Current role of image-guided robotic radiosurgery (Cyberknife ) for prostate cancer treatment

Size: px
Start display at page:

Download "Current role of image-guided robotic radiosurgery (Cyberknife ) for prostate cancer treatment"

Transcription

1 Current role of image-guided robotic radiosurgery (Cyberknife ) for prostate cancer treatment Thomas Seisen, Sarah J. Drouin, Véronique Phé, Jérome Parra, Pierre Mozer, Marc-Olivier Bitker, Olivier Cussenot and Morgan Rouprêt Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France and Institut Universitaire de Cancerologie GRC 5 Oncotype Euro, Pitié Hospital, Paris, France Objectives To describe the most recent data from phase I and II clinical trials of stereotactic body radiation therapy (SBRT) using image-guided robotic radiosurgery, specifically the Cyberknife (Accuracy Incorporated, Sunnyvale, CA, USA). To better determine thecurrent role of this type of radiosurgery in prostate cancer (PCa) management. Materials and Methods Current clinical trials and relevant retrospective studies were identified from the literature, clinical trial databases, websites and conference abstracts. The indications, technical aspects, efficacy and toxicity of SBRT using the Cyberknife system were summarized. Results The Cyberknife system is an experimental treatment mostly used for localized PCa in stage ct1/t2a b N0 M0 with a Gleason score 7 and PSA level 20 ng/ml. Hypofractionated radiation therapy was delivered in five fractions of Gy for a total dose of Gy. After treatment, the median PSA levelfell from ng/ml to ng/ml at a median follow-up of 4 60 months. The biochemical progression-free survival rates ranged from 78.3 to 100%. Acute and late toxicities were mostly grade 1/2 rectal or urinary complications. Few grade 3 and no grade 4 toxicities occurred during follow-up; however, erectile dysfunction and testes toxicity were also reported. Conclusions The use of the Cyberknife system is limited mainly by its pretreatment and maintenance costs. Despite encouraging preliminary results, longer-term follow-up and randomized controlled phase III clinical trials are necessary before the Cyberknife system becomes a standard treatment method. Keywords Cyberknife, stereotactic body radiation therapy, hypofractionated radiation therapy, prostate cancer Introduction Medicinecontinues to progress through evolutionary change, as reflected in the modern era of robot-assisted surgery, and the terms robot and surgery are becoming more commonplace and interchangeable. Such terms generate visions and perceptions, particularly for patients, of some form of operation (under anaesthesia) that uses state of the art technology to remove or reconstruct tissue with the aim of improving the outcomes and minimizing complications and morbidity. The concepts of therapeutic and technological advancement are common in the management of patients with prostate cancer (PCa) and theattractive notion of robotic surgical intervention has now also extended to non-surgical treatment methods, including radiotherapy (RT)-based treatments for PCa. In an effort to improve precision with regard to the target field, to decrease toxicity related to adjacent structure irradiation and to increase the dose administered to achieve potentially better cancer outcomes, radiobiologists have developed techniques to deliver hypofractionated image-guided RT, e.g intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). In the literature SBRT is referred to as radiosurgery but it still represents the delivery of RT, albeit high-dose hypofractionated image-guided RT, and does not involve procedures that the public or clinicians would regard as surgical. Cyberknife (Accuracy Incorporated, Sunnyvale, 2013 BJU International 111, doi: /bju

2 Seisen et al. CA, USA) SBRT is a specific form that has features well suited to the SBRT of PCa, as it includes non-coplanar beamsfromalinearacceleratorandtheabilitytotrack real-time prostate motion whilst delivering highly conformal hypofractionated doses [1 3]. The Cyberknife system uses fiducial markers, placed in the prostate, to verify organ position in real time which allows the correction of position during treatment. The procedure usesa robotic arm, leading some to term it robotic radiosurgery. To date, Cyberknife hasbeenusedtotreat tumours of the lung, liver, pancreas, spine, kidney head and neck, vaginal cuff and prostate. In the present review, we describe the current indications, technique, results and limitations of Cyberknife SBRT in the treatment of PCa and discuss the merits and implications of such terms as robot, knife and radiosurgery when referring to non-surgical procedures. Studies of Cyberknife in PCA Currently, SBRT using Cyberknife is still regarded as an experimental treatment for PCa andthere areno international guideline recommendations on its use. Most published studies report prospective phase I or II clinical trial data, including patients with low- or intermediate-risk PCa (e.g. ct1/t2a b N0 M0 with a Gleason score 7 and PSA level 20 ng/ml). To date, 12 phase I or II prospective clinical trials and a few retrospective studies have been reported in the literature for Cyberknife as treatment for PCa [1 13]. Table 1 [1 13]shows the patient populations, PCa risk groups, SBRT protocols and trial designs for these studies. Cyberknife has also been used for the management of locally recurrent, lymph-node-positive or systemic metastatic PCa. One prospective clinical trial, whichincluded 34 patients, evaluatedthe Cyberknife system as a treatment for local lymph node recurrence (obturator or external iliac) or metastases to retroperitoneal lymph nodes or bone after external beam radiation therapy or radical prostatectomy [14]. Technical Aspects of Cyberknife Cyberknife is a treatment device used to deliverhigh-dose hypofractionated SBRT and, owing to the use of a robotic arm in combination with intrafractional prostate motion tracking, it hassuperior target accuracycompared with external beam radiation therapy (<5 mm). Cyberknife has been used for almost 20 years to treat different types of tumour but the first feasibility study on its use for PCa was published in 2003 by King et al. [15]. The system has undergone several technological advances and the latest model was released in 2010 (the Cyberknife VSI System) [16]. There are two principal phases of a Cyberknife SBRT protocol: treatment planning and treatment delivery. Treatment Planning Approximately 10 days before treatment, three to four gold fiducial markers (GFMs) are implanted in the prostate using TRUS for image-guided positioning and motion tracking. GFMs must be implanted at the apex, intermediate lateral zone and base of the prostate. Sometimes fused to MRI, treatment planning with CT is performed at a slice thickness of 1.25 mm 1week after GFM placement to differentiate the prostate and proximal seminal vesicles from surrounding tissues. The prostate Table 1 Population characteristics and protocol for the management of localized PCa using Cyberknife. Analysis type LE N Risk group Median (range) initial PSA, ng/ml Protocol Choi et al., 2007 [1] Prospective, P2 2b 44 Low, Intermediate, High 32 Gy (4 8Gy) 36 Gy (4 9Gy) Fuller et al., 2008 [2] Prospective, P2 2b 10 Low, Intermediate 6.9 ( ) 38 Gy (4 9Gy) King et al., 2009 [3] Prospective, P2 2b 41 Low 5.6 (0.7 10) Gy ( Gy) Friedland et al [4] Prospective, P2 2b 112 Low, Intermediate 5.2 ( ) 35 Gy (5 7Gy) Meier et al [5] Prospective, P1 2b 29 Low, Intermediate < Gy ( Gy) Aluwini et al [6] Prospective, P1 2b 10 Low, Intermediate 8.3 ( ) 38 Gy (4 9.5 Gy) Katz et al [7] Prospective, P2 2b 304 Low, Intermediate, High 5.8 ( ) 35 Gy (5 7Gy) Gy ( Gy) Bolzicco et al [8] Prospective, P2 2b 45 Low, Intermediate 8.07 (2 20) 35 Gy (5 7Gy) Mc Bride et al [9] Prospective, P1 2b 45 Low 4.9 ( ) Gy ( Gy) 37.5 Gy (5 7.5 Gy) Freeman et al [10] Prospective, P2 2b 41 Low 5.4 (3 7.8) Gy ( Gy) Katz et al [11] Prospective, P2 1b 82 Low, Intermediate 5.35 ( ) 35 Gy (5 7Gy) Gy ( Gy) Kang et al [12] Retrospective 3 44 Low, Intermediate, High 32 GY (4 8Gy) 34 Gy (4 8.5 Gy) 36 Gy (4 9Gy) King et al [13] Prospective, P2 2b 67 Low < Gy ( Gy) BJU International

