CyberKnife SBRT for Prostate Cancer

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CyberKnife SBRT for Prostate Cancer"

Transcription

1 CyberKnife SBRT for Prostate Cancer Robert Meier, MD Swedish Radiosurgery Center Swedish Cancer Institute Seattle, WA

2 2017 ESTRO Meeting, Vienna Austria 5-year safety, efficacy & quality of life outcomes from multicenter SBRT trial for prostate cancer R. Meier 1, A. Beckman 2, G. Henning 3, N. Mohideen 4, S. A. Woodhouse 5, C. Cotrutz 1, and I. D. Kaplan 6 1 Swedish Cancer Institute, Seattle, WA, 2 Central Baptist Hospital, Lexington, KY, 3 Huron River Radiation Oncology, Brighton, MI, 4 Northwest Community Hospital, Arlington Heights, IL, 5 Community Cancer Center, Normal, IL, 6 Beth Israel Deaconess Medical Center, Boston, MA

3 Disclosures ClinicalTrials.gov identifier NCT This study is supported by Accuray Inc. R. Meier: remuneration for speaking donated to charity The views expressed in this presentation are those of the presenter and do not reflect the views or policies of Accuray Incorporated or it s subsidiaries. No official endorsement by Accuray Incorporated or any of its subsidiaries of any vendor, products or services contained in this presentation is intended or should be inferred.

4 Dose-bDFS Relationship in Prostate Cancer Proportion of Patients Cancer-free (based on non-rising PSA) Fowler et al. IJROBP 56(4):

5 Randomized LDR+EBRT vs EBRT 398 Interm & high-risk 6.5 yrs median f/u Morris et al, ASCENDE-RT trial, IJROBP (in press)

6 SBRT: Theoretical Advantages Radiobiology of prostate CA may favor hypofractionation SBRT allows dose escalation to 100Gy (α/β=2gy) Improved dose conformality could spare adjacent normal tissues Brief treatment course offers convenience & cost saving

7 Background Single institution SBRT series have demonstrated Gy in 5 fractions using CyberKnife System is safe & effective Meta-analysis suggested trend in improved bdfs at 38-40Gy level Dose-escalation trial reported unacceptable toxicity with >45Gy

8 Hypotheses Across multiple community, regional and academic hospitals, precise delivery of SBRT at 8Gy x 5 level Is safe, with gr 3+ GU/GI toxicities 10% (a rate deemed excessive) In low-risk patients, would improve 5-year nadir + 2 bdfs, over 93% historical control rate expected w/ EBRT

9 Primary Safety Objective For both the low- and intermediate-risk groups: 101 pts required, for 90% power to identify excessive toxicity (one-sided 5% significance level) Accounting for ineligible pts, enrollment of 129 pts into each group was required

10 Primary Efficacy Objective: Low-risk Pts

11 Patient Eligibility Prostate adenocarcinoma, confirmed by central pathologic review Clinical staging stratified into risk groups: Low-risk: CS T1-T2a, Gleason 6, PSA<10ng/ml Intermediate-risk: CS T1-T2b, Gleason=7 & PSA<10ng/ml; or Gleason<6 & PSA 10-20ng/ml Other enrollment criteria: No previous treatment ECOG 0-1 No previous pelvic RT No concomitant or adjuvant hormone therapy Prostate volume 100 cc

12 Patient and Tumor Characteristic Entire Group Low-risk Interm-risk Evaluable patients Number Age (years) Median Prostate Volume (ml) Mean Clinical Stage T1b 3 (1%) 1 (0.6%) 2 (1%) T1c 244 (79%) 140 (81%) 104 (76%) T2a 53 (17%) 31 (18%) 22 (16%) T2b 9 (3%) 0 9 (7%) Initial PSA (ng/ml) Mean Gleason Score (65%) 172 (100%) 30 (22%)

13 SBRT Platform: CyberKnife System Real-time tracking implanted fiducials, correction for both translational & rotational motion Non-isocentric treatment, approx beams

14 Treatment Planning MRI fusion to assist target localization Prostate prescribed 8Gy x 5 = 40Gy: EQD 2,α/β=2 = 100Gy 2 nd Rx of 7.25Gy x 5 to: Low-risk: Prostate + 3-5mm Interm-risk pts: Prostate + 2cm seminal vesicles + 3-5mm

