brachytherapy

The radiobiological advantage of delivering a HDR per fraction to the prostate while sparing the rectum and bladder, together with the ability to make real-time adjustments to both source positioning and dwell times of the radioactive sources thereby allowing for optimal dose distribution, has led to interest in other indications in which HDR prostate brachytherapy might be applied. One of the main practical attractions of HDR over EBRT is the shorter treatment times, and thus more recent work has focused on HDR monotherapy. This has been predominantly applied for more favourable intermediate- and low-risk disease, in which LDR has been well established. Such treatment requires multiple fractions/implants, typically given over 23 days, with some centres also repeating the implant 12 weeks later. Thus, although the number of hospital visits is lower than with EBRT, they are more intense and require inpatient stay. While the results are not as mature as with HDR boost, monotherapy studies have reported freedom from biochemical relapse rates of 89100% in low- and intermediate-risk patients, which compare favourably with findings with LDR brachytherapy . At present this approach is not recommended routinely, but should the long-term outcome data become favourable, this will undoubtedly help to establish HDR monotherapy as a credible option for localised prostate patients.

Brachytherapy: A Highly Targeted And Effective Option For Treating Prostate Cancer

Prostate cancer is the second most common cancer in American men, with about 250,000 new cases diagnosed each year. It starts when cells inside the prostate gland, which is located below the bladder and in front of the rectum, begin to grow out of control.

While prostate cancer affects around 1 in 8 men during their lifetime, the good news is that there are effective treatment options, including a treatment called brachytherapy.

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What Should I Look Out For After Treatment

Your doctor or nurse will give you a telephone number to call if you have any questions or concerns. Contact them or go to your local accident and emergency department if any of the following happen.

  • If your urine is very bloody or has clots in it, this could mean you have bleeding in your prostate. This may need treatment as soon as possible.
  • If you are suddenly not able to urinate, this could be acute urinary retention. This will need treatment as soon as possible.
  • If you have a high temperature with or without chills, this may be a sign of infection.

The Findings Indicate A Serial Response For Rectal Bleeding

High

In agreement with other studies the high-dose metrics for the rectum were significantly correlated with rectal bleeding for both distribution-adding and parameter-adding. The significant correlation between near maximum dose metrics for the rectum and rectal bleeding indicates the dose-volume effects follow a serial response. The confirmation of the expected importance of near maximum doses after registration is important as a previous study without registration did not find any significance for near maximum doses and the GEC/ESTRO recommendation is to limit the D2cc to 75 Gy . Additionally, the identified seriality is consistent with the suggestion rectal bleeding is associated with epithelial damage and mucositis as a result of exposure of parts of the rectal wall to near maximum doses .

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Indications For High Dose Rate Brachytherapy

Currently, the main indication for HDR brachytherapy is in the context of safe dose escalation to the prostate, for intermediate- and high-risk disease in which pelvic treatment is required and the radiation dose is limited by bowel tolerance. In these circumstances, the HDR is given as a boost treatment to the prostate together with EBRT to the pelvis. This has gained National Institute for Health and Clinical Excellence approval since 2005 . Although there are reports of using HDR brachytherapy as monotherapy, this tends to be reserved for lower-risk disease and should be considered investigational at this stage.

Radiation Therapy For Prostate Cancer

    Radiation therapy uses high-energy rays or particles todestroy cancer cells. It is usually used to treat prostate cancer. Yourhealthcare team will consider your personal needs to plan the type and amountof radiation, and when and how it is given. You may also be given hormonetherapy together with radiation therapy.

    Radiation therapy is given for different reasons. You mayhave radiation therapy to:

    • destroy cancer cells in the body
    • treat cancer that is not removed completely with surgery or that comesback after surgery
    • relieve pain or control the symptoms of advanced prostate cancer

    The following types of radiation therapy are most commonlyused to treat prostate cancer.

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    Intensity Modulated Radiation Therapy

    IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

    Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

    A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.

    Hdr Brachytherapy For Prostate Cancer

    An Overview of HDR Brachytherapy Radiation Therapy to Treat Cancer

    Prostate Cancer Is no longer a dreadful problem. Alternative Nonsurgical Treatment HDR Brachytherapy for Prostate Cancer, a radiation therapy with quick recovery

    Prostate Cancer Is no longer a dreadful problem. Alternative Nonsurgical Treatment HDR Brachytherapy for Prostate Cancer, a radiation therapy with quick recovery

    HDR Brachytherapy for Prostate CancerWith over 15-year experience

    • One overnight stay in the hospital
    • Back to work the next day
    • No incontinence
    • Less side effect on sexual function

    Terms of Service

    • Packages price are valid to use from now 31 December 2021.
    • This price is reserved for Thais and foreigners residing in Thailand only.
    • The hospital reserves the right to change the terms of service without prior notice.
    • For convenience, We recommend making an appointment in advance before using the service.