3 Image-guided robotic radiosurgery for prostate cancer gland, seminal vesicles, rectum, bladder, penile bulb and femoral heads can be contoured. The planning target volume depends on the PCa risk category but often consists of a 5-mm expansion zone anteriorly/laterally, reduced to 3 mm posteriorly. When coregistering and for MRI it is alsopossible to segment neurovascular bundles in some cases. Treatment Delivery The Cyberknife system is composed of a 6 MV linear accelerator mounted on a robotic arm, with two orthogonal X-ray imagers to track GFM and perform real-time corrections for target repositioning during the treatment. Re-imaging every 40 s ensures adequate and precise tracking to deliver hypofractionated RT [17]. Cyberknife produces hypofractionated RT with treatment plan conformality superior to IMRT [18]. Several treatment schedules have been reported in the literature to treat localized PCa. Kang et al. [12] used four fractions of 8.5 Gy for a total dose of 34 Gy, whereas Aluwini et al. [6] delivered four fractions of 9.5 Gy for a total dose of 39 Gy; however, most studies describe a protocol using five fractions of Gy, amounting to a total dose of Gy. In two SBRT protocols, androgen deprivation therapy (ADT) was administered in combination with the Cyberknife [7,8]. The principal treatment schedules for the management of localized PCa are listed in Table 1. For the management of local recurrence, lymph-node-positive or metastatic disease, Cyberknife SBRT protocols differ. Patients with local recurrence after external beam radiation therapy or radical prostatectomyreceived 30 Gy in five fractions (55% also received ADT), whereas those with lymph-node-positive disease or metastatic spread received 33 or 36 Gy in three fractions (75% ADT), respectively [14]. Oncological Resultsfor Cyberknife In the available studies, patients with localized PCa had a median initial PSA level ranging from 4.9 to 8.3 ng/ml. The median post-treatment PSA levels fell to between 0.1 and 1.6 ng/ml with median follow-up ranging from 4 to 60 months. There is no evidence that the total dose of SBRT correlates with PSA response [2,3,6]. The comparison of two SBRT protocols revealed no significant correlation between doses of 35 Gy (5 7 Gy) and Gy ( Gy) and subsequent PCa control (Level of Evidence [LE]:1b) [6]. Overall, 16 38% of patients experience PSA bounce with median values ranging from 0.35 to 0.4 ng/mland a median follow-up between 11.6 and 18 months. Post-PSA bounce, levels decreased progressively to reach the median PSA nadir. Though not mentioned in the majority of studies, the median PSA nadir was often equivalent to the median post-treatment value and also ranged from 0.1 to 1.6 ng/ml. The biochemical progression-free survival (bpfs) rates of patients with localized PCa treated using Cyberknife range from 78.3 to 100%. bpfs was defined as the time from pathological diagnosis to biochemical failure or patient s death. The Phoenix criteria of biochemical failure (PSA nadir + 2 ng/ml) was used. Overall, five studies reported no biochemical failure and a bpfs rate of 100%. Freeman et al. [10] reported a bpfs rate of 92.7% with a median follow-up of 60 months. Among 41 patients with low-risk PCa, only three developed biochemical progression, at 33, 37 and 42 months, respectively. Katz et al. [11] observed a bpfs rate of 97.6% in a population of patients with lowand intermediate-risk PCa. In their population study including a high risk PCa cohort, Kang et al. [12] reported a bpfs rate of 100% with a median follow-up of 40 months. Overall, 11 clinical recurrences have been diagnosed amongst the 874 patients included in the available phase I or II clinical trials evaluating Cyberknife. In 72% of cases, recurrence was local, confirmed pathologicallyby TRUS biopsy and treated with cryotherapy or high-intensity focused ultrasonography as salvage therapy [4]. In 28% of cases, metastatic evaluation revealed secondary bone deposits which were treated by conventional ADT. Cyberknife outcomes in relation to local, lymph node or metastatic recurrent PCa are disappointing. The overall 30-month bpfs rate is 42.6% [14]. The oncological results for the management of localized PCa with Cyberknife are shown in Table 2 [1 13]. Toxicity of Cyberknife Acute and late toxicity were reported with oncological results during phase I or II clinical trials and retrospective studies. Rectal (rt) and urinary toxicities (ut) were scored according to the Radiation Therapy Oncology Group scale. Acute grade 1/2 rtranged from 9 to 80%, compared with 10% for grade 3 [6]. In the majority of studies, rt was proctitis with faecal urgency and diarrhoea. During the evaluation of long-term rectal functional outcomes, late grade 1/2 rt ranged from 0 to 48% with grade 3 rtoccurring in only 1 5% of patients [4,9]. Rectal bleedingwas rarely observed after SBRT using Cyberknife [4]. Some patients experienced late grade 3 proctitis that resolved with argon plasma laser ablation, butno acute or late grade 4 rt was reported. During phase I or II clinical trials, acute grade 1/2 ut ranged from 13.5 to 78%, whereas only 5% reported grade 2013 BJU International 763

4 Seisen et al. Table 2 Oncological results for localized PCa management using Cyberknife. Median (range) follow-up, months Median PSA, ng/ml Median PSA nadir, ng/ml % of patients with benign PSA bounce (value) Median time to benign PSA bounce, months bpfs rate, % Reccurence Choi et al [1] 13 (4 46) 78.3 Fuller et al [2] King et al [3] 33 (6 45) (0.4 ng/ml) Friedland et al [4] L, 1M Meier et al [5] Aluwini et al [6] Katz et al [7] 30 (26 37) (0.35 ng/ml) L Bolzicco et al [8] 20 (6 42) Mc Bride et al [9] 44.5 (0 62) (0.4 ng/ml) 11.6 ( ) Freeman et al [10] L Katz et al [11] 51 (45 58) M Kang et al [12] 40 (12 78) King et al [13] L L, local recurrence; M, metastatic recurrence. 3 ut in one study [3] (LE:2b). In a retrospective study, Towsend et al. [19] observed 64% of acute grade 1/2 ut including symptoms of frequency/nocturia and dysuria because of epididymitis from fiducial placement (LE:3). Acute grade 3 ut was reported by 8% of patients and included symptoms such as frequency/nocturia and dysuria. Late grade 1/2 ut ranged from 0 to 65%. Late grade 3 ut was observed in four studies with a rate ranging from 0.5 to 5%. The main complication was urinary obstruction requiring TURP [9] (LE:2b); however, no acute or late grade 4 ut was reported. Erectile dysfunction (ED) was the main acute or late sexual toxicity during phase I or II clinical trials. ED analyses were performed using the Sexual Health Inventory for Men (SHIM). Concerning acute ED, the mean SHIM score seemed to decrease during treatment but returned to baseline within 1 month [4]. There was no significant decrease in SHIM score at 3 months [9]. Late ED ranges from 13 to 18%. Katz et al. [7] reported 87% of patients maintained potency with or without ED medication at 18 months follow-up. Friedland et al. [4] reported apotency rate of ~82%at 3 years. Wiegener et al. [20] specifically evaluated ED after SBRT using the Cyberknife system. The mean Expanded Prostate Cancer Index Composite sexual domain summary score, sexual function score and sexual bother score decreasedby 45, 49 and 25%, respectively (at 50 months follow-up). The baseline ED rate was 38% and increased significantly to 71% after treatment. ED medication was usedby 3% of patients at baseline and this increased to 25% after SBRT treatment. In patients <70 years, 60% maintained satisfactory erectile function after treatment compared with only 12% of patients >70 years. Penile bulb dose was not associated with ED. Owing to the use of non-coplanar beams, testes toxicity can ariseafter treatment with the Cyberknife system, as noted by King et al. [21]. Potentially excessive testicular radiation exposure might be responsible for hypogonadism and might also confound PSA results; however, 80% of patients maintained at least 80% of their pretreatment testosterone levels. Among these, 97 and 90% retained absolute testosterone levels >100 ng/dl and 200 ng/dl, respectively. Despite this, Fuller et al. [22] recommended that all transtesticular beam pathways be blocked because, like King et al. [21], they found that it caused no significant degradation in target volume coverage or other dosimetry statistics. As mentioned, Fossa et al. [14] reported poor oncological outcomes (an overall 30-month bpfs rate of 42.6%) after using Cyberknife to treat recurrent (local, lymph node or metastatic) PCa. The authors also reported a 15% rate of acute and late grade 1/2 ut and 6% grade 3 toxicity. Acute and late grade 1/2 rt occurred in 6% of patients. Data are summarized in Table 3 [1 13]. Limitations of Cyberknife Despite cost-savingsforseveral applications, the real cost of the Cyberknife system for the management of PCa remains unknown. The price of equipment alone seems to be $4 5 million. This pretreatment cost might be offset by the fact that far fewer fractions are delivered with Cyberknife compared with IMRT or other forms of conventional radiation therapy; however, robotic system maintenance appears to be far more expensive, and other treatment methods currently used forlow-risk PCa might be as effective but cheaper. Parthan et al. [23] presented an abstract about the cost of Cyberknife at the 2011 ASCO congress. Compared with SBRT and IMRT, surgery was the least expensive treatment option. The cost-effectiveness of Cyberknife is yet to be assessed and compared with BJU International

