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
High dose rate
High-dose conformal
Proton
Ultra-high-dose
Brachytherapy
Low dose rate
Brachytherapy/external beam
Any of the above with
androgen deprivation or chemotherapy
Conformal radiation therapy
Prostate
Conformal therapy
Conventional
therapy
Constraints:
Volume rectum
Volume of bladder
Hips
Why IMRT?
"Classical" Conformation
Intensity Modulation
Treated
Volume
Target Volume
Treated
Volume
Tumor
CollimatorCritical
structure
Tumor
Target
Volum
Critical
structure
Answer: great for treating donuts and bananas
IMRT
Fontenot, MDACC, IJROBP 2009
Percent of Rectal wall
receiving high doses of
radiation
Tufts, NEMC
60
50
40
IMRT
3D CRT
30
20
10
0
50 Gray
60 Gray
70 Gray
Plans run on 23 patients with prostate cancer
Tomotherapy
Contemporary prostate brachytherapy:
Trans-perineal approach
HIGH DOSE RATE “TEMPO
BRACHYTHERAPY
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 10
Min score
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 10
Min score
Radiation Therapy Approaches
 Many
options
 Must be tailored to meet patient needs
 Highly conformal resulting in:


Better tumor control
Fewer side effects
 Comparable
years
to other therapies over 10-15
THANK YOU
Prostate Cancer Treatment:
What’s Best for You
Daniel P. Petrylak
Professor 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 followup due to the natural history of disease
– By selecting the highest risk patients,
reduce the available patient pool
• Clinical trial accrual has been poor.