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PROSTATE CANCER: RADIATION THERAPY APPROACHES

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.

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PROSTATE CANCER: RADIATION THERAPY APPROACHES

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  1. PROSTATE CANCER:RADIATION THERAPYAPPROACHES ANDREW L. SALNER, MD FACR DIRECTOR HELEN & HARRY GRAY CANCER CENTER HARTFORD HOSPITAL, CT

  2. ARS ? ??

  3. CHOICES!!! Conventional external beam 3-D IMRT Conformal external beam Proton High-dose conformal Ultra-high-dose High dose rate Brachytherapy Low dose rate Brachytherapy/external beam Any of the above with androgen deprivation or chemotherapy

  4. Conformal radiation therapy Prostate Conformal therapy Conventional therapy Constraints: Volume rectum Volume of bladder Hips

  5. Why IMRT? "Classical" Conformation Intensity Modulation Treated Volume Treated Volume Target Volume Target Volume Tumor Tumor Collimator Critical structure Critical structure Answer: great for treating donuts and bananas

  6. IMRT

  7. Fontenot, MDACC, IJROBP 2009

  8. Percent of Rectal wall receiving high doses of radiation Tufts, NEMC Plans run on 23 patients with prostate cancer

  9. Tomotherapy

  10. Contemporary prostate brachytherapy: Trans-perineal approach

  11. HIGH DOSE RATE “TEMPORARY” BRACHYTHERAPY

  12. Quality of life after treatment for early-stage prostate cancer Talcott et al 2003 Prospective study Brachytherapy n = 80 Median age 64 years Max score 100 Min score 0

  13. Quality of life after treatment for early-stage prostate cancer Talcott et al 2003 Prospective study External beam radiation N = 182 Median age 69 years Max score 100 Min score 0

  14. Radiation Therapy Approaches • Many options • Must be tailored to meet patient needs • Highly conformal resulting in: • Better tumor control • Fewer side effects • Comparable to other therapies over 10-15 years

  15. THANK YOU

  16. Prostate Cancer Treatment: What’s Best for You Daniel P. Petrylak Professor of Medicine Columbia University Medical Center/NY Presbyterian Hospital

  17. 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

  18. 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.

  19. 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.

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