5 Image-guided robotic radiosurgery for prostate cancer Table 3 Toxicity of the localized PCa management using Cyberknife. Acute toxicities Late toxicities rt ut Sexual toxicity rt ut Sexual toxicity Choi et al [1] 32% G1/2 39% G1/2 0% 0% Fuller et al [2] 60% G1/2 60% G1/2 King et al [3] 48% G1/2 + 5%G3 58% G1/2 + 16% G3 48% G1/2 65% G1/2 + 5% G3 Friedland et al [4] Rectal urgency Dysuria ED 1% G3 0% 18% ED Meier et al [5] Aluwini et al [6] 20% G1/2 + 10% G3 50% G1 Katz et al [7] 80% G1/2 76% G1/2 9% G1/2 9% G1/2, + 0.5% G3 13% ED Bolzicco et al [8] 48.8% G1/2 46.6% G1/2 2.2% G2 8.8% G1/ % G3 Mc Bride et al [9] 38% G1/2 78% G1/2 0% 14% G1/2 + 5% G3 34% G1/2 ED Freeman et al [10] G1/2 G1/2 15.5% G1/2 32% G1/ % G3 Katz et al [11] 11% 12% G1/2 ED Kang et al [12] 9% G2 13.5% G2 11.4% G2 7% G2 King et al [13] 16% G1/2 28% G1/2+ 3.5% G3 surgery or external beam radiation therapyin experimental studies using quality-adjusted life years as a measure of value. Accuracy Incorporated produced a press release in 2007 declaring that >1000 men have been successfully and safely treated for PCa with the Cyberknife system, but no scientific evidence wasproduced to support such a presumption. Indeed, when a robotic device is newly released, its safety and effectiveness must be shown through the use of clinical trials [24]. Despite many phase I or II clinical trials, Cyberknife should also be tested in randomized controlled phase III trials to prove its superior efficacy and to recommend its use. Longer-term follow-up is also necessary to evaluate the best robotic SBRT. The evidencebaseis therefore not available to show whether the Cyberknife system is at least as effective and safe as other forms of radiation therapy for the treatment of localized PCa. According to phase I and II clinical trials results, Cyberknife appears to be more effective than other PCa treatments for the management ofpatients with low- or intermediate-risk PCa than for high-risk or recurrent disease, but such patients might alsobenefit from active surveillance with muchless toxicity. New expensive treatment methods and/or devices for the management of PCa seem to enter the market every day. Despite the importance of introducing new technologyto medicine, only technological advances thatimprove treatment results should be considered and used in daily practice [25]. In conclusion, the use of the Cyberknife system for the treatment of PCa is currently limited by the fact that departments need to demonstratein a business plan that they have a suitable patient workload and mix to justify thepurchase ofa niche machine, especially as phase III data showing a benefit over a conventional linear acceleratorare not available. Despite encouraging preliminary results, longer-term follow-up and randomized controlled phase III clinical trials are necessary before the Cyberknife systemcan become a standard treatment option for PCa. Conflict of Interest None declared. References 1 Choi C, Cho C, Kim G, Park K, Jo M, Lee C. Stereotactic radiation therapy of localized prostate cancer using cyberknife. Int J Radiat Oncol Biol Phys 2007; 69: S375 2 Fuller DB, Naithoh J, Lee C, Hardy S, Jin H. Virtual HDR SM Cyberknife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. Int J Radiat Oncol Biol Phys 2008; 70: King CR, Brooks JD, Gill H. Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial. Int J RadiatOncolBiolPhys2009; 73: Friedland JL, Freeman DE, Masterson-McGary ME, Spellberg DM. Stereotactic body radiotherapy: an emerging treatment approach for localized prostate cancer. Technol Cancer Res Treat 2009; 8: Meier R, Cotrutz C. MRI-planned stereotactic body radiotherapy for organ-confined prostate cancer: feasibility and early results. Int J Radiat Oncol Biol Phys 2009; 75: S Aluwini S, Van Rooij P, Hoogeman M et al. Cyberknife stereotactic radiotherapy as monotherapy for low to intermediate stage prostate cancer: early experience, feasibility and tolerance. J Endourol 2010; 24: Katz AJ, Santoro M, Ashley R, Diblasio F, Witten M BJU International 765