15 Normal Tissue Constraints Structure Constraint Revised Constraint Rectum V36Gy < 1cc Bowel V30Gy < 1cc Bladder V37Gy < 5-10cc V37Gy < 2cc Penile bulb D50 < 29.5Gy Prostatic urethra* D20 < 47Gy D20 < 42Gy Membranous urethra* D50 < 37Gy Neurovascular bundles* D50 < 38Gy D50 < 37.5Gy Testes no beams may traverse *if visualized

16 Assessments & Follow Up Toxicities were assessed using CTCAE v3 criteria Patient-reported quality of life outcomes were assessed with the EPIC-26 Actuarial survival outcomes were calculated using Kaplan Meier methods. Median follow-up was 61 months.

17 No Gr 4-5 toxicities RESULTS: Safety Five grade 3 side effects occurred in 4 pts, far below the 10% rate considered excessive: In low-risk group: Two pts (1.2%) had 3 Gr3 toxicities, p<0.001 In interm-risk group: Two pts (1.5%) had 2 Gr3 toxicities, p<0.001

18 Toxicities All grade 3 toxicities were GU and occurred between 11 and 51 months after treatment: Hematuria requiring cystoscopy in 2 pts Urinary obstruction & associated infection Bladder/ureter injury requiring ureteral stent Five patients (1.6%) developed urinary retention which required a temporary catheter placement. Seven patients were diagnosed with bladder cancers between 21 and 50 months after treatment.

19

20

21

22

23

24

25 Patient-reported QoL Assessments Expanded Prostate Cancer Index Composite, short form (EPIC-26): a validated questionnaire for patient-reported QOL in multiple domains affected by prostate cancer treatment: Urinary (incontinence & irritation/obstruction) Bowel Sexual AUA Symptom Index

26 EPIC Urinary Incontinence Score 100 Mean EPIC Score Clinically relevant change: > ½ σ from baseline score NO clinically relevant changes Months # Responses

27 EPIC Urinary Irritative Score 100 Mean EPIC Score month & 1 year Clinically relevant Months # Responses

28

29 Epic Bowel Score 100 Mean EPIC Score month: clinically relevant Months # Responses

30 EPIC Urinary Incontinence Score External Beam RT LDR Brachytherapy Sanda M. Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors. N Engl J Med 2008;358:1250

31 EPIC Urinary Irritation or Obstruction Score External Beam RT LDR Brachytherapy Sanda M. Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors. N Engl J Med 2008;358:1250

32 EPIC Bowel Score External Beam RT LDR Brachytherapy Sanda M. Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors. N Engl J Med 2008;358:1250

33 All Patients: Overall Survival

34 All Patients: Relapse Free Survival (Nadir +2)

35 Low-risk Patients 5-yr Nadir+2 Disease-Free Survival 93% expected from EBRT historical controls 97.3% SBRT rate proved superior to historic comparison P=0.014 ASTRO definition = 92.3%

36 Intermediate-risk Patients 5-yr Nadir+2 Disease-Free Survival ASTRO definition = 91.3%

37 Conclusions Using the CyberKnife platform, dose-escalated prostate SBRT is safe, with a low rate of serious side effects. QOL outcomes show a brief acute effect on GI & GU QOL; Urinary irritative symptoms at 1 year resolve 5-year biochemical relapse rates following SBRT are very favorable compared to historical data CyberKnife SBRT is a suitable option for low- and intermediate-risk prostate cancer, and may be preferable to other treatment approaches.

