Monday, September 26, 2022

Imrt Vs Sbrt For Prostate Cancer

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IMRT vs SBRT vs Protons vs Brachytherapy | Ask a Prostate Expert, Mark Scholz, MD

An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.

Stereotactic Body Radiation Therapy Or Intensity

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Recruitment Status : Active, not recruitingFirst Posted : December 11, 2017Last Update Posted : June 10, 2022
Condition or disease
Radiation: Intensity-Modulated Radiation Therapy Radiation: Stereotactic Body Radiation Therapy Phase 3

PRIMARY OBJECTIVES:

I. To determine whether stereotactic body radiation therapy can be shown to be superior to hypofractionated intensity-modulated radiation therapy in terms of genitourinary and gastrointestinal toxicity by having fewer patients that experience a minimal important decline in urinary irritation/obstructive and bowel Health Related Quality of Life as measured by Expanded Prostate Cancer Index Composite -26 at 24 months post completion of therapy.

SECONDARY OBJECTIVES:

I. To determine if SBRT is superior to hypofractionated IMRT as measured by disease free survival .

III. To determine if SBRT is superior to hypofractionated IMRT as measured by biochemical failure, overall survival, local failure, prostate cancer specific survival, and distant metastases.

TERTIARY OBJECTIVES:

III. Collect specimens for future translational research analyses.

Should Sbrt Be The Preferred Treatment For Intermediate

Last year, the American Society of Radiation Oncologists looked at the available evidence comparing hypofractionated radiotherapy to standard fractionation , and found it was at least as good in terms of oncological outcomes and toxicity. They found strong evidence for this recommendation . There are obvious benefits for the patient in terms of convenience and cost. They stopped short of strongly endorsing ultrahypofractionated radiation therapy , which is usually completed in only four or five treatments. There wasnt enough published data at the time.

Since then, there have been several published clinical trials, some with randomized comparisons. Jackson et al. have now compiled data from 38 prospective clinical trials comprising 6,116 patients treated with SBRT for localized prostate cancer. Their meta-analysis found that:

  • 5-year biochemical recurrence-free survival was
  • 95 percent among all patients
  • 97 percent among low-risk patients
  • 92 percent among intermediate-risk patients
  • 7-year bRFS was 94 percent among all patients
  • They also reported that

    • More studies included intermediate-risk than low-risk patients.
    • There were not enough high-risk patients to reliably report yet.
    • bRFS increased with higher doses of SBRT
    • bRFS was not affected by the use of adjuvant androgen deprivation therapy

    In terms of physician-reported toxicity, Jackson et al. found that:

    In terms of patient-reported adverse effects of treatment:

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    Exams For Women Whove Had Cervical Cancer

    If youve had cervical cancer, you need a different plan to check for cancer recurrence.

    Print and share MD Andersons cervical cancer survivorship chart with your doctor. Your doctor can use this chart to develop a more tailored plan for you.

    The screening plans on this page apply to women expected to live for at least 10 years. Theyre not for women who have a health condition that may make it hard to diagnose or treat cervical cancer.

    What You Need To Know About The Prostate Sbrt Vs Imrt For Prostate Cancer

    PPT

    The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.

    A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

    While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

    Also Check: Does Enlarged Prostate Cause Kidney Failure

    Can I Get Sbrt For High

    Yes, as of 2020, SBRT is considered a standard of care option for patients with high-risk and very-high risk prostate cancer. Dr. Kishan led the largest study of SBRT for high-risk prostate cancer, which was published in early 2021 and pooled data from seven trials from across the world . This study showed extremely favorable outcomes for SBRT for high- and very-high risk prostate cancer in a group of 344 patients.

    Conflicts Of Interest Statement

    The authors Dr. Rachelle Lanciano, Dr. John Lamond, Dr. Steven Arrigo, and Dr. Luther Brady each own a small percentage of the single unit Cyberknife used at the Philadelphia Cyberknife Center. The authors Dr. Caspian Oliai, Matthew Bernetich, Dr. Jun Yang, Dr. Alexandra Hanlon, Michael Good, Dr. Michael Mooreville, and Dr. Bruce Garber do not have any conflicts of interest to report.

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    Toxicity Compared Between Sbrt And Imrt In Prostate Cancer

    Journal of Clinical Oncology

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  • Androgen Deprivation Therapy With Prostate Sbrt

    Clinical Trial: SBRT vs IMRT For Low Risk to Intermediate-Risk Prostate Cancer | PCRI

    The addition of ADT to EBRT has been shown to improve overall survival for patients with intermediate- and high-risk prostate cancer, though these studies were conducted before the era of dose-escalated EBRT . In a modern trial by Bolla et al. demonstrating the superiority of ADT with EBRT compared to patients treated with EBRT alone, only 197/819 patients received dose-escalated EBRT, and though the study did demonstrate improved clinical outcomes for these patients, the study was not powered to show improvements for the patients receiving dose-escalation . Whether or not ADT has a role in the era of dose-escalated EBRT for patients with intermediate risk prostate cancer is currently an active research question, and is being investigated by RTOG 0815. The indications of ADT for patients undergoing prostate SBRT are similarly unclear. In a multi-institutional pooled data set of patients undergoing SBRT for prostate cancer, 147 patients underwent ADT in conjunction with SBRT . There was no difference in 5-year FFBF between patients receiving ADT and those not receiving ADT, though there was no uniform criteria for ADT use. The relatively poor results with SBRT alone for patients with high-risk prostate cancer suggest that some additional form of systemic therapy may prove beneficial. However, there are at this time no clear indications for the use of ADT with SBRT for patients with prostate cancer.

