A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LDR) or high-dose rate (HDR) brachytherapy to EBRT, although only ASCENDE-RT compared brachytherapy to dose-escalated EBRT but did report an over 50% improvement in biochemical failure with a LDR boost. Multiple single institution and comparative research series also support the use of a brachytherapy boost in the DE-EBRT era and demonstrate excellent prostate cancer specific outcomes. Despite improved oncologic outcomes with a brachytherapy boost in the high-risk setting, the utilization of both LDR, and HDR brachytherapy use is declining. The acute genitourinary toxicities when brachytherapy boost is combined with EBRT, particularly a LDR boost, are of concern in comparison to EBRT alone. HDR brachytherapy boost has many physical properties inherent to its rapid delivery of a large dose which may reduce acute toxicities and also appeal to the radiobiology of...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research

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Conclusion: The study did not demonstrate a significant benefit in administering resistant starch over and above normal diet to patients receiving pelvic radiotherapy. The reasons may be attributed to concurrent use of chemotherapy and decrease in intestinal probiotics. The use of digestible starch in the control arm may have contributed to lower incidence of the toxicity endpoints as well.
Source: Journal of Cancer Research and Therapeutics - Category: Cancer & Oncology Authors: Source Type: research
AbstractProstate cancer is the most common cancer among men in the USA. Interestingly, recent studies suggest that patients with inflammatory bowel disease (IBD) are at increased risk of developing prostate cancer. Importantly, patients with IBD who develop prostate cancer require thoughtful care when using immunosuppressants to treat the IBD in the setting of malignancy. Further, consideration must be given to the proximity of the prostate to the gastrointestinal tract when treating with radiation where there is concern for the effects of inadvertent exposure of radiation to the diseased bowel. In general, management of i...
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
ConclusionEBRT  + BT was associated with a significantly better prostate CSS compared with surgery or EBRT. EBRT alone was inferior to surgery by OS.
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate risk prostate cancer (IRPC).
Source: Urology - Category: Urology & Nephrology Authors: Source Type: research
Whole pelvis radiation therapy (WPRT) may improve clinical outcomes over prostate-only radiation therapy (PORT) in high-risk prostate cancer patients by sterilization of micrometastatic nodal disease, provided there is optimal control of the primary site.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Clinical Investigation Source Type: research
There is now clear evidence of improved biochemical disease free survival (bDFS) with radiotherapy dose-escalation in all prostate cancer (PCa) risk groups [1,2]. Despite the advent of new techniques, external beam radiotherapy (EBRT) is limited in dose escalation due to the continuous change in the position, shape and volume of the target volume as well as the organs at risk (OARs). High-dose-rate brachytherapy (HDR) is a recommended treatment of eligible patients with prostate cancer as a method of dose escalation in conjunction with external beam radiation therapy according to the American Society of Clinical Oncology&a...
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Original Article Source Type: research
Healthcare systems are often compared with the aviation industry. Progress in both is highly desired but must always be achieved with safety in mind. Everyone wants to get from point A to point B faster and more comfortably, but how much risk of uncertainty is one ready to accept to achieve that extra speed? Both industries also share the aspect of competition for customers. In the field of localized prostate cancer, patients have an ever-increasing choice of options: radical surgery (open vs laparoscopic vs robot-assisted), external beam radiation therapy (EBRT) (with photons or protons), brachytherapy (low-dose rate or h...
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Clinical Investigation Source Type: research
Conclusions: Fluoroscopy and 3D CT image-guided interstitial brachytherapy is feasible and appears to be a suitable treatment technique for patients with clinically localized prostate cancer after previous rectal resection and external beam radiation therapy. PMID: 31435432 [PubMed]
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
Prostatic artery embolization (PAE) is a safe and efficacious treatment for moderate to severe lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to medical therapy, including those in patients with multiple comorbidities who are poor surgical candidates or have large prostates (>80 mL) (1). Stereotactic body radiation therapy (SBRT) delivers high-dose radiation over a short time course, providing prostate cancer treatment outcomes similar to those in conventional external beam radiation therapy (EBRT) or brachytherapy (2).
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Letter to the Editor Source Type: research
In this study we evaluate the lesion detection efficacy of18F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value.MethodsA total of 248 consecutive patients were evaluated and underwent scanning with18F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120  min after injection of a median dose of 311 MBq18F-DCFPyL.ResultsIn 214 out of 248 PET/CT scans (86.3%), at least one lesion sug...
Source: European Journal of Nuclear Medicine and Molecular Imaging - Category: Nuclear Medicine Source Type: research
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