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

External Beam Radiation Therapy for Low/Intermediate Risk Prostate Cancer

External Beam Radiation Therapy for Low/Intermediate Risk Prostate Cancer External Beam Therapy for Low/Intermediate Risk Prostate Cancer Jeff Michalski, M.D. The Carlos A. Perez Distinguished Professor of Department of and Siteman Cancer Center Learning Objectives Understand

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

Disclosures. Proton therapy advantages. Why are comparing therapies difficult? Proton Therapy for Low Risk Prostate Cancer

Disclosures. Proton therapy advantages. Why are comparing therapies difficult? Proton Therapy for Low Risk Prostate Cancer Proton Therapy for Low Risk Prostate Cancer Disclosures No relevant financial disclosures This presentation will not discuss off-label or investigational treatments Andrew K. Lee, MD, MPH Associate Professor

More information

10th anniversary of 1st validated CaPspecific

10th anniversary of 1st validated CaPspecific Quality of Life after Treatment of Localised Prostate Cancer Dr Jeremy Grummet Clinical Uro-Oncology Fellow May 28, 2008 1 Why? This is important May be viewed as soft science Until we know which treatment

More information

Andrew K. Lee, MD, MPH Associate Professor Department tof fradiation Oncology M.D. Anderson Cancer Center

Andrew K. Lee, MD, MPH Associate Professor Department tof fradiation Oncology M.D. Anderson Cancer Center Proton Therapy for Prostate Cancer Andrew K. Lee, MD, MPH Associate Professor Department tof fradiation Oncology M.D. Anderson Cancer Center Seungtaek Choi, MD Assistant Professor Department tof fradiation

More information

HDR Brachytherapy: Results and Future Studies in Monotherapy

HDR Brachytherapy: Results and Future Studies in Monotherapy HDR Brachytherapy: Results and Future Studies in Monotherapy Nikolaos Zamboglou and Nikolaos Tselis Strahlenklinik Klinikum Offenbach - Germany Prostate Brachytherapy UK & Ireland Conference 2013 Comparison

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

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

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

Treating Multiple. Brain Metastases (BM)

Treating Multiple. Brain Metastases (BM) ESTRO 36 5-9 May 2017, Vienna Austria, Accuray Symposium Treating Multiple Brain Metastases (BM) with CyberKnife System Frederic Dhermain MD PhD, Radiation Oncologist Gustave Roussy University Hospital,

More information

A schematic of the rectal probe in contact with the prostate is show in this diagram.

A schematic of the rectal probe in contact with the prostate is show in this diagram. Hello. My name is William Osai. I am a nurse practitioner in the GU Medical Oncology Department at The University of Texas MD Anderson Cancer Center in Houston. Today s presentation is Part 2 of the Overview

More information

Prostate Cancer Treatments. Hasan Murshed, MD., DABR Radiation Oncology Residency, UAB Fellowship, MDACC Board Certified, ABR

Prostate Cancer Treatments. Hasan Murshed, MD., DABR Radiation Oncology Residency, UAB Fellowship, MDACC Board Certified, ABR Prostate Cancer Treatments Hasan Murshed, MD., DABR Radiation Oncology Residency, UAB Fellowship, MDACC Board Certified, ABR A Brief History of Radiation Wilhelm Roentgen discovered X- rays on November

More information

MRI Applications in Radiation Oncology:

MRI Applications in Radiation Oncology: MRI Applications in Radiation Oncology: Physician s Perspective Jeff Olsen, MD Department of Radiation Oncology Washington University, St. Louis, MO Disclosures Washington University has research and service

More information

Definitions. Brachytherapy in treatment of cancer. Implantation Techniques and Methods of Dose Specifications. Importance of Brachytherapy in GYN

Definitions. Brachytherapy in treatment of cancer. Implantation Techniques and Methods of Dose Specifications. Importance of Brachytherapy in GYN Implantation Techniques and Methods of Dose Specifications Brachytherapy Course Lecture V Krishna Reddy, MD, PhD Assistant Professor, Radiation Oncology Brachytherapy in treatment of cancer GYN Cervical

More information

GYNECOLOGIC CANCER and RADIATION THERAPY. Jon Anders M.D. Radiation Oncology

GYNECOLOGIC CANCER and RADIATION THERAPY. Jon Anders M.D. Radiation Oncology GYNECOLOGIC CANCER and RADIATION THERAPY Jon Anders M.D. Radiation Oncology Brachytherapy Comes from the Greek brakhus meaning short Brachytherapy is treatment at short distance Intracavitary vs interstitial

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

Alan Katz Josephine Kang

Alan Katz Josephine Kang Radiation Oncology This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Stereotactic body radiotherapy

