IMRT for prostate cancer

M Levin, MD — Sun, 23 Sep 2012 16:56:27 +0000

IMRT is a rapidly evolving technique, which affords a more precise radiation dose delivery of escalated doses, in appropriate cases, to targeted tumors, while sparing nearby healthy tissue structures. The FDA clearance of numerous devices for the technical delivery of IMRT is based on the capability of this technology to incorporate accurate dose calculation algorithms, associated with a verifiable dose distribution, as managed by the treating physician, (i.e., radiation oncologist). Although, to date, no randomized trials have matured to document long-term outcomes data and efficacy for IMRT, the scientific evidence currently available indicates that IMRT permits better treatment planning and sparing of surrounding tissues, which is of particular usefulness with “Radiosensitive” tumors of the head/neck, prostate and CNS lesions where the target volume is in close proximity to critical healthy structures that must be protected. These results may be extrapolated to the treatment of other cancers at other anatomic sites; however, a number of technical issues need to be resolved before IMRT can be recommended routinely for lung cancer use, particularly the issue of tumor mobility must be addressed, (e.g., a lung tumor moving with respiration)” . CCited from: htttp://atc.wustl.edu/home/NCI/NCI_IMRT_Guidelines_2006.pdf

Currently, there are no randomized controlled trials of IMRT compared with other radiation techniques for treatment of prostate cancer. This means that the evidence to support IMRT is less than conclusive. It can be said that it causes less toxicity but that it produces beter outcome cannot be concluded. Non-randomized studies consistently demonstrate reduced rates of toxicity in IMRT-treated patients. The 2010 Agency for Healthcare Research and Quality (AHRQ) comparative evaluation of radiation treatments for clinically localized prostate cancer concluded that data on comparative effectiveness between different forms of radiation treatments are inconclusive with respect to overall or disease-specific survival. In addition, the AHRQ technology assessment states that more studies of better quality are needed to confirm or refute the suggested findings in the studies that compared outcomes in patients treated with different forms of radiation therapy.

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Brachytherapy for Prostate Cancer

M Levin, MD — Thu, 16 Aug 2012 20:18:14 +0000

Prostate brachytherapy is among several roughly comparable options for front line treatment of localized prostate cancer available at this time. Unfortunately, there had not been a comparative prospective trial comparing external radiation, seed implants, brachytherapy, robotic prostatectomy, nerve sparing prostatectomy or conventional prostatectomy, proton beam radiotherapy and hormonal manipulation. Look-back reviews of past studies show these options to be similarly effective. A 2008 research summary by the Agency for Healthcare Research and Quality (AHRQ) noted that no randomized controlled trials had compared brachytherapy with other major treatment options for clinically localized prostate cancer. Currently, brachytherapy is widely used but with external beam radiotherapy( EBRT) support. The reason for it is that brachytherapy delivers radiation over very small distances. It does not, for example, get enough radiation to the outer part of the prostate. EBRT treats the areas in which radiation distribution from brachytherapy is decreased. High dose approaches and combinations with other treatments may do what ERBT currently does. Whether some patients can avoid EBRT is being investigated.

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Cancer Treatment Today » Radiation

IMRT for prostate cancer

Brachytherapy for Prostate Cancer