    Recommended Reading: Does Prostate Size Increase With Age

    Radiation Therapy For Prostate Cancer

    Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

    • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
    • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
    • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
    • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

    What Types Of Items Can I Donate

    To best serve the needs of MD Anderson patients, Volunteer Servicesappreciates your assistance in donating only the items listed below.Donations must be in new condition and from smoke-free environments.Donated items cannot have religious messages or logos attached.

    Donation deliveries must be prearranged with the Volunteer Servicesdepartment by calling 713-792-7180.

    Handmade items:

    Book and magazine donations must be prearranged with thePatient/Family Library by calling 713-792-1080.

    Current magazines issues no older than three months

    Current foreign language magazines issues no older thanthree months

    Paperback books fiction and nonfiction preferred.

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    Exams For Women Who Have Had A Hysterectomy

    If youve have had a hysterectomy, but have not had cervical cancer or severe cervical dysplasia, you should:

    • Speak with your doctor about whether you should continue screening if your hysterectomy included removal of the cervix.
    • Get a Pap test and HPV test every five years if your hysterectomy didnt include removal of the cervix.

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    Seed implant v. IMRT v. Protons v. Cyberknife (SBRT)

    Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.

    Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.

    A physician can recommend a number of treatments to address an enlarged prostate. An enlarged prostate will require surgery to relieve the symptoms. In most cases, surgical treatment for an enlargement of the penis is enough. Moreover, a doctor may recommend a course of treatment based on symptoms. A TURP procedure is not painful and requires less recovery time than open surgery. The recovery period will be shorter and less traumatic.

    Read Also: How To Lower Prostate Specific Antigen

    Proton Beam Radiation Therapy

    Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

    Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

    New Prostate Cancer Treatment Convenient Less Expensive But May Be Riskier

    A faster and less expensive form of radiotherapy for treating prostate cancer may come at a price, according to a new study by Yale School of Medicine researchers a higher rate of urinary toxicity or urine poisoning.

    The standard therapy for prostate cancer is called intensity modulated radiation therapy . Stereotactic body radiotherapy is a newer treatment that delivers a greater dose of radiation than IMRT. Patients receiving SBRT can complete an entire course of treatment in one to two weeks, compared to seven to nine weeks for IMRT. There have been few studies comparing the costs of these treatments, and their toxicity.

    This new study published in the March 10 Journal of Clinical Oncology by researchers at the Cancer Outcomes, Public Policy and Effectiveness Research Center at Yale Cancer Center compared IMRT to SBRT in a national sample of 4,005 Medicare patients age 66 and older receiving prostate cancer treatment. Participants received either SBRT or IMRT as a primary treatment for prostate cancer during 2008 to 2011.

    All the reports we have about the toxicity of SBRT comes from pioneering institutions, said first author Dr. James Yu, assistant professor of therapeutic radiology at Yale Cancer Center. But now that SBRT is being used nationally, it is important to determine the costs and complications on a national level.

    The study was funded by a grant from the National Cancer Institute .

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    Psa Kinetics Following Prostate Sbrt

    The PSA kinetics following prostate SBRT are distinct and may suggest a greater degree of efficacy when compared to those following treatment with CF-EBRT. One study from UCLA compared patterns of PSA response for 439 patients with low- or intermediate-risk prostate cancer following treatment with SBRT, high-dose-rate brachytherapy, or CF-intensity modulated radiation therapy . The authors found that significantly more patients treated with SBRT or HDR brachytherapy had PSA nadirs of < 0.5 ng/mL than those treated with IMRT and that overall, SBRT and HDR brachytherapy caused significantly larger PSA decay rates than IMRT, leading the authors to conclude that this difference in PSA kinetics may present a distinct radiobiological effect, and may be predictive of superior clinical outcomes. Other studies have confirmed that after one year of treatment, when compared to patients receiving treatment with CF-EBRT, the median PSA slope and nadir are lower for patients treated with SBRT .

    What Are The Locations And Hours Of Operation For Md Anderson Ctscan/diagnostics Centers

    Proton Therapy, IMRT, and SBRT | Mark Scholz, MD | PCRI

    MD Anderson offers diagnostic services in our Texas Medical Centerand other community-based locations. Diagnostic imaging clinics offerblood draws and preventative screening. A sub-specialized radiologistwith expertise on advanced imaging techniques is available at each location.

    Texas Medical Center locations

    Monday-Friday: 7 a.m.-3:30 p.m.

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    Radiopharmaceuticals That Target Psma

    Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.

    Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.

    This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.

    This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.

    Possible side effects

    Some of the more common side effects of this drug include:

    • Feeling tired
    • Constipation

    This drug can lower blood cell counts:

    • A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
    • A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
    • A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.

    This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.

    How Does Sbrt Compare With Longer Courses Of Radiation

    As of 2020, SBRT is considered a standard of care option for any patient with low through very-high risk prostate cancer who is considering radiation therapy. The first patient to be treated with modern prostate SBRT was treated in December 2000. Since then, a large amount of data and evidence have amassed demonstrating the safety and efficacy of SBRT. UCLA investigators have played a leading role in accumulating and publishing these data. To date, the best data available to support SBRT for prostate cancer are:

    A study led by Dr. Amar Kishan that compiled the outcomes of 2142 men treated with SBRT between 2000-2012, showing low rates of toxicity and high efficacy with a median follow-up of nearly 7 years. The article can be found here:

    The HYPO-RT-PC randomized trial, which directly compared conventional radiation against a high-dose-per-day treatment across seven sessions in 1200 Swedish men. Importantly, this trial used older radiation planning techniques and did not deliver modern SBRT. Regardless, the efficacy and long-term side effects were equivalent in both arms of the trial. The article can be found here:

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