More information

Clinical Case Conference

Clinical Case Conference Clinical Case Conference Intermediate-risk prostate cancer 08/06/2014 Long Pham Clinical Case 64 yo man was found to have elevated PSA of 8.65. TRUS-biopies were negative. Surveillance PSA was 7.2 in 3

More information

Clinical Management Guideline for Planning and Treatment. The process to be followed when a course of chemotherapy is required to treat:

Clinical Management Guideline for Planning and Treatment. The process to be followed when a course of chemotherapy is required to treat: Clinical Management Guideline for Planning and Treatment The process to be followed when a course of chemotherapy is required to treat: PROSTATE CANCER Patient information given at each stage following

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

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED

More information

Prostate cancer: Update from the BCCA

Prostate cancer: Update from the BCCA Prostate cancer: Update from the BCCA Tom Pickles Clinical Professor, UBC Topics 1. Incidence & Utilization rates 2. New developments with External Beam RT IGRT, VMAT and other enhancements Optimizing

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

Different approaches are used in the treatment of low-risk

Different approaches are used in the treatment of low-risk ORIGINAL ARTICLE Hypofractionated Versus Standard Fractionated Proton-beam Therapy for Low-risk Prostate Cancer Interim Results of a Randomized Trial PCG GU 002 Carlos E. Vargas, MD,* William F. Hartsell,

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

Hypofractionated RT in Cervix Cancer. Anuja Jhingran, MD

Hypofractionated RT in Cervix Cancer. Anuja Jhingran, MD Hypofractionated RT in Cervix Cancer Anuja Jhingran, MD Hypofractionated RT in Cervix Cancer: Clinicaltrials.gov 919 cervix trials 134 hypofractionated RT trials Prostate, breast, NSCLC, GBM 0 cervix trials

More information

TREATING PROSTATE CANCER

TREATING PROSTATE CANCER TREATING PROSTATE CANCER If you find out you have cancer, you should discuss your treatment options with a radiation oncologist a cancer doctor who specializes in treating disease with radiation therapy,

More information

Proton Therapy for Prostate Cancer. Andrew K. Lee, MD, MPH Director Proton Therapy Center

Proton Therapy for Prostate Cancer. Andrew K. Lee, MD, MPH Director Proton Therapy Center Proton Therapy for Prostate Cancer Andrew K. Lee, MD, MPH Director Proton Therapy Center Disclosures No relevant financial disclosures This presentation will not discuss off-label or investigational treatments

More information

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer

A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer ORIGINAL RESEARCH A comparative study of radical prostatectomy and permanent seed brachytherapy for low- and intermediate-risk prostate cancer Daniel Taussky, MD; 1 Véronique Ouellet, MD; 2 Guila Delouya,

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

Systematic Review of Brachytherapy & Proton Beam Therapy for Low-Risk Prostate Cancer: Preliminary Findings

Systematic Review of Brachytherapy & Proton Beam Therapy for Low-Risk Prostate Cancer: Preliminary Findings Systematic Review of Brachytherapy & Proton Beam Therapy for Low-Risk Prostate Cancer: Preliminary Findings May 28, 2008 Dan Ollendorf, MPH, ARM Chief Review Officer Systematic Review Objectives To compare

More information

Chapter 18: Glossary

Chapter 18: Glossary Chapter 18: Glossary Sutter Health Cancer Service Line: Prostate Committee Advanced cancer: When the cancer has spread to other parts of the body (including lymph nodes, bones, or other organs) and is

More information

Collection of Recorded Radiotherapy Seminars

Collection of Recorded Radiotherapy Seminars IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org High Dose Rate Brachytherapy in Cervix Cancer Luis Souhami, MD Professor Department of Radiation Oncology

More information

The Radiation Biology of Dose Fractionation: Determinants of Effect

The Radiation Biology of Dose Fractionation: Determinants of Effect The Radiation Biology of Dose Fractionation: Determinants of Effect E. Day Werts, Ph.D. Department of Radiation Oncology West Penn Allegheny Radiation Oncology Network Allegheny General Hospital Historical

More information

CyberKnife-based prostate cancer patient radioablation early results of irradiation in 200 patients

