“The addition of external-beam radiotherapy (EBRT) to interstitial brachytherapy failed to reduce prostate cancer progression compared to brachytherapy alone in men with intermediate-risk disease, interim data from a randomized trial showed.
“The 5-year freedom from progression was 84.5% with combined-modality radiotherapy and 85.6% with prostate brachytherapy alone. The odds ratio (OR) for brachytherapy versus combined radiotherapy was 1.09 after a median follow-up of 7.7 years, a difference that did not achieve statistical significance for efficacy or meet the prespecified statistical value to stop the trial for futility.”
“For men with intermediate risk prostate cancer, radiation treatment with brachytherapy alone can result in similar cancer control with fewer long-term side effects, when compared to more aggressive treatment that combines brachytherapy with external beam therapy (EBT), according to research presented today at the 58th Annual Meeting the American Society for Radiation Oncology (ASTRO).”
“For some early stage breast cancer patients, accelerated partial breast irradiation (APBI) using multicatheter brachytherapy following breast conserving surgery may be an excellent treatment option, as it has now been proven to be as effective as the current standard treatment – whole breast irradiation (WBI) – in local control, disease-free and overall survival rates, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting.
“Breast cancer patients often receive radiation therapy (RT) after breast-conserving surgery to help lower the chance that the cancer will recur or metastasize in the nearby lymph nodes. WBI using external beam radiation is a longstanding standard RT for breast cancer patients, during which the entire breast and often the surrounding chest area receives radiation for several weeks, followed by an extra boost of radiation to the area where the cancer was removed. Many women in the U.S. who are eligible for breast conserving surgery still choose to undergo mastectomy in the hopes that it will make subsequent WBI unnecessary, due largely to the long-duration of WBI and/or because of fears concerning the potential side effects of radiation to surrounding organs.”
“A week-long course of accelerated partial breast irradiation (APBI) after lumpectomy led to low rates of breast cancer recurrence and a 10-year survival of 96%, investigators in a multi-institutional study reported.
“Patients treated with the interstitial brachytherapy protocol had a 10-year actuarial risk of ipsilateral recurrence of 7.6%, regional failure rate of 2.3%, and distant metastasis rate of 3.8%. High-grade disease at diagnosis and positive surgical margins were the only significant predictors of an increased risk of local recurrence.
“The results compare favorably with those associated with whole-breast irradiation that requires 6 or 7 weeks to complete, Mitchell Kamrava, MD, of the University of California Los Angeles, and co-authors indicated in an article published online in Annals of Surgical Oncology.
” ‘While we await the results of level 1 evidence, these data provide valuable information that 5-day APBI in appropriately selected women can be considered as an alternative to conventional 6- to 7-week external-beam whole-breast irradiation (WBI),’ they concluded.”
“Low-dose brachytherapy boosts held prostate cancer in check significantly better than dose-escalated external-beam radiation therapy (EBRT) in men with unfavorable-risk disease, a randomized trial showed.
“Patients treated with brachytherapy after androgen deprivation therapy (ADT) and whole-pelvis EBRT had an estimated 9-year relapse-free survival (RFS) of 83% compared with 63% for patients who received a conformal EBRT boost. The difference in favor of brachytherapy emerged after 5 years of follow-up, Scott Tyldesley, MD, of the British Columbia Cancer Agency in Vancouver, reported here at the Genitourinary Cancers Symposium.
” ‘In the context of 12 months of androgen deprivation therapy and whole pelvis external beam radiotherapy, treatment with a low-dose pelvic brachytherapy boost results in a 50% reduction in biochemical relapse compared to dose-escalated EBRT to 78 Gray,’ Tyldesley said. ‘At 6.5 years of follow-up, there was no difference in overall survival, prostate cancer specific survival, or metastasis-free survival.’
“However, ‘there was increased late grade 3 or higher GU toxicity with the low-dose rate boost, a 5% to 6% increase in the prevalence of late GU toxicity,’ he said.”
The gist: A recent scientific study showed that radiation therapy that avoids damaging tissue next to a prostate tumor can be effective and preserve long-term sexual function.
“A comparison of five-year sexual function outcomes, as reported by patients treated with external beam radiotherapy (EBRT) versus combination EBRT plus brachytherapy, indicates that the utilization of vessel-sparing radiation therapy makes cure possible without compromising long-term sexual function, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.
“The study examined the patient-reported outcomes of 91 men with prostate cancer who received MRI-guided, vessel-sparing radiation at University of Michigan Providence Cancer Institute. The vessel-sparing radiation technique limits the amount of radiation to critical erectile tissues using MRI scans to identify the blood vessels responsible for erections. When radiation dose is limited to these critical structures, the risk of erectile dysfunction is lowered.
“Of the 91 patients studied, all patients received EBRT. Forty-two of the patients received only EBRT (>77.8Gy), and 49 patients received EBRT plus brachytherapy, the implantation of radioactive seeds near the prostate. The combination patients received brachytherapy in the form of an I-125 permanent prostate implant. None of the patients received androgen deprivation therapy (ADT)…
“ ‘In the past, men with prostate cancer expected to pay a high toll in loss of quality of life to achieve cure and were willing to accept that as necessary,’ said lead study author Patrick W. McLaughlin, MD, director of radiation oncology at University of Michigan Providence Cancer Institute in Novi, Mich. ‘This study makes it clear that even with combination radiation protocols, which are capable of curing the majority of prostate cancers more than 90 percent of the time, avoidance of critical adjacent tissues, such as vessel-sparing, makes cure and quality of life an achievable goal for many men.’ ”
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“The use of brachytherapy for localized prostate cancer has declined at National Cancer Data Base institutions since 2003, even among low-risk patients for whom more costly approaches might not be necessary, according to study results.
“Researchers used the National Cancer Data Base to evaluate data from more than 1.5 million patients with prostate cancer who did not have lymph node-positive or metastatic disease. The data covered 1998 through 2010.”
“The use of permanent brachytherapy, a procedure where radioactive sources are placed inside the prostate, into or near to the tumour, preserves erectile function in approximately 50% of patients with prostate cancer, a researcher will tell the ESTRO 33 congress today (Saturday).
“Brachytherapy works by giving a high dose of radiotherapy directly to the tumour, but only a very low dose to the surrounding normal tissues. Since erectile dysfunction (ED) can occur in up to 68% of patients who receive external beam radiotherapy for the condition, this is a significant improvement and the treatment should be offered to all patients, particularly those who are sexually active, the researchers say.”