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    Toxicity Is Also Influenced By Low Doses And The Lower End Of The Mid

    The association of urgency/tenesmus with distribution-adding doses at the lower end of the mid-dose range is consistent with the finding from another study where violation of the V40 Gy dose constraint was important for urgency . Additionally, the results indicate the lower end of the mid-dose range and the low doses may be associated with anorectal pain and rectal bleeding respectively. The correlation of toxicities with low doses and the lower end of the mid-dose range is possible as it is plausible that a low-dose bath to a large volume will be associated with detriment. However, these findings of association should be considered with respect to toxicity event rates, sample size and the potential of random discovery.

    Treatment For A Rising Psa After Brachytherapy

    A PSA test measures prostate-specific antigen levels in the blood. Benign enlargement of the prostate, inflammation of the prostate, and prostate cancer can all cause a high PSA.

    PSA levels sometimes rise after brachytherapy. However, your doctor wont recommend further cancer treatment based on this test alone. Theyll look for a rising trend in PSA over time and consider other factors, such as imaging tests, before recommending further treatment.

    Even if your doctor cant see cancer cells with imaging, they may recommend you undergo treatment again based on a risk-benefit analysis. The benefit of catching all the cancer may outweigh the risk of additional treatment.

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    Who Qualifies For Hdr Prostate Brachytherapy Focal Therapy

    Patients who have a local only recurrence after previous radiation therapy are potentially candidates for “focal salvage”. In this type of treatment only the area of recurrence is treated rather than retreating the entire prostate gland. The rationale for this is that the majority of men who develop a local recurrence after radiation do so at the site of where the most dominant focus of disease was at the beginning of treatment. The goal of focal salvage is to cure the patient of his disease while limiting the risk of both short and long term side effects. Focal therapy in the up-front setting with no previous treatment is not currently standard of care and is best pursued on a clinical trial.

    The physician determines whether HDR monotherapy or combination therapy is appropriate for the patient during his initial consultation.

    Below is an example of the standard template that we use for prostate brachytherapy here at UCLA.

    Once the flexiguides are in position the template is sutured to the perineum to stabilize the implant.

    A camera is used to look into the bladder to ensure appropriate placement of the flexiguides and then a foley catheter is left in the bladder.

    After a brief stay in the recovery room the patient has a CT simulation where the placement of the flexiguides is confirmed. Once the images of the implant are obtained the patient waits for the customized treatment plan to be generated.

    Back To Top23 Benefit Of Hdr Brachytherapy

    Brachytherapy: Prostate Cancer Treatment
    • Organ Preservation
    • Accuracy and precision of radiation dose delivery
    • Knowledge of radiation dose before treatment is given
    • Ability to shape the radiation dose to fit the tumor and avoid normal tissue
    • Fewer urinary, rectal and sexual side effects
    • No radiation source migration into other organs
    • No radiation exposure to other people
    • Short course of treatment measured in days to weeks rather than months
    • Excellent coverage of microscopic extension of cancer immediately beyond the prostate
    • Minimizes areas of radiation overdose or underdose within the prostate
    • Organ motion is not an issue for HDR as it is with EBRT
    • It can be an effective treatment for cancer recurrence
    • Combined HDR brachytherapy offers several other advantages over the 7-8 week course of EBRT without HDR. It offers the best opportunity to control the distribution of radiation within and around the prostate . Control rates are correspondingly high and complication rates low with HDR brachytherapy. Simultaneous with the best dosimetry the HDR and EBRT treatment course is shorter than EBRT alone. The radiobiologic advantages to shorter treatment courses in the treatment of prostate cancer are now well known.
    • HDR Monotherapy has the shortest course and is the most conformal of all forms of radiation.

    3. Effectiveness of HDR Brachytherapy

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    Faq: Radiation Therapy For Prostate Cancer

    Why would I choose radiation therapy?

    Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.

    How should I expect to feel during radiation therapy?

    Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:

    • Increase in the frequency of urination
    • Urinary urgency
    • Softer and smaller volume bowel movements
    • Increased frequency of bowel movements
    • Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue

    Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.

    How should I expect to feel after radiation therapy?