6 Seisen et al. Stereotactic body radiotherapy as boost for organ-confined prostate cancer. Technol Cancer Res Treat 2010; 9: Bolzicco G, Favretto MS, Scremin E, Tambone C, Tasca A, Guglielmi R. Image-guidedstereotactic body radiation therapy for clinically localized prostate cancer: preliminary clinical results. Technol Cancer Res Treat 2010; 9: McBride SM, Wong DS, Dombrowski JJ et al. Hypofractionated stereotactic body radiotherapy in low-risk prostate adenocarcinoma: preliminary results of a multi-institutional phase 1 feasibility trial. Cancer 2012; 118: Freeman DE, King CR. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes. Radiat Oncol. 2011; 6: 3 11 Katz AJ, Santoro M, Ashley R, Diblasio F. Stereotactic body radiotherapy for low- and Low-Intermediate Risk Prostate Cancer : is there a dose effect. Front Oncol 2011; 1: Kang JK, Cho CK, Chi CW et al. Image-guided stereotactic body radiation therapy for localized prostate cancer. Tumori 2011; 97: King CR, Brooks JD, Gill H, Presti JCJ. Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. IntJRadiat OncolBiolPhys2012; 82: Jereczek-Fossa BA, Beltramo G, Fariselli L et al. Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer. Int J Radiat Oncol Biol Phys 2012; 82: King CR, Lehmann J, Adler JR, Hai J. CyberKnife radiotherapy for localized prostate cancer: rationale and technical feasibility. Technol Cancer Res Treat 2003; 2: Kilby W, Dooley JR, Kuduvalli G, Sayeh S, Maurer CR. The Cyberknife robotic radiosurgery system in Technol Cancer Res Treat 2010; 9: Xie Y, Djajaputra D, King CR, Hossain S, Ma L, Xing L. Intrafractional motion of the prostate during hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72: Hossain S, Xia P, Huang K et al. Dose gradient near target-normal structure interface for nonisocentric CyberKnife and isocentric intensity-modulated body radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010; 78: Townsend NC, Huth BJ, Ding W et al. Acute toxicity after CyberKnife-delivered hypofractionated radiotherapy for treatment of prostate cancer. Am J Clin Oncol 2011; 34: Wiegner EA, King CR. Sexual function after stereotactic body radiotherapy for prostate cancer: results of a prospective clinical trial. IntJRadiatOncol Biol Phys 2010; 78: King CR, Lo A, Kapp DS. Testicular dose from prostate Cyberknife: a cautionary note. IntJRadiat OncolBiolPhys2009; 73: Fuller DB. Testicular dose from prostate cyberknife: a cautionary note in regard to King et al. IntJRadiat OncolBiolPhys2009; 73: Parthan A, Pruttivarasin N, Taylor D et al. Cyberknife for prostate cancer: is it cost effective? J Clin Oncol 2011; (Suppl. 7); Abstract Zietman A, Ibbott G. Aclinical approach to technology assessment: how do we and how should we choose the right treatment? Semin Radiat Oncol 2012; 22: Fraass BA, Moran JM. Quality, technology and outcomes: evolution and evaluation of new treatments and/or new technology. Semin Radiat Oncol 2012; 22: Brenner DJ, Martinez AA, Edmundson GK, Mitchell C, Thames HD, Armour EP. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys 2002; 52: Martinez AA, Demanes J, Vargas C, Schour L, Ghilezan M, Gustafson GS. High-Dose-Rate Prostate Brachytherapy: an Excellent Accelerated-Hypofractionated Treatment for Favorable Prostate Cancer. AmJClinOncol2010; 33: MartinA,GayaA.Stereotactic body radiotherapy: a review. ClinOncol(RCollRadiol)2010; 22: Correspondence: Morgan Rouprêt, Department of Urology, Pitié-Salpêtrière Hospital, boulevard de l hopital, Paris, France. morgan.roupret@psl.aphp.fr Abbreviations: SBRT, stereotactic body radiation therapy; PCa, prostate cancer; bpfs, biochemical progression-free survival; RT, radiotherapy; IMRT, intensity-modulated radiation therapy; GFM, gold fiducial marker; ADT, androgen deprivation therapy; rt, rectal toxicity; ut, urinary toxicity; LE, level of evidence; ED, erectile dysfunction; SHIM, Sexual Health Inventory for Men BJU International

Prostate Cancer Appraisal Addendum: Stereotactic Body Radiation Therapy (SBRT)

Prostate Cancer Appraisal Addendum: Stereotactic Body Radiation Therapy (SBRT) Prostate Cancer Appraisal Addendum: Stereotactic Body Radiation Therapy (SBRT) The Institute for Clinical and Economic Review (ICER) has published appraisals on multiple management options for clinically-localized,

More information

Would SBRT Hypofractionated Approach Be as Good? Then Why Bother With Brachytherapy?

Would SBRT Hypofractionated Approach Be as Good? Then Why Bother With Brachytherapy? Would SBRT Hypofractionated Approach Be as Good? Then Why Bother With Brachytherapy? Yasuo Yoshioka, MD Department of Radiation Oncology Osaka University Graduate School of Medicine Osaka, Japan Disclosure

More information

Phase II study of FFF-SBRT in 5 fractions for low and intermediate risk prostate cancer

Phase II study of FFF-SBRT in 5 fractions for low and intermediate risk prostate cancer Phase II study of FFF-SBRT in 5 fractions for low and intermediate risk prostate cancer Ciro Franzese, G D Agostino, E Clerici, E Villa, A Tozzi, T Comito, C Iftode, AM Ascolese, F De Rose, S Pentimalli,

More information

Prostate SBRT Heterogeneous Dose Distribution: Rationale, Methods, Outcomes and Future Direction: 2017 Update

Prostate SBRT Heterogeneous Dose Distribution: Rationale, Methods, Outcomes and Future Direction: 2017 Update Prostate SBRT Heterogeneous Dose Distribution: Rationale, Methods, Outcomes and Future Direction: 2017 Update DONALD B. FULLER, M.D. RADIATION ONCOLOGIST GENESIS HEALTHCARE Disclosure & Disclaimer The

More information

CyberKnife SBRT for Prostate Cancer

CyberKnife SBRT for Prostate Cancer CyberKnife SBRT for Prostate Cancer Robert Meier, MD Swedish Radiosurgery Center Swedish Cancer Institute Seattle, WA 2017 ESTRO Meeting, Vienna Austria 5-year safety, efficacy & quality of life outcomes

More information

Linac Based SBRT for Low-intermediate Risk Prostate Cancer in 5 Fractions: Preliminary Report of a Phase II Study with FFF Delivery

Linac Based SBRT for Low-intermediate Risk Prostate Cancer in 5 Fractions: Preliminary Report of a Phase II Study with FFF Delivery Linac Based SBRT for Low-intermediate Risk Prostate Cancer in 5 Fractions: Preliminary Report of a Phase II Study with FFF Delivery FILIPPO ALONGI MD Radiation Oncology & Radiosurgery Istituto Clinico

More information

New Technologies for the Radiotherapy of Prostate Cancer

New Technologies for the Radiotherapy of Prostate Cancer Prostate Cancer Meyer JL (ed): IMRT, IGRT, SBRT Advances in the Treatment Planning and Delivery of Radiotherapy. Front Radiat Ther Oncol. Basel, Karger, 27, vol. 4, pp 315 337 New Technologies for the

More information

Technological Advances in Radiotherapy for the Treatment of Localized Prostate Cancer - A Systematic Review

Technological Advances in Radiotherapy for the Treatment of Localized Prostate Cancer - A Systematic Review Technological Advances in Radiotherapy for the Treatment of Localized Prostate Cancer - A Systematic Review Jayatissa R.M.G.C.S.B. (B.Sc.) Department of Radiography/Radiotherapy, Faculty of Allied Health

More information

Clinical Commissioning Policy Proposition: Proton Beam Therapy for Cancer of the Prostate

Clinical Commissioning Policy Proposition: Proton Beam Therapy for Cancer of the Prostate Clinical Commissioning Policy Proposition: Proton Beam Therapy for Cancer of the Prostate Reference: NHS England B01X09 First published: March 2016 Prepared by NHS England Specialised Services Clinical

More information

Stereotactic Ablative Radiotherapy for Prostate Cancer

Stereotactic Ablative Radiotherapy for Prostate Cancer Stereotactic Ablative Radiotherapy for Prostate Cancer Laurie Cuttino, MD Associate Professor of Radiation Oncology VCU Massey Cancer Center Director of Radiation Oncology Sarah Cannon Cancer Center at

More information

Prostatectomy as salvage therapy. Cases. Paul Cathcart - Guy s & St Thomas NHS Trust, London

Prostatectomy as salvage therapy. Cases. Paul Cathcart - Guy s & St Thomas NHS Trust, London Prostatectomy as salvage therapy Cases Paul Cathcart - Guy s & St Thomas NHS Trust, London Attributes of brachytherapy appeal to young men who place high utility on genitourinary function At risk of