CyberKnife-based prostate cancer patient radioablation early results of irradiation in 200 patients 289 O R I G I N A L P A P E R UROLOGICAL ONCOLOGY CyberKnife-based prostate cancer patient radioablation early results of irradiation in 200 patients Leszek Miszczyk, Aleksandra Napieralska, Agnieszka

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

NRG ONCOLOGY (12/17/14)

NRG ONCOLOGY (12/17/14) NRG ONCOLOGY (12/17/14) RTOG 0232 A PHASE III STUDY COMPARING COMBINED EXTERNAL BEAM RADIATION AND TRANSPERINEAL INTERSTITIAL PERMANENT BRACHYTHERAPY WITH BRACHYTHERAPY ALONE FOR SELECTED PATIENTS WITH

More information

The Four R s. Repair Reoxygenation Repopulation Redistribution. The Radiobiology of Small Fraction Numbers. The Radiobiology of Small Fraction Numbers

The Four R s. Repair Reoxygenation Repopulation Redistribution. The Radiobiology of Small Fraction Numbers. The Radiobiology of Small Fraction Numbers The Radiobiology of Small Fraction Numbers David J. Brenner, PhD, DSc Center for Radiological Research Columbia University Medical Center djb3@columbia.edu The Radiobiology of Small Fraction Numbers 1.

More information

Neoplasie prostatiche Radioterapia: le nuove strategie

Neoplasie prostatiche Radioterapia: le nuove strategie Neoplasie prostatiche Radioterapia: le nuove strategie Dr. PL Losardo U.O.C di Radioterapia Azienda Ospedaliero-Universitaria di Parma Parma, 19.5.2015 VS Very Low risk Low risk Intermediate risk High

More information

Prostate Cancer Incidence

Prostate Cancer Incidence Prostate Cancer: Prevention, Screening and Treatment Philip Kantoff MD Dana-Farber Cancer Institute Professor of fmedicine i Harvard Medical School Prostate Cancer Incidence # of patients 350,000 New Cases

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

Tanaka et al. BMC Cancer (2017) 17:573 DOI /s

Tanaka et al. BMC Cancer (2017) 17:573 DOI /s Tanaka et al. BMC Cancer (2017) 17:573 DOI 10.1186/s12885-017-3565-1 RESEARCH ARTICLE Comparison of PSA value at last follow-up of patients who underwent low-dose rate brachytherapy and intensity-modulated

More information

UCL. Rectum Adenocarcinoma. Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans

UCL. Rectum Adenocarcinoma. Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans Rectum Adenocarcinoma Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans Fifth Belgian Surgical Week May 6th, 2004, Oostende SOR rectum adenocarcinoma Indication of radiotherapy

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

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

Outline. WBRT field. Brain Metastases. Whole Brain RT Prophylactic WBRT Stereotactic radiosurgery (SRS) 1 fraction Stereotactic frame

Outline. WBRT field. Brain Metastases. Whole Brain RT Prophylactic WBRT Stereotactic radiosurgery (SRS) 1 fraction Stereotactic frame Radiation Therapy for Advanced NSC Lung Ca Alexander Gottschalk, M.D., Ph.D. Associate Professor Director of CyberKnife Radiosurgery Department of Radiation Oncology University of California San Francisco

More information

Basics of Cervix Cancer Brachytherapy

Basics of Cervix Cancer Brachytherapy Gynecologic Cancer InterGroup Cervix Cancer Research Network Basics of Cervix Cancer Brachytherapy David Gaffney MDPhD, FASTRO, FACR University of Utah Huntsman Cancer Institute Incidence Cervix: 445,000

More information

Name of Policy: High-Dose Rate Temporary Prostate Brachytherapy

Name of Policy: High-Dose Rate Temporary Prostate Brachytherapy Name of Policy: High-Dose Rate Temporary Prostate Brachytherapy Policy #: 024 Latest Review Date: June 2014 Category: Therapy Policy Grade: C Background/Definitions: As a general rule, benefits are payable

More information

Image guided brachytherapy in cervical cancer Clinical Aspects

Image guided brachytherapy in cervical cancer Clinical Aspects Image guided brachytherapy in cervical cancer Clinical Aspects Richard Pötter MD Department of Radiation Oncology, Medical University of Vienna, Austria ICARO-2, IAEA, Vienna, June, 22, 2017 Outline Tumor

