What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Traditionally, we deliver external beam radiation in 45 to 48 sessions over a span of ten weeks, using very sophisticated computer-based planning and enhanced imaging techniques and tumor tracking during the treatment. This is called image-guided IMRT and it is the current standard of care.
But there is increasing interest in giving this radiation in shorter courses of treatment. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. MSK Precise is a form of SBRT that can be given in five sessions instead of the usual 45 to 50. MSK has been doing this for the past nine years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated, with outcomes that are at least equivalent to and possibly better than the standard ten weeks of treatment. Because of its superior precision, MSK Precise has less side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low and similar to what is experienced with conventional external radiation techniques. And of course, its much more convenient for patients.
For patients with more-advanced tumors, we are completing a phase II trial in which were combining sophisticated brachytherapy approaches with MSK Precise. This kind of combination of dose-intense or escalated radiation may end up being a very effective regimen.
New Yorks First Proton Therapy Center Begins Treating Patients
The New York Proton Centers hospital partnersMemorial Sloan Kettering Cancer Center, Montefiore Health System and Mount Sinai Health Systemhave begun treating patients at the new state-of-the-art facility in East Harlem
The center is expected to treat 1,400 patients annually, including the majority of children in New York City with solid tumors
New York, NY The New York Proton Center, the first proton therapy facility to open in New York State, has begun treating patients. The centers unique consortium of partners, comprised of three leading New York City health systemsMemorial Sloan Kettering Cancer Center , Montefiore Health System and Mount Sinai Health Systembegan sending patients to the state-of-the-art East Harlem facility in August. Those who receive treatment at the center will have access to top-quality care from an experienced clinical team of proton therapy-trained specialists leveraging the most advanced radiation technology in the world.
The New York Proton Center is projected to treat approximately 1,400 patients annually, receiving patients from its consortium partner institutions and those throughout the New York metro area and beyond who are looking for the most effective radiation care possible. The majority of children in New York City with solid tumors will be treated at the center due to the particular effectiveness proton therapy has shown in reducing side effects for pediatric patients.
Side Effects Of Radiation Therapy
Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.
With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.
This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.
Radical Prostatectomy vs. Radiation: How to Compare the Results
Making a decision about prostate cancer treatment is not easy. When considering radiation therapy or radical prostatectomy, one of your top concerns is seeking reassurance that your cancer will be cured following treatment.
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Diet Guidelines To Minimize Bloating
During your radiation therapy, gas or fluid can build up in your bowels and cause bloating. When your bowels are bloated, they can expand into the treatment area and be exposed to radiation. This can cause side effects or make your side effects worse.
Follow the guidelines below to lower your risk of bloating during radiation therapy. Its best to start 2 to 3 days before your simulation and continue until you have finished your radiation therapy.
- Chew your food well.
- Prunes
If youre bloated, keeping a food journal can help you see which foods may be causing it. Write down your foods and drinks, the time you have them, and the time you start feeling bloated. Bring your food journal to your appointments. Your healthcare provider will use it to help you manage the bloating.
A clinical dietitian nutritionist can talk with you about your diet and help you design an eating plan that meets your needs. If youd like to meet with a clinical dietitian nutritionist, ask your radiation oncologist or nurse for a referral.
Starting 3 Days Before Your Simulation Appointment
| Purpose | ||
|---|---|---|
| Methylcellulose dissolvable fiber supplement |
|
To help you have regular bowel movements and minimize gas and bloating during your radiation therapy. |
| Vitamins and other dietary supplements |
|
To help your radiation therapy work its best. |
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Your Role On Your Radiation Therapy Team
Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:
- Getting to your appointments on time.
- Asking questions and talking about your concerns.
- Telling someone on your radiation therapy team when you have side effects.
- Telling your someone on your radiation therapy team if youre in pain.
- Caring for yourself at home by:
- Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
- Caring for your skin as instructed.
- Drinking liquids as instructed.
What Are The Side Effects
HIFU has fewer side effects than many other treatments for prostate cancer.
After HIFU, you may have trouble getting an erection, but this usually goes away in time, and medicine can help while you regain this ability. Some men also have trouble peeing or may leak urine between trips to the bathroom.
