IMRT for prostate cancer – pro

M Levin, MD — Sun, 23 Sep 2012 16:52:15 +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. 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.

Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA 2012; 307:1611.

Alongi F, Fiorino C, Cozzarini C, et al. IMRT significantly reduces acute toxicity of whole-pelvis irradiation in patients treated with post-operative adjuvant or salvage radiotherapy after radical prostatectomy. Radiother Oncol 2009; 93:207.

Zelefsky MJ, Levin EJ, Hunt M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70:1124

Blue Cross Blue Shield Association. Special Report: Intensity Modulation Radiation Therapy for Cancer of the Breast or Lung. TEC Assessment. Chicago, IL. December 2005; 20 (13)

Das, I., Cheng, C., Chopra, K., et al. Intensity modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. Journal of the National Cancer Institute. 2008.National Cancer Institute (NCI). National Cancer Institute Guidelines for the use of Intensity Modulated Radiation Therapy in Clinical Trials. Bethesda, MD: NCI; January 14, 2005

Agency for Healthcare Research and Quality (AHRQ) Technology Assessments. Comparative evaluation of radiation treatments for clinically locazlized prostate cancer: an update. Available from: http://www.cms.gov/coveragegeninfo/downloads/id69ta.pdf

Wilt TJ, Shamliyan T, Taylor B et al. Comparative effectiveness of therapies for clinically localized prostate cancer. Comparative Effectiveness Review No. 13. Agency for Healthcare Research and Quality. February 2008.

Pearson SD, Ladapo, Prosser L. Intensity modulated radiation therapy (IMRT) for localized prostate cancer. Institute for Clinical and Economic Review. 2007.

Staffurth, J. A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2010 Oct;22(8):643-57.

Zelefsky, MJ, Levin, EJ, Hunt, M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1124-9.

For Lay version please see here

Brachytherapy for Prostate Cancer – pro

M Levin, MD — Thu, 16 Aug 2012 20:14:27 +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 seed implants, brachytherapy, external radiation, robotic prostatectomy, nerve sparing prostatectomy or conventional prostatectomy, proton beam radiotherapy and hormonal manipulation. Retrospective reviews, however, 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 radation distribution from brachytherapy is decreased. High dose approaches and combnations with other treatments may do what ERBT currently does. Whether some patients can avoid EBRT is being investigated.

Agency for Healthcare Research and Quality. Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer. AHRQ: Agency for Healthcare Research and Quality. Available at http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=9&DocID=79. Accessed January 15, 2009.

Frank SJ, Grimm PD, Sylvester JE, Merrick GS, Davis BJ, Zietman A, et al. Interstitial implant alone or in combination with external beam radiation therapy for intermediate-risk prostate cancer: a survey of practice patterns in the United States. Brachytherapy. Jan-Mar 2007;6(1):2-8.

Grimm P, Billiet I, Bostwick D, Dicker AP, Frank S, Immerzeel J, et al. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU Int. Feb 2012;109 Suppl 1:22-9. [Medline].

Wattson DA, Chen MH, Moul JW, Moran BJ, Dosoretz DE, Robertson CN, et al. The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality After Brachytherapy: Implications for Treatment Selection. Int J Radiat Oncol Biol Phys. Jan 31 2012;[Medline].

Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, et al. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. Jan-Feb 2012;11(1):20-32.

Read the Layperson version here.

Cancer Treatment Today » Radiation

IMRT for prostate cancer – pro

Brachytherapy for Prostate Cancer – pro