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

2011 PROSTATE BRACHYTHERAPY STUDY

2011 PROSTATE BRACHYTHERAPY STUDY 20 PROSTATE BRACHYTHERAPY STUDY CRITERIA Patients receiving prostate brachytherapy at Cox from 2002-200. In this study, we will look at patients with the following prognostic features: PSA

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

Screening and Diagnosis Prostate Cancer

Screening and Diagnosis Prostate Cancer Screening and Diagnosis Prostate Cancer Daniel Heng MD MPH FRCPC Chair, Genitourinary Tumor Group Tom Baker Cancer Center University of Calgary, Canada @DrDanielHeng Outline Screening Evidence Recommendations

More information

The Evolution of RT Techniques for Gynaecological Cancers in a developing country context

The Evolution of RT Techniques for Gynaecological Cancers in a developing country context The Evolution of RT Techniques for Gynaecological Cancers in a developing country context Hannah Simonds Stellenbosch University/ Tygerberg Academic Hospital ESMO Africa 2017 I have no disclosures External

More information

When PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy

When PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA

More information

Financial Disclosures. Prostate Cancer Screening and Surgical Management

Financial Disclosures. Prostate Cancer Screening and Surgical Management Prostate Cancer Screening and Surgical Management Dr. Ken Jacobsohn Director, Minimally Invasive Urologic Surgery Assistant Professor, Department of Urology Medical College of Wisconsin Financial Disclosures

More information

Alliance A Alliance SWOG ECOG/ACRIN - NRG

Alliance A Alliance SWOG ECOG/ACRIN - NRG Preoperative chemotherapy and chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas Alliance A021501 Alliance SWOG ECOG/ACRIN - NRG Clinical

More information

High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients

High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients Tselis et al. Tselis et al. Radiation Oncology 213, 8:115

More information

Objectives. Prostate Cancer Screening and Surgical Management

Objectives. Prostate Cancer Screening and Surgical Management Prostate Cancer Screening and Surgical Management Dr. Ken Jacobsohn Director, Minimally Invasive Urologic Surgery Assistant Professor, Department of Urology Medical College of Wisconsin Objectives Update

More information

Basic Concepts in Image Based Brachytherapy (GEC-ESTRO Target Concept & Contouring)

Basic Concepts in Image Based Brachytherapy (GEC-ESTRO Target Concept & Contouring) Basic Concepts in Image Based Brachytherapy (GEC-ESTRO Target Concept & Contouring) Dr Umesh Mahantshetty, Professor, Radiation Oncology GYN & Urology Disease Management Group (DMG) Member Tata Memorial

More information

Proton beam therapy for prostate cancer. 1. What is the clinical effectiveness of proton beam therapy in the treatment of prostate cancer?

Proton beam therapy for prostate cancer. 1. What is the clinical effectiveness of proton beam therapy in the treatment of prostate cancer? QUESTION(S) TO BE ADDRESSED Proton beam therapy for prostate cancer 1. What is the clinical effectiveness of proton beam therapy in the treatment of prostate cancer? 2. What is the cost effectiveness of

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

Clinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults)

Clinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults) Clinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults) Reference: NHS England: 170021/P Standard NHS England INFORMATION READER

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

Permanent Prostate Brachytherapy Post Procedure Evaluation

Permanent Prostate Brachytherapy Post Procedure Evaluation Permanent Prostate Brachytherapy Post Procedure Evaluation William S. Bice, Jr., Ph.D. UTHSCSA, San Antonio, Texas IMPS, San Antonio, Texas Texas Cancer Clinic, San Antonio, Texas Implant Evaluation for

More information

The Role of Adjuvant vs Salvage Radiation Therapy after Prostatectomy. Dr. Matt Andrews Supervisor: Dr. David Bowes

The Role of Adjuvant vs Salvage Radiation Therapy after Prostatectomy. Dr. Matt Andrews Supervisor: Dr. David Bowes The Role of Adjuvant vs Salvage Radiation Therapy after Prostatectomy Dr. Matt Andrews Supervisor: Dr. David Bowes Objectives Discuss the evidence for adjuvant radiotherapy (ART) EORTC, SWOG, ARO Current