Other side effects include pain between your testicles and your rectum, which can often be handled with medication. There’s also a risk for blood in your urine, a urinary infection, and an infection in your testicles. Always call your doctor right away if you have signs of any of these.
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Minimally Invasive Surgical Options
In minimally invasive surgical procedures, we make several small incisions in your abdomen. We then insert a tiny, lighted telescopic camera called a laparoscope, along with specially designed surgical instruments that a surgeon uses to perform the operation.
When you have minimally invasive surgery, youre likely to have less discomfort after the procedure and more likely to recover faster than with a traditional open surgery, in which incisions are larger and more extensive. Many men who have their prostates removed in a minimally invasive operation are able to return home the following day.
We offer two types of minimally invasive surgery.
Many of our surgeons perform robot-assisted laparoscopic prostatectomy. This sophisticated tool offers much finer precision than any other surgical technique.
Using a device called the da Vinci® Surgical System, a surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a three-dimensional image, magnified tenfold, of the prostate and the surrounding area. This allows the surgeon to view the surgical site in great detail. The robot then translates the surgeons hand, wrist, and finger movements into real-time movements of the instruments inside the patient.
Remove Devices From Your Skin
If you wear any of the following devices on your skin, the manufacturer recommends you remove it before your simulation or treatment:
- Continuous glucose monitor
- Insulin pump
Talk with your radiation oncologist about whether you may need to remove your device before your simulation or treatment. Make sure you have an extra device with you to put on after your simulation or treatment.
If youre not sure how to manage your glucose while your device is off, talk with the healthcare provider who manages your diabetes care before your appointment.
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What Happens After Radiation Therapy Treatment Ends
Once treatment ends, you will have follow-up appointments with the radiation oncologist. Its important to continue your follow-up care, which includes:
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Checking on your recovery
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Watching for treatment side effects, which may not happen right away
As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.
Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a persons quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
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A PSA test every 3 to 6 months
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A DRE at least once every year
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Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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Treatment Options For Prostate Cancer
For men with slow-growing prostate cancer that may have been detected during screening but is not aggressive in behavior, we offer active surveillance. During active surveillance, your doctors regularly monitor your tumors characteristics for any signs that it is changing.
For patients who are interested in or who are advised to undergo surgery, our surgeons are among the worlds most experienced in performing prostate operations, and were continually working to improve the safety and effectiveness of radical prostatectomy. We offer robotic as well as laparoscopic and open surgery. Our surgeons are also highly experienced in performing a procedure called salvage radical prostatectomy, which is sometimes done for men who experience prostate cancer recurrence after radiation therapy.
Our radiation oncology team is one of the most experienced in the world and has an established track record of treating prostate cancer with various types of radiotherapy. Our physicians have broad experience using image-guided, intensity-modulated radiation therapy , stereotactic high-precision radiosurgery , stereotactic hypofractionated radiation therapy , and low-dose-rate permanent seed implants and high-dose-rate temporary seed implants .
Cyberknife System Provides Excellent Prostate Cancer Survival Rates In Five Or Fewer Sessions
Recently published data demonstrate benefits of CyberKnife treatment for both low- and intermediate-risk patients at five years post-treatment
September 27, 2018 Accuray Inc. announced that published data from two prospective, multi-center studies using differing protocols provide consistent results and reinforce the use of the CyberKnife System for the effective management of low- and intermediate-risk prostate cancer. These studies are the largest conducted to date evaluating stereotactic body radiation therapy in patients with localized prostate cancer. The studies were recently published online in the International Journal of Radiation Oncology*Biology*Physics1 and in European Urology Oncology.2
The CyberKnife System delivers radiation with sub-millimeter precision, enhancing clinicians’ ability to treat effectively while preserving healthy tissue. In addition to clinical benefits, SBRT is more convenient for patients and has been shown to be less costly than long courses of intensity-modulated radiation therapy .
In the studies, prostate SBRT administered by the CyberKnife System resulted in the following disease-free survival rates:
- Ninety-seven to 100 percent for low-risk patients
- Superior to the 92-94 percent from conventional radiation therapy historic data
- Equivalent to low dose rate brachytherapy and high dose rate brachytherapy without the inconvenience and risk associated with invasive seed and catheter implants
For more information: www.accuray.com
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External Beam Radiation For Prostate Cancer
When most patients think of radiation therapy, they think of external beam radiation therapy , in which a beam of radiation is directed at cancerous tissue from outside the body. Technological advances, such as intensity-modulated radiation therapy and image-guided radiation therapy , allow radiation oncologists to use computer-controlled devices and image-guidance technology to see and target a three-dimensional image of the tumor, making the treatment more precise than ever before.