    Back To Top41 Who Qualifies For Monotherapy

    1. Stage T1c, T2a, or small T2b

    2. PSA< 15

    3. Gleason 2-7

    The above criteria are applied to patients on an individual case basis. Most patients with low risk group disease will probably be candidates for HDR monotherapy. Some patients categorization as intermediate risk group will be also considered candidates. For example, a patient with Gleason score of 3+4=7, a small palpable tumor , and a PSA < 15 would be consider a candidate for HDR monotherapy, if a only small percentage of the biopsy specimen is positive and the MRI indicates a low volume of disease and no extracapsular extension.

    Certain patients with prior radiation who have biopsy proven evidence of persistent disease may be candidates for “salvage” HDR monotherapy.

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    Back To Top71 3d Ct Based Dosimetry

    Fig 2: These four images are used to evaluate the implant using the 3D CT based software. The upper left image shows the implant in 3D. The physician can rotate the implant to assess the radiation coverage by the prescription dose “cloud” from any angle, and the proximity of the implant to other structures, such as the rectum and bladder. Clockwise, three CT images show the radiation dose levels at the top, middle and bottom of the gland.
    Fig 3: This close-up 3-D image of the 100% isodose cloud, showing near complete coverage of not only the prostate plus 5mm margin, but also the proximal seminal vesicles, shown semi-transparently. Notice how the dose cloud is shaped posteriorly to spare the anterior rectal wall.
    Fig 4: This view evaluates the implant from the top. The red areas are the small portions of the target volume that are spared the full prescription dose: the bladder neck and the lower bulbous urethra to prevent urinary incontinence and urethral stricture respectively.

    Drink The Nylytely Bowel Preparation

    HDR Brachytherapy for Prostate Cancer

    At 3:00 pm on the day before your procedure, start drinking the NuLYTELY. Drink 1 glass of the mixture every 15 minutes. Drink only half of the NuLYTELY solution . Throw out the other half. Then, keep drinking clear liquids.

    The NuLYTELY will cause frequent bowel movements, so be sure to be near a bathroom when you start drinking it. To help prevent irritation, you can apply petroleum jelly or A& D® ointment to the skin around your anus after every bowel movement.

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    Questions To Ask Your Doctor Or Nurse

    • Will I have external beam radiotherapy before or after temporary brachytherapy?
    • Do I need hormone treatment before and/or after temporary brachytherapy?
    • What are the chances of side effects such as urinary problems, erection problems and bowel problems with this treatment?
    • How many treatments will I have?
    • Will I be asleep or awake during treatment?
    • How long will I need to stay in hospital for the treatment?
    • How will we know if the treatment has worked?
    • What should my PSA level be after treatment and how often will you measure it?
    • If my PSA continues to rise, what other treatments are available?

    Back To Top72 Dose Volume Histrogram

    Fig 5: This DVH shows that 97.4 % of the target volume is being encompassed by the prescription dose. 35% of the urethra received doses slightly higher than the prescription dose, with the maximum dose being around 110% of the prescription dose. The maximum anterior rectal wall dose our physicians allow is 75% of the prescription dose, versus up to 100% with seeds or external beam.

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    Hdr In Conjunction With External Beam

    When first used for prostate cancer, HDR brachytherapy was predominantly implemented to boost the prostate as an adjunct to pelvic EBRT. This was considered particularly advantageous when first being used given the contemporary EBRT doses of 66-70 Gy that were considered standard at the time. Several single-institution experiences reported on the safety and efficacy of such treatment, and a prospective, randomized trial published by Hoskin et al6 demonstrated superior biochemical control in patients receiving HDR brachytherapy boost treatment relative to those patients treated with EBRT alone.

    Biological analyses of responses to changes in HDR dosing/fractionation suggested a high sensitivity of prostate cancer cells to increasing fractional doses. That is, prostate cancer has a low alpha-beta ratio, and biologically equivalent dose , it was found, could be dramatically increased through relatively small increases in HDR fraction size. In fact, evidence of dose response in terms of enhanced biochemical control was demonstrated across a range of HDR fractionation regimens increasing progressively from as low as 550 cGy x 3 fractions up to 1150 cGy x 2 fractions.7 More recently, HDR boost regimens given in a single fraction of 1500 cGy 8,9 has gained favor and is the recommended dosing in the most recent open Radiation Therapy Oncology Group protocol to allow HDR brachytherapy as a boost.

    When Is Radiation Therapy Used

    Principles of radiotherapy

    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.

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