The Advanced Alternative Payment Model: Catalyst for Prostate Brachytherapy Adoption?
The impending implementation of the Radiation Oncology Alternative Payment Model (APM) is poised to initiate dramatic disruption in the financial incentives associated with radiation oncology practice, reversing previous incentives for increased fractionation and moving toward incentivizing brevity of care.1 Such incentivization theoretically favors treatment modalities such as hypofractionation and stereotactic body radiation therapy over traditional external beam radiation therapy (EBRT), provided they can yield comparable outcomes to EBRT.
Authors: Konat-Bąska K, Chicheł A, Staszek-Szewczyk U, Maciejczyk A, Matkowski R Abstract Purpose: Prostate and colorectal cancers are the first and the third most popular malignancies in male population, in which some patients may develop these tumors metachronously or synchronously. At present, there are no standard recommendations, and oncologists need to provide an optimal management for two different cancers with an acceptable risk of possible treatment of adverse effects. Material and methods: This case report presents the treatment of a 61-year-old patient suffering from synchronous prostate and rectal...
Keratinocyte carcinoma (KC, previously nonmelanoma skin cancer) represents the most common cancer worldwide. While surgical treatment is commonly utilized, various radiation therapy techniques are available including external beam and brachytherapy. As such, the American Brachytherapy Society has created an updated consensus statement regarding the use of brachytherapy in the treatment of KCs.
ConclusionsHDR PoBT is safe, feasible, and well tolerated and allows for a moderate radiation dose escalation with acceptable rates of tumor control. Further follow-up is necessary to confirm impact on final outcomes.
According to international recommendations by GEC-ESTRO GYN working group , combined radiation therapy is the most effective treatment for locally advanced cervical cancer (LACC). Classical combined radiotherapy includes two sequential stages: external beam radiotherapy (EBRT) and brachytherapy (BT) . EBRT is used for irradiation of the tumour itself and the lymph nodes to total dose values up to 50Gy. BT is used as a boost for irradiation of the tumour up to EQD2 doses as high as 90Gy. The golden standard of modern combined radiotherapy includes EBRT followed by image-guided adaptive BT.
ConclusionFive-year local control and disease-specific survival rates of patients surgically treated for vaginal non-SCC were favorable. Therefore, surgery could be a safe and reasonable option for early-stage primary vaginal non-SCC.
High dose-rate (HDR) brachytherapy is commonly administered as a boost to external beam radiation therapy (EBRT). Our purpose was to compare toxicity with increasingly hypofractionated EBRT in combination with a single 15 Gy HDR boost for men with intermediate-risk prostate cancer.
Conclusions: The first interstitial and surface HDR brachytherapy for cutaneous squamous cell carcinoma of a finger interspace for hand function preservation is presented. The initial experience revealed that brachytherapy was tolerated but with notable acute and late side effects. Treatment did result in tumor shrinkage with organ preservation and function of two rays. A larger cohort of patients will be required for additional conclusions related to long-term clinical benefits in patients who refuse ray amputation. PMID: 32190070 [PubMed]
The standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent cisplatin followed by brachytherapy. Traditionally, 2-dimensional brachytherapy (2DBT) or computed tomography guided brachytherapy (CTgBT) has been used, but magnetic resonance guided brachytherapy (MRgBT) improves clinical outcomes and has become the new standard of care. This cost-utility analysis was undertaken to compare MRgBT to CTgBT and 2DBT.
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights. Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance (which entails checking the tumor periodically and treating it only if it begins to grow). Cancers in all the men were still confined to the p...
Conclusions: Our findings suggest that IMRT may represent a viable alternative in delivering the boost in patients diagnosed with gynaecological cancer not amenable to ICBRT. PMID: 32010217 [PubMed]