EBRT used to require 40-45 daily treatments. Now, 25-28 treatments are the norm. This type of protracted, fractionated radiation therapy, however, is now generally considered to be less appropriate for low-risk and favorable intermediate-risk patients. Instead, hypofractionated techniques and brachytherapy techniques are generally more advisable for many patients.
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Msk Fellows Develop Online Resource To Increase Awareness Of Genetic Cascade Testing
NEW YORK Gynecologic oncology fellows at Memorial Sloan Kettering have developed an online resource for cancer patients, family members, and doctors aiming to raise awareness of genetic cancer risks and spur more testing among relatives for familial mutations.
MSK fellows Ryan Kahn and Sushmita Gordhandas launched a website called Cascade Resources Network last month after receiving a grant from the Foundation for Women’s Cancer and Perlman Family CCARE Lynch Syndrome Research Foundation for the project earlier this year.
They wanted to create a single online resource for unbiased information about genetic testing and genetic counseling, including testing guidelines, results, and financial assistance. It currently functions as a hub for cancer patients to get information on companies and organizations that provide testing and interpret results, and to identify patient groups for support.
According to Gordhandas, a main goal in building the online resource is to increase the rate of genetic testing among blood relatives of patients with inherited cancer risk mutations, commonly referred to as cascade testing. Such testing can help identify cancer early in families and prevent future cancers altogether, Kahn said.
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Stereotactic Body Radiation Therapy
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.
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High Dose Rate Brachytherapy
Brachytherapy involves the use of radioactive sources that are either implanted into the tumor or placed near it, generally in a body cavity . For example, uterine and cervical cancers are often treated with intracavitary brachytherapy, and prostate cancers can be treated using interstitial brachytherapy. Often, HDR is combined with one of the types of external beam radiotherapy described above.
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Determining Your Treatment Options
Once your diagnostic tests are complete, well determine which of the following four clinical states best fits your condition. Each has different treatment goals as well as a set of treatment options that have been shown to be most effective at managing the disease.
We have vast experience in detecting prostate cancer and helping patients evaluate their options. Some risk factors place certain men at a higher risk of developing prostate cancer than others. If youre concerned about prostate cancer, contact our Bendheim Prostate Cancer Diagnostic Center to determine whether you have the disease or to get a better sense of your level of risk. At MSK, we offer diagnostic tests that can reveal evidence of the disease, including:
- blood tests for prostate-specific antigen levels
- digital rectal examination
- family history analysis
- diagnostic imaging studies
If tests indicate that you might have prostate cancer, our doctors can advise you on your treatment options.
Epic Sciences Msk Identify Potential Prostate Cancer Therapy Response Biomarker
NEW YORK A group of researchers at Memorial Sloan Kettering Cancer Center and Epic Sciences has identified a chromosomal instability biomarker in circulating tumor cells that it believes can potentially help guide treatment for metastatic castration-resistant prostate cancer .
San Diego-based Epic Sciences may also pursue the development of a multi-marker panel integrating the new biomarker along with others for predicting prostate cancer treatment response, depending on the results of future validation studies.
The firm identifies CTCs by immunofluorescent staining for CD45, DAPI, and other biomarkers against a large background of normal cells. Researchers can then choose individual cells, pick them out of the slide, and use them in downstream analyses. The platform’s workflow has a turnaround time of two to three days.
MSK oncologist Howard Scher said that his team originally applied Epic Sciences’ CTC platform to develop an assay that detects the presence of androgen receptor splice variant 7 in patient CTCs. The AR-V7 test helps clinicians decide whether to use taxane or androgen receptor signaling inhibitor therapy in patients with progressing mCRPC who were going to begin second- or third-line therapy.
Epic Sciences has since commercialized the CE-marked AR-V7 liquid biopsy assay, which is marketed by Genomic Health in the US.
Commercial potential
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