prostate cancer: radiation therapy approaches
DESCRIPTION
PROSTATE CANCER: RADIATION THERAPY APPROACHES. ANDREW L. SALNER, MD FACR DIRECTOR HELEN & HARRY GRAY CANCER CENTER HARTFORD HOSPITAL, CT. ARS. ?. ? ?. CHOICES!!!. Conventional external beam . 3-D. IMRT. Conformal external beam . Proton. High-dose conformal. Ultra-high-dose. - PowerPoint PPT PresentationTRANSCRIPT
PROSTATE CANCER:PROSTATE CANCER:RADIATION THERAPYRADIATION THERAPY
APPROACHESAPPROACHESANDREW L. SALNER, MD FACRANDREW L. SALNER, MD FACR
DIRECTORDIRECTORHELEN & HARRY GRAY CANCER CENTERHELEN & HARRY GRAY CANCER CENTER
HARTFORD HOSPITAL, CTHARTFORD HOSPITAL, CT
ARS
???
Conventional external beam
Conformal external beam
High-dose conformal
Brachytherapy
Brachytherapy/external beam
Any of the above withandrogen deprivation or chemotherapy
3-D
IMRT
Proton
Ultra-high-doseHigh dose rate
Low dose rate
CHOICES!!!
ProstateConformal therapyConventional therapy
Constraints: Volume rectumVolume of bladderHips
Conformal radiation therapy
Why IMRT?Why IMRT?
TreatedVolume
Tumor TumorTargetVolume
Intensity Modulation
TreatedVolume
Criticalstructure
Target Volume
Collimator
"Classical" Conformation
Criticalstructure
Answer: great for treating donuts and bananas
IMRT
Fontenot, MDACC, IJROBP 2009
Percent of Rectal wall Percent of Rectal wall receiving high doses of receiving high doses of
radiationradiation
0
10
20
30
40
50
60
50 Gray 60 Gray 70 Gray
IMRT3D CRT
Plans run on 23 patients with prostate cancer
Tufts, NEMC
TomotherapyTomotherapy
Contemporary prostate brachytherapy:Trans-perineal approach
HIGH DOSE RATE “TEMPORARY” BRACHYTHERAPY
Quality of life after treatment for early-stage prostate cancer
Talcott et al 2003
Prospective studyBrachytherapyn = 80 Median age 64 years
Max score 100Min score 0
Quality of life after treatment for early-stage prostate cancer
Talcott et al 2003
Prospective studyExternal beam radiationN = 182 Median age 69 years
Max score 100Min score 0
Radiation Therapy ApproachesRadiation Therapy Approaches
Many optionsMany options Must be tailored to meet patient needsMust be tailored to meet patient needs Highly conformal resulting in:Highly conformal resulting in:
Better tumor controlBetter tumor control Fewer side effectsFewer side effects
Comparable to other therapies over 10-15 Comparable to other therapies over 10-15 yearsyears
THANK YOUTHANK YOU
Prostate Cancer Treatment: What’s Best for You
Daniel P. PetrylakProfessor of Medicine
Columbia University Medical Center/NY Presbyterian Hospital
When does a patient see a medical oncologist
• Local disease: As “unbiased” opinion for local therapy
• High Risk Disease: Add hormone or chemotherapy to decrease risk of relapse
• Metastatic disease: Initiation of second line hormones, chemotherapy, radiation therapy
High-Risk CAP: The Options• Surgery
– Standard RP, wide/extended resection RP
– Hormone therapy: NHT, AHT
– ART
– Chemotherapy: Neoadjuvant, adjuvant
• RT
– EBRT with NHT and/or AHT
– Dose escalation
– EBRT with chemohormonal therapy
– Other RT techniques
• HT alone
• New therapies
NHT = neoadjuvant hormone therapy; AHT = adjuvant hormone therapy; ART = adjuvant radiotherapy.Payne, 2009.
Challenges for the Implementation of Multimodality Therapy
• High risk local therapy– Role of chemotherapy not defined– Investigational studies require long follow-
up due to the natural history of disease– By selecting the highest risk patients,
reduce the available patient pool • Clinical trial accrual has been poor.