More information

1. CyberKnife Centers of San Diego, CA 2. Coast Urology La Jolla, CA 3. Sletten Cancer Center Great Falls, MT

1. CyberKnife Centers of San Diego, CA 2. Coast Urology La Jolla, CA 3. Sletten Cancer Center Great Falls, MT Donald B. Fuller, M.D. 1, John Naitoh, M.D. 2, Mark Reilly, M.D. 3, Chad Lee, Ph.D 1. 1. CyberKnife Centers of San Diego, CA 2. Coast Urology La Jolla, CA 3. Sletten Cancer Center Great Falls, MT Typically,

More information

Treatment of Prostate Cancer Local Recurrence After Whole-Gland Cryosurgery With Frameless Robotic Stereotactic Body Radiotherapy: Initial Experience

Treatment of Prostate Cancer Local Recurrence After Whole-Gland Cryosurgery With Frameless Robotic Stereotactic Body Radiotherapy: Initial Experience Treatment of Prostate Cancer Local Recurrence After Whole-Gland Cryosurgery With Frameless Robotic Stereotactic Body Radiotherapy: Initial Experience Scott Quarrier, 1 Aaron Katz, 2 Jonathan Haas 3 Abstract

More information

PACE Study. Hypofractionation 17/12/2014. Traditional Model of Fractionation 200 Response. What s the fraction sensitivity of prostate cancer?

PACE Study. Hypofractionation 17/12/2014. Traditional Model of Fractionation 200 Response. What s the fraction sensitivity of prostate cancer? 0 0 17/12/2014 2 Outline of today s talk PACE Study Background rationale for PACE? Dr Nicholas van As A bit about technology. What is PACE? How can I get involved? London: 1 December 2014 250 Hypofractionation

More information

CYBERKNIFE SBRT FOR THE TREATMENT OF PROSTATE CANCER: 5 VS. 44 FRACTIONS THE PHILADELPHIA CYBERKNIFE CENTER EXPERIENCE

CYBERKNIFE SBRT FOR THE TREATMENT OF PROSTATE CANCER: 5 VS. 44 FRACTIONS THE PHILADELPHIA CYBERKNIFE CENTER EXPERIENCE CYBERKNIFE SBRT FOR THE TREATMENT OF PROSTATE CANCER: 5 VS. 44 FRACTIONS THE PHILADELPHIA CYBERKNIFE CENTER EXPERIENCE Olusola Obayomi-Davies M.D. Philadelphia CyberKnife Center September 26 th, 2017 Disclosure

More information

Erectile Dysfunction (ED) after Radiotherapy (RT) for Prostate Cancer. William M. Mendenhall, MD

Erectile Dysfunction (ED) after Radiotherapy (RT) for Prostate Cancer. William M. Mendenhall, MD Erectile Dysfunction (ED) after Radiotherapy (RT) for Prostate Cancer William M. Mendenhall, MD Meta-Analysis of Probability of Maintaining Erectile Function after Treatment of Localized Cancer Treatment

More information

CyberKnife Radiotherapy For Localized Prostate Cancer: Rationale And Technical Feasibility

CyberKnife Radiotherapy For Localized Prostate Cancer: Rationale And Technical Feasibility Open Access Article The authors, the publisher, and the right holders grant the right to use, reproduce, and disseminate the work in digital form to all users. Technology in Cancer Research & Treatment

More information

Stereotactic ablative body radiation for prostate cancer SABR

Stereotactic ablative body radiation for prostate cancer SABR Stereotactic ablative body radiation for prostate cancer SABR John Armstrong. Sinead Callinan. Luke Rock. Beacon Hospital, Dublin, Ireland Low- Intermediate Risk Prostate Comparing treatment choices IMRT

More information

Building a Stereotactic Radiosurgery Program for the Treatment of Prostate Cancer

Building a Stereotactic Radiosurgery Program for the Treatment of Prostate Cancer 2 3 Building a Stereotactic Radiosurgery Program for the Treatment of Prostate Cancer 3 1 4 ALAN J. KATZ 5 6 7 8 9 3.1 Abstract C O N T E N T S 3.1 Abstract 000 3.2 Introduction 000 3.3 The Team 000 3.3.1

More information

PROSTATE CANCER TREATMENT

PROSTATE CANCER TREATMENT PROSTATE CANCER TREATMENT INFORMATION GUIDE Several effective treatment options exist today for men diagnosed with prostate cancer. Each man s particular cancer, overall health, age, and lifestyle will

More information

Understanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD

Understanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics

More information

BRACHYTHERAPY FOR PROSTATE CANCER. Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital

BRACHYTHERAPY FOR PROSTATE CANCER. Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital BRACHYTHERAPY FOR PROSTATE CANCER Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital PROSTATE BRACHYTHERAPY Why brachytherapy? How do we do it? What are the results? Questions?

More information

PSA is rising: What to do? After curative intended radiotherapy: More local options?

PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinik und Poliklinik für Urologie und Kinderurologie Direktor: Prof. Dr. H. Riedmiller PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinische und molekulare Charakterisierung

More information

4D Radiotherapy in early ca Lung. Prof. Manoj Gupta Dept of Radiotherapy & oncology I.G.Medical College Shimla

4D Radiotherapy in early ca Lung. Prof. Manoj Gupta Dept of Radiotherapy & oncology I.G.Medical College Shimla 4D Radiotherapy in early ca Lung Prof. Manoj Gupta Dept of Radiotherapy & oncology I.G.Medical College Shimla Presentation focus on ---- Limitation of Conventional RT Why Interest in early lung cancer

More information

Radiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008

Radiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008 Radiation Therapy for Prostate Cancer Amy Hou,, MD Resident Dept of Urology General Surgery Grand Round November 24, 2008 External Beam Radiation Advances Improving Therapy Generation of linear accelerators

More information

Stereotactic Radiosurgery. Extracranial Stereotactic Radiosurgery. Linear accelerators. Basic technique. Indications of SRS

Stereotactic Radiosurgery. Extracranial Stereotactic Radiosurgery. Linear accelerators. Basic technique. Indications of SRS Stereotactic Radiosurgery Extracranial Stereotactic Radiosurgery Annette Quinn, MSN, RN Program Manager, University of Pittsburgh Medical Center Using stereotactic techniques, give a lethal dose of ionizing

More information

PSA nadir post LDR Brachytherapy and early Salvage Therapy. Dr Duncan McLaren UK & Ireland Users Group Meeting 2016

PSA nadir post LDR Brachytherapy and early Salvage Therapy. Dr Duncan McLaren UK & Ireland Users Group Meeting 2016 PSA nadir post LDR Brachytherapy and early Salvage Therapy Dr Duncan McLaren UK & Ireland Users Group Meeting 2016 Differences in PSA relapse rates based on definition used PSA ng/ml Recurrence ASTRO Recurrence

More information

Section: Therapy Effective Date: October 15, 2016 Subsection: Therapy Original Policy Date: December 7, 2011 Subject:

Section: Therapy Effective Date: October 15, 2016 Subsection: Therapy Original Policy Date: December 7, 2011 Subject: Last Review Status/Date: September 2016 Page: 1 of 10 Description High-dose rate (HDR) temporary prostate brachytherapy is a technique of delivering a high-intensity radiation source directly to the prostate

More information

20 Prostate Cancer Dan Ash

20 Prostate Cancer Dan Ash 20 Prostate Cancer Dan Ash 1 Introduction Prostate cancer is a disease of ageing men for which the aetiology remains unknown. The incidence rises up to 30 to 40% in men over 80. The symptoms of localised

More information

Trina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April

Trina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April Trina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April 17, 2016 Discuss permanent prostate brachytherapy and