More information

OPTIMIZATION OF COLLIMATOR PARAMETERS TO REDUCE RECTAL DOSE IN INTENSITY-MODULATED PROSTATE TREATMENT PLANNING

OPTIMIZATION OF COLLIMATOR PARAMETERS TO REDUCE RECTAL DOSE IN INTENSITY-MODULATED PROSTATE TREATMENT PLANNING Medical Dosimetry, Vol. 30, No. 4, pp. 205-212, 2005 Copyright 2005 American Association of Medical Dosimetrists Printed in the USA. All rights reserved 0958-3947/05/$ see front matter doi:10.1016/j.meddos.2005.06.002

More information

Radiation with oral hormonal manipulation for non-metastatic, intermediate or high risk prostate cancer in men 70 and older or with comorbidities

Radiation with oral hormonal manipulation for non-metastatic, intermediate or high risk prostate cancer in men 70 and older or with comorbidities Radiation with oral hormonal manipulation for non-metastatic, intermediate or high risk prostate cancer in men 70 and older or with comorbidities Prostate cancer is predominately a disease of older men,

More information

2015 Coding Changes Webinar

2015 Coding Changes Webinar 2015 Coding Changes Webinar William Hartsell, MD Immediate Past Chair, Code Utilization and Application Subcommittee Member, Code Development and Valuation Subcommittee Medical Director, CDH Proton Center

More information

Basic radiobiology: fractionation, 5 Rs, α/β ratio, QUANTEC. Gill Barnett Consultant Oncologist Addenbrookes Hospital

Basic radiobiology: fractionation, 5 Rs, α/β ratio, QUANTEC. Gill Barnett Consultant Oncologist Addenbrookes Hospital Basic radiobiology: fractionation, 5 Rs, α/β ratio, QUANTEC Gill Barnett Consultant Oncologist Addenbrookes Hospital Radiotherapy (RT) Fractionation RT is an important component of multi-modality cancer

More information

The dependence of optimal fractionation schemes on the spatial dose distribution

The dependence of optimal fractionation schemes on the spatial dose distribution The dependence of optimal fractionation schemes on the spatial dose distribution Jan Unkelbach 1, David Craft 1, Ehsan Salari 1, Jagdish Ramakrishnan 1,2, Thomas Bortfeld 1 1 Department of Radiation Oncology,

More information

Date Modified: March 31, Clinical Quality Measures for PQRS

Date Modified: March 31, Clinical Quality Measures for PQRS Date Modified: March 31, 2015 2015 Clinical Quality s for PQRS # Domain Title Description Type Denominator Numerator Denominator Exclusions/Exceptions 1 Patient Safety Prostate Biopsy Antibiotic Process

More information

Who Should Know Radiation Oncology Coding?

Who Should Know Radiation Oncology Coding? Why Should We Learn Radiation Oncology Coding? Terry Wu, Ph.D. Chief Physicist Radiation Oncology Department Willis-Knighton Cancer Center Who Should Know Radiation Oncology Coding? Radiation Oncologist

More information

Overview of MLC-based Linac Radiosurgery

Overview of MLC-based Linac Radiosurgery SRT I: Comparison of SRT Techniques 1 Overview of MLC-based Linac Radiosurgery Grace Gwe-Ya Kim, Ph.D. DABR 2 MLC based Linac SRS Better conformity for irregular target Improved dose homogeneity inside

More information

Prostate and Lymph Node VMAT Treatment Planning

Prostate and Lymph Node VMAT Treatment Planning Prostate and Lymph Node VMAT Treatment Planning Jess France, Alison McVey, Graham McVey, Jaap Vaarkamp 1 Presentation Outline Old planning method multi-phase New planning method single-phase Comparison

More information

Regulatory Guidelines and Computational Methods for Safe Release of Radioactive Patients II. Brachytherapy

Regulatory Guidelines and Computational Methods for Safe Release of Radioactive Patients II. Brachytherapy Regulatory Guidelines and Computational Methods for Safe Release of Radioactive Patients II. Brachytherapy Firas Mourtada, Ph.D., DABR Chief of Clinical Physics Helen F. Graham Cancer Center Christiana

More information

Incremental Cost Effectiveness

Incremental Cost Effectiveