Radical External Beam Research Articles

Permanent Interstitial Brachytherapy in the Treatment of Localized Prostatic Carcinoma: The Piedmont Experience

The modern interstitial brachytherapy plays a first-rate role in the treatment of the organ-confined prostatic carcinoma as a substantial alternative to radical prostatectomy and external beam radiotherapy in selected patients. Materials and Methods In our Centre 50 patients with a localized prostatic carcinoma were treated with transperineal and transrectal ultrasound-guided permanent implantation of I-125 radioactive seeds. 35 patients also underwent a neoadjuvant hormonal-therapy. Main end points were the biochemical control of the neoplasia and the treatment complications during a 24 months follow-up. Results We had two biochemical neoplasia recurrences, both in the neoadjuvant group. The most frequently observed complications were: slight irritative symptoms (12%), severe irritative symptoms (30%), urinary retention (10%), hematuria (8%), loss of seeds (6%), erectile dysfunction (46%). Urinary incontinence, urethral stricture and proctitis were not observed. Conclusions So far no large clinical trial compared the clinical efficacy of interstitial brachytherapy versus the other “conventional” treatments options (radical prostatectomy, external beam radiotherapy). The results of our study and the actual evidences, based on cohort observation studies and case-control ones comparing brachytherapy versus surgery or external irradiation, support the therapeutical value of permanent interstitial implant with regard to oncological results and complications.

Health related quality of life changes during the first 6 months following interstitial brachytherapy compared with radical prostatectomy and external beam radiotherapy for localized prostate cancer

Health related quality of life changes during the first 6 months following interstitial brachytherapy compared with radical prostatectomy and external beam radiotherapy for localized prostate cancer

Radical retropubic prostatectomy versus external beam radiotherapy for clinically localised prostate cancer: preliminary results of a controlled randomised trial

Radical retropubic prostatectomy versus external beam radiotherapy for clinically localised prostate cancer: preliminary results of a controlled randomised trial

Prostate cancer diagnosis, staging and survival.

Prostate cancer is the most common malignancy in men and the second most common cancer related death. Through research, we have found that African-American men and men with a family history of prostate cancer have a significantly higher risk of prostate cancer. In the 90's the mortality rate from prostate cancer decreased, presumably due to PSA testing. Patients with organ-confined tumors, particularly if they have a moderate Gleason score have an excellent chance of long-term survival with radical prostatectomy or external beam radiation therapy. Advances in detecting micrometastatic disease are needed to further impact on this disease.

Localized prostate cancer.

Much controversy still surrounds the diagnosis and treatment of localized prostate cancer. Urologists generally believe that early detection and aggressive surgical therapy saves lives despite the absence of confirmatory randomized trials. Furthermore, a recent survey of radiation oncologists and urologists revealed marked polarization toward their own specialties when asked how they would counsel patients on therapy for newly diagnosed localized disease. Some issues are not controversial, however. There is general agreement that pretreatment tumor characteristics, including serum prostate-specific antigen level at diagnosis, tumor grade, and clinical stage as judged by digital rectal examination, are important prognosticators for treatment outcomes independent of the type of treatment. Also, there is sufficient experience with standard therapies (radical prostatectomy and external beam radiotherapy) to counsel patients on the chance for cure and the expected incidence of acute and chronic toxicities. A comparative evaluation of various therapies for prostate cancer should include consideration of cancer control, acute toxicity, treatment-related quality of life issues, salvage of treatment failures, and cost. Within this context, we believe that newly diagnosed patients should be counseled on all available treatment options before embarking on a course of therapy.

197 Efficacy of local therapies for localized prostate cancer in the PSA era (1987–1998): A large single institution experience with radical prostatectomy and external beam radiotherapy

197 Efficacy of local therapies for localized prostate cancer in the PSA era (1987–1998): A large single institution experience with radical prostatectomy and external beam radiotherapy

Transperineal image-guided permanent brachytherapy for localized cancer of the prostate

Traditionally, organ-confined adenocarcinoma of the prostate has been treated with radical prostatectomy or external beam radiotherapy (EBRT). Permanent implantation of iodine-125 (I-125) seeds into the prostate via a free-hand, retropubic approach was introduced in 1970. However, its popularity was short-lived because suboptimal results were obtained due to the inadequate and inhomogeneous distribution of seeds within the prostate gland. Over the last decade, there has been a resurgence in prostate brachytherapy due to the introduction of a transperineal approach, transrectal ultrasound imaging, fluoroscopy, three-dimensional visualization, and computerized treatment planning. Thus, the radioactive seeds can be placed more accurately and homogeneously within the prostate gland. Selection criteria for brachytherapy is based on the pretreatment prostate specific antigen level, clinical stage at presentation, and Gleason grade. Patients with high likelihood of organ-confined disease are treated with brachytherapy only, whereas those with more advanced disease are treated with brachytherapy in conjunction with EBRT and/or hormonal manipulation. I-125 (145 Gy) or palladium-103 (120 Gy) are the common radioisotopes used. Ten-year actuarial biochemical progression-free rates of 64 to 93% (which are comparable to those obtained by surgery or EBRT), with minimum associated morbidity, have been reported from centers routinely performing transperineal permanent prostate brachytherapy. Brachytherapy is a good treatment option for localized prostate cancer and the results very much depend on the expertise, skill, and experience of the brachytherapy team. Randomized clinical trials are required to firmly establish the role of brachytherapy in the management of localized prostate cancer.

Patient self-assessed health related quality of life in localized prostate carcinoma: Radical prostatectomy versus external beam radiotherapy

Patient self-assessed health related quality of life in localized prostate carcinoma: Radical prostatectomy versus external beam radiotherapy

UNRESECTABLE COLORECTAL-CARCINOMA - 10 YEARS EXPERIENCE WITH PATIENTS TREATED WITH RADICAL OR PALLIATIVE EXTERNAL-BEAM RADIOTHERAPY IN GREECE

Our analysis presents a group of 86 patients with unresectable colorectal cancer who were treated with radical or palliative external beam radiotherapy from 1979-1990 at the Radiation Oncology Department of Greek Anticancer Institute, St. Savvas Hospital, Athens. The dose applied to the tumor area was 20-50 Gy in 2-6 weeks. A CAT-scan guided boost field portal to the primary tumor bed and immediately adjacent nodes was also used. Irradiation was given with a Co-60 unit or a 6 MeV Linear Accelerator using a two, three or 4-field technique. Complete symptomatic relief was achieved in 90% of patients with rectal bleeding, 63% with pain and 37% with mucous discharge. Although the majority of our patients received a higher than 40Gy radiation dose, we have seen symptomatic relief in up to 90% of patients treated with 20-30 Gy in 2-3 weeks. However, the duration of improvement in symptomatic relief of our patients was better for those who had been given higher doses of radiation therapy. The radiation dose was sufficient to relieve symptoms in 40 patients (46.5%) for more than 12 months and in 20 patients (23.2%) for 8-12 months.