More information

Dosimetric impacts of endorectal balloon in CyberKnife stereotactic body radiation therapy (SBRT) for early-stage prostate cancer

Dosimetric impacts of endorectal balloon in CyberKnife stereotactic body radiation therapy (SBRT) for early-stage prostate cancer Received: 31 October 2016 Revised: 24 January 2017 Accepted: 7 February 2017 DOI: 10.1002/acm2.12063 RADIATION ONCOLOGY PHYSICS Dosimetric impacts of endorectal balloon in CyberKnife stereotactic body

More information

CyberKnife Radiosurgery for Prostate Cancer

CyberKnife Radiosurgery for Prostate Cancer Technology in Cancer Research and Treatment ISSN 1533-0346 Volume 9, Number 5, October 2010 Adenine Press (2010) CyberKnife Radiosurgery for Prostate Cancer www.tcrt.org Treatment of prostate cancer with

More information

Original Date: April 2016 Page 1 of 7 FOR CMS (MEDICARE) MEMBERS ONLY

Original Date: April 2016 Page 1 of 7 FOR CMS (MEDICARE) MEMBERS ONLY National Imaging Associates, Inc. Clinical guidelines STEREOTACTIC RADIATION THERAPY: STEREO RADIOSURGERY (SRS) AND STEREOTACTIC BODY RADIATION THERAPY (SBRT) CPT4 Codes: Please refer to pages 5-6 LCD

More information

MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER

MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

CLINICAL WORKSHOP IMAGE-GUIDED HDR BRACHYTHERAPY OF PROSTATE CANCER

CLINICAL WORKSHOP IMAGE-GUIDED HDR BRACHYTHERAPY OF PROSTATE CANCER CLINICAL WORKSHOP IMAGE-GUIDED HDR BRACHYTHERAPY OF PROSTATE CANCER Klinikum Offenbach Nucletron April 27 th 28 th, 2014 History HDR Protocols for Boost and Monotherapy, Results, Logistics and Practical

More information

Modern Dose Fractionation and Treatment Techniques for Definitive Prostate RT

Modern Dose Fractionation and Treatment Techniques for Definitive Prostate RT Modern Dose Fractionation and Treatment Techniques for Definitive Prostate RT Daniel J Bourgeois, III MD, MPH Board Certified Radiation Oncologist Southeast Louisiana Radiation Oncology Group (SLROG) Disclosures

More information

Innovazioni tecnologiche in Radioterapia" Sergio Fersino Radioterapia Oncologica

Innovazioni tecnologiche in Radioterapia Sergio Fersino Radioterapia Oncologica Innovazioni tecnologiche in Radioterapia" Sergio Fersino Radioterapia Oncologica 2014 HYPOFRACTIONATION & PROSTATE CANCER HYPOFRACTIONATION & PROSTATE CANCER: TECHNOLOGY: HIGH CONFORMAL DOSE & IMAGING

More information

EORTC radiation Oncology Group Intergroup collaboration with RTOG EORTC 1331-ROG; RTOG 0924

EORTC radiation Oncology Group Intergroup collaboration with RTOG EORTC 1331-ROG; RTOG 0924 EORTC radiation Oncology Group Intergroup collaboration with RTOG EORTC 1331-ROG; RTOG 0924 Title of the Study Medical Condition Androgen deprivation therapy and high dose radiotherapy with or without

More information

The Paul Evans Memorial Lecture Functional radiotherapy targeting using focused dose escalation. Roberto Alonzi Mount Vernon Cancer Centre

The Paul Evans Memorial Lecture Functional radiotherapy targeting using focused dose escalation. Roberto Alonzi Mount Vernon Cancer Centre The Paul Evans Memorial Lecture Functional radiotherapy targeting using focused dose escalation Roberto Alonzi Mount Vernon Cancer Centre Overview Introduction and rationale for focused dose escalation

More information

Linac or Non-Linac Demystifying And Decoding The Physics Of SBRT/SABR

Linac or Non-Linac Demystifying And Decoding The Physics Of SBRT/SABR Linac or Non-Linac Demystifying And Decoding The Physics Of SBRT/SABR PhD, FAAPM, FACR, FASTRO Department of Radiation Oncology Indiana University School of Medicine Indianapolis, IN, USA Indra J. Das,

More information

PROSTATE CANCER BRACHYTHERAPY. Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College

PROSTATE CANCER BRACHYTHERAPY. Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College PROSTATE CANCER BRACHYTHERAPY Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College Risk categorization Very Low Risk Low Risk Intermediate Risk High Risk

More information

An Update on Radiation Therapy for Prostate Cancer

An Update on Radiation Therapy for Prostate Cancer An Update on Radiation Therapy for Prostate Cancer David C. Beyer, MD, FACR, FACRO, FASTRO Arizona Oncology Services Phoenix, Arizona Objectives Review significant new data Identify leading trends in PCa

More information

CyberKnife Monotherapy for Prostate Cancer

CyberKnife Monotherapy for Prostate Cancer C H A P T E R 29 CyberKnife Monotherapy for Prostate Cancer Clinton A. Medbery Marianne M. Young Astrid E. Morrison J. Stephen Archer Maximian F. D Souza Cindy Parry Abstract The purpose of our planned

More information

S Y N C H R O N Y R E S P I R A T O R Y T R A C K I N G S Y S T E M

S Y N C H R O N Y R E S P I R A T O R Y T R A C K I N G S Y S T E M s y n c h r o n y r e s p i r a t o r y t r a c k i n g s y s t e m S Y N C H R O N Y R E S P I R A T O R Y T R A C K I N G S Y S T E M The Synchrony System tracks respiration in real time and automatically

More information

External Beam Radiotherapy for Prostate Cancer

External Beam Radiotherapy for Prostate Cancer External Beam Radiotherapy for Prostate Cancer Chomporn Sitathanee, Radiation Oncology Unit Ramathibodi Hospital, Mahidol University Roles of RT in prostate cancer Definitive RT; intact prostate Post radical

More information

Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir

Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir Anwar et al. Radiation Oncology 2014, 9:42 RESEARCH Open Access Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir Mekhail Anwar *, Vivian

More information

TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY

TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY 1 TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY BRENDAN CAREY, MD TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY 2 TRANSRECTAL ULTRASOUND-GUIDED

More information

Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer

Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer Dosimetric Analysis of 3DCRT or IMRT with Vaginal-cuff Brachytherapy (VCB) for Gynaecological Cancer Tan Chek Wee 15 06 2016 National University Cancer Institute, Singapore Clinical Care Education Research

More information

Improving plan quality and consistency by standardization of dose constraints in prostate cancer patients treated with CyberKnife

Improving plan quality and consistency by standardization of dose constraints in prostate cancer patients treated with CyberKnife JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 14, NUMBER 5, 2013 Improving plan quality and consistency by standardization of dose constraints in prostate cancer patients treated with CyberKnife

More information

Hypofractionated Stereotactic Body Radiotherapy in Low-Risk Prostate Adenocarcinoma

Hypofractionated Stereotactic Body Radiotherapy in Low-Risk Prostate Adenocarcinoma Hypofractionated Stereotactic Body Radiotherapy in Low-Risk Prostate Adenocarcinoma Preliminary Results of a Multi-Institutional Phase 1 Feasibility Trial Sean M. McBride, MD 1 ; Douglas S. Wong, MD, PhD,

More information

MEDICAL POLICY. SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER POLICY NUMBER: CATEGORY: Technology Assessment

MEDICAL POLICY. SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER POLICY NUMBER: CATEGORY: Technology Assessment MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

Radiotherapy re-treatments can be clinically useful but require careful dose and treatment technique selection.

Radiotherapy re-treatments can be clinically useful but require careful dose and treatment technique selection. Pelvic re-irradiation 08:30 09:15 The basics of re-irradiation Professor Bleddyn Jones, Oxford Institute of Radiation Radiotherapy re-treatments can be clinically useful but require careful dose and treatment

More information

LDR Monotherapy vs. HDR Monotherapy

LDR Monotherapy vs. HDR Monotherapy Abstract No. 1234 LDR Monotherapy vs. HDR Monotherapy Is it time for LDR to retire? Gerard Morton 2 LDR Seed Brachytherapy First 2000 LDR patients from BCCA Low and Intermediate Risk LDR Implant Morris

More information

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer AN OPEN-LABEL, MULTICENTER, RANDOMIZED PHASE II

More information

Prostate Cancer. 3DCRT vs IMRT : Hasan Murshed

Prostate Cancer. 3DCRT vs IMRT : Hasan Murshed Prostate Cancer 3DCRT vs IMRT : the second debate Hasan Murshed Take home message IMRT allows dose escalation. Preliminary data shows IMRT technique improves cancer control while keeping acceptable morbidity

More information

New research in prostate brachytherapy

New research in prostate brachytherapy New research in prostate brachytherapy Dr Ann Henry Associate Professor in Clinical Oncology University of Leeds and Leeds Cancer Centre PIVOTAL boost opening 2017 To evaluate - The benefits of pelvic

More information

The benefit of a preplanning procedure - view from oncologist. Dorota Kazberuk November, 2014 Otwock

The benefit of a preplanning procedure - view from oncologist. Dorota Kazberuk November, 2014 Otwock The benefit of a preplanning procedure - view from oncologist Dorota Kazberuk 21-22 November, 2014 Otwock Brachytherapy is supreme tool in prostate cancer management with a wide range of options in every

More information

Prostate Cancer. What is prostate cancer?

Prostate Cancer. What is prostate cancer? Scan for mobile link. Prostate Cancer Prostate cancer is a tumor of the prostate gland, which is located in front of the rectum and below the bladder. Your doctor may perform a physical exam, prostate-specific

More information

BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY

BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY AZHAN BIN YUSOFF AZHAN BIN YUSOFF 2013 SCENARIO A 66 year old man underwent Robotic Radical Prostatectomy for a T1c Gleason 4+4, PSA 15 ng/ml prostate

More information

PORT after RP. Adjuvant. Salvage

PORT after RP. Adjuvant. Salvage PORT after RP Adjuvant Or Salvage RT after RP 40-50% PSA relapse after RP in HR Definition: PSA should be undetectable within 6 weeks of RP Initial PSA is measured 6-12 weeks after RP AUA defines biochemical

More information

Prostate Cancer Case Study 1. Medical Student Case-Based Learning

Prostate Cancer Case Study 1. Medical Student Case-Based Learning Prostate Cancer Case Study 1 Medical Student Case-Based Learning The Case of Mr. Powers Prostatic Nodule The effervescent Mr. Powers is found by his primary care provider to have a prostatic nodule. You

More information

Optimal Imaging and Technical Aspects of Prostate SRT

Optimal Imaging and Technical Aspects of Prostate SRT Optimal Imaging and Technical Aspects of Prostate SRT Maris Mezeckis Dr., MBA, Vladislav Buryk Dr., PhD Sigulda Hospital Stereotactic Radiosurgery centre Homogeneous planning: PTV=prostate + 5 mm, 3 mm

More information

Advances in external beam radiotherapy

Advances in external beam radiotherapy International Conference on Modern Radiotherapy: Advances and Challenges in Radiation Protection of Patients Advances in external beam radiotherapy New techniques, new benefits and new risks Michael Brada

More information

Prostate Cancer Treatment

Prostate Cancer Treatment Scan for mobile link. Prostate Cancer Treatment Prostate cancer overview Prostate cancer is the most common form of cancer in American men, most prevalent in men over age 65 and fairly common in men 50-64

More information

Open clinical uro-oncology trials in Canada

Open clinical uro-oncology trials in Canada Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1

More information

3/22/2014. Goals of this Presentation: in 15 min & 5 min Q & A. Radiotherapy for. Localized Prostate Cancer: What is New in 2014?

3/22/2014. Goals of this Presentation: in 15 min & 5 min Q & A. Radiotherapy for. Localized Prostate Cancer: What is New in 2014? 3/22/ Goals of this Presentation: in 15 min & 5 min Q & A 1. Potency Preservation. a. Dosimetric considerations Radiotherapy for b. Drugs 2. Update on duration of short term ADT Mack III, MD Professor

More information

Department of Urology, Cochin hospital Paris Descartes University

Department of Urology, Cochin hospital Paris Descartes University Technical advances in the treatment of localized prostate cancer Pr Michaël Peyromaure Department of Urology, Cochin hospital Paris Descartes University Introduction Curative treatments of localized prostate

More information

Department of Radiotherapy & Nuclear Medicine, National Cancer Institute, Cairo University, Cairo, Egypt.

Department of Radiotherapy & Nuclear Medicine, National Cancer Institute, Cairo University, Cairo, Egypt. Original article Res. Oncol. Vol. 12, No. 1, Jun. 2016:10-14 Dosimetric comparison of 3D conformal conventional radiotherapy versus intensity-modulated radiation therapy both in conventional and high dose

More information

Embracing Technology & Timing of Salvage Hormones

Embracing Technology & Timing of Salvage Hormones Embracing Technology & Timing of Salvage Hormones Andrew Loblaw BSc, MD, MSc, FRCPC, CIP Department of Radiation Oncology Sunnybrook Health Sciences Centre University of Toronto Us Too, Brampton October

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY Measure #104 (NQF 0390): Prostate Cancer: Adjuvant Hormonal Therapy for High Risk or Very High Risk Prostate Cancer National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL

More information

Patient Information. Prostate Tissue Ablation. High Intensity Focused Ultrasound for

Patient Information. Prostate Tissue Ablation. High Intensity Focused Ultrasound for High Intensity Focused Ultrasound for Prostate Tissue Ablation Patient Information CAUTION: Federal law restricts this device to sell by or on the order of a physician CONTENT Introduction... 3 The prostate...

More information

Irreversible Electroporation for the Treatment of Recurrent Prostate Cancer

Irreversible Electroporation for the Treatment of Recurrent Prostate Cancer Irreversible Electroporation for the Treatment of Recurrent Prostate Cancer after prostatectomy, radiation therapy and HiFU R. Schwartzberg, E. Günther, N. Klein, S. Zapf, R. El-Idrissi, J. Cooper, B.

More information

High-Dose Rate Temporary Prostate Brachytherapy. Original Policy Date

High-Dose Rate Temporary Prostate Brachytherapy. Original Policy Date MP 8.01.15 High-Dose Rate Temporary Prostate Brachytherapy Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return

More information

HDR vs. LDR Is One Better Than The Other?

HDR vs. LDR Is One Better Than The Other? HDR vs. LDR Is One Better Than The Other? Daniel Fernandez, MD, PhD 11/3/2017 New Frontiers in Urologic Oncology Learning Objectives Indications for prostate brachytherapy Identify pros/cons of HDR vs

More information

Disclosure SBRT. SBRT for Spinal Metastases 5/2/2010. No conflicts of interest. Overview

Disclosure SBRT. SBRT for Spinal Metastases 5/2/2010. No conflicts of interest. Overview Stereotactic Body Radiotherapy (SBRT) for Recurrent Spine Tumors Arjun Sahgal M.D., F.R.C.P.C. Assistant Professor Princess Margaret Hospital Sunnybrook Health Sciences Center University of Toronto Department

More information

Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer

Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer Ju et al. Radiation Oncology 2013, 8:30 RESEARCH Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer Andrew W Ju 1, Hongkun Wang 2, Eric K Oermann

More information

PET imaging of cancer metabolism is commonly performed with F18

PET imaging of cancer metabolism is commonly performed with F18 PCRI Insights, August 2012, Vol. 15: No. 3 Carbon-11-Acetate PET/CT Imaging in Prostate Cancer Fabio Almeida, M.D. Medical Director, Arizona Molecular Imaging Center - Phoenix PET imaging of cancer metabolism

More information

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD CLINICAL TRIALS Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS

More information

Advanced Tumor Treatment

Advanced Tumor Treatment Advanced Tumor Treatment What is CyberKnife? The CyberKnife Stereotactic Radiosurgery System, offered by Southwest Washington Medical Center, is a noninvasive outpatient treatment without the risks and

More information

Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer

Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer J Radiat Oncol (2016) 5:187 195 DOI 10.1007/s13566-015-0237-0 ORIGINAL RESEARCH Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer Caspian Oliai 1 &

More information

Quality of Life After Modern Treatment Options for Prostate Cancer Ronald Chen, MD, MPH

Quality of Life After Modern Treatment Options for Prostate Cancer Ronald Chen, MD, MPH Quality of Life After Modern Treatment Options I will be presenting some recently published data on the quality of life after modern treatment options for prostate cancer. My name is Dr. Ronald Chen. I'm

More information

Salvage HDR Brachytherapy. Amit Bahl Consultant Clinical Oncologist The Bristol Cancer Institute, UK

Salvage HDR Brachytherapy. Amit Bahl Consultant Clinical Oncologist The Bristol Cancer Institute, UK Salvage HDR Brachytherapy Amit Bahl Consultant Clinical Oncologist The Bristol Cancer Institute, UK Disclosures Still No financial disclosures! Limited personal experience of HDR Brachy as salvage option

More information

VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE

VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE Session 3 Advanced prostate cancer VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE 1 PSA is a serine protease and the physiological role is believed to be liquefying the seminal fluid PSA

More information

PCa Commentary. Seattle Prostate Institute CONTENTS. Volume 71 September-October 2011

PCa Commentary. Seattle Prostate Institute CONTENTS. Volume 71 September-October 2011 Volume 71 September-October 2011 PCa Commentary CONTENTS PERMANENT SEED BRACHYTHERAPY FOR HIGH- RISK PROSTATE CANCER: 1 CABOZANTINIB: Startling Responses Reported at June ASCO Meeting in Metastatic Castrate

More information

Helical Tomotherapy Experience. TomoTherapy Whole Brain Head & Neck Prostate Lung Summary. HI-ART TomoTherapy System. HI-ART TomoTherapy System

Helical Tomotherapy Experience. TomoTherapy Whole Brain Head & Neck Prostate Lung Summary. HI-ART TomoTherapy System. HI-ART TomoTherapy System The Challenges Associated with Differential Dose Delivery using IMRT Chester Ramsey, Ph.D. Director of Medical Physics Thompson Cancer Center Knoxville, Tennessee, U.S.A Collaborators Chester Ramsey, Ph.D.

More information

PROSTATE CANCER, Radiotherapy ADVANCES in RADIOTHERAPY for PROSTATE CANCER

PROSTATE CANCER, Radiotherapy ADVANCES in RADIOTHERAPY for PROSTATE CANCER PROSTATE CANCER, Radiotherapy ADVANCES in RADIOTHERAPY for PROSTATE CANCER Alberto Bossi Radiotherapy and Oncology Gustave Roussy, Villejuif, France PROSTATE CANCER, Radiotherapy IGRT RT + ADT: short vs

More information

Three-year outcomes of 324 prostate carcinoma patients treated with combination high-dose-rate brachytherapy and intensity modulated radiation therapy

Three-year outcomes of 324 prostate carcinoma patients treated with combination high-dose-rate brachytherapy and intensity modulated radiation therapy Original Article Three-year outcomes of 324 prostate carcinoma patients treated with combination high-dose-rate brachytherapy and intensity modulated radiation therapy Jekwon Yeh, Brandon Lehrich, Albert

More information

18-Oct-16. Take home messages. An update for GPs on modern radiation therapy & hormones for prostate cancer. Session plan

18-Oct-16. Take home messages. An update for GPs on modern radiation therapy & hormones for prostate cancer. Session plan An update for GPs on modern radiation therapy & hormones for prostate cancer A/Prof Jeremy Millar Director Radiation Oncology, Alfred Health Clinical lead Prostate Cancer Outcomes Registry, Monash University

More information

Prostate Cancer: 2010 Guidelines Update

Prostate Cancer: 2010 Guidelines Update Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer

More information

Consensus and Controversies in Cancer of Prostate BASIS FOR FURHTER STUDIES. Luis A. Linares MD FACRO Medical Director

Consensus and Controversies in Cancer of Prostate BASIS FOR FURHTER STUDIES. Luis A. Linares MD FACRO Medical Director BASIS FOR FURHTER STUDIES Main controversies In prostate Cancer: 1-Screening 2-Management Observation Surgery Standard Laparoscopic Robotic Radiation: (no discussion on Cryosurgery-RF etc.) Standard SBRT

More information

S Crouzet, O Rouvière, JY Chapelon, F Mege, X martin, A Gelet

S Crouzet, O Rouvière, JY Chapelon, F Mege, X martin, A Gelet S Crouzet, O Rouvière, JY Chapelon, F Mege, X martin, A Gelet Why HIFU? Efficacy demonstrated Real time control of the target Early control of the necrosis area is possible with MRI or TRUS using contrast

More information

Description. Section: Therapy Effective Date: October 15, 2015 Subsection: Therapy Original Policy Date: December 7, 2011 Subject:

Description. Section: Therapy Effective Date: October 15, 2015 Subsection: Therapy Original Policy Date: December 7, 2011 Subject: Last Review Status/Date: September 2015 Page: 1 of 14 Description High-dose rate (HDR) temporary prostate brachytherapy is a technique of delivering a high-intensity radiation source directly to the prostate

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process Quality ID #102 (NQF 0389): Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS

More information

Q&A. Overview. Collecting Cancer Data: Prostate. Collecting Cancer Data: Prostate 5/5/2011. NAACCR Webinar Series 1

Q&A. Overview. Collecting Cancer Data: Prostate. Collecting Cancer Data: Prostate 5/5/2011. NAACCR Webinar Series 1 Collecting Cancer Data: Prostate NAACCR 2010-2011 Webinar Series May 5, 2011 Q&A Please submit all questions concerning webinar content through the Q&A panel Overview NAACCR 2010-2011 Webinar Series 1

More information

Outcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer

Outcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer Clinical Urology Post-radiotherapy Prostate Biopsy for Recurrent Disease International Braz J Urol Vol. 36 (1): 44-48, January - February, 2010 doi: 10.1590/S1677-55382010000100007 Outcomes Following Negative

More information

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/01/2017 Section: Radiology

More information

Best Papers. F. Fusco

Best Papers. F. Fusco Best Papers UROLOGY F. Fusco Best papers - 2015 RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND This cohort reflects the current clinical

More information

JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 6, NUMBER 2, SPRING 2005

JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 6, NUMBER 2, SPRING 2005 JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 6, NUMBER 2, SPRING 2005 Advantages of inflatable multichannel endorectal applicator in the neo-adjuvant treatment of patients with locally advanced

More information

Prostate Case Scenario 1

Prostate Case Scenario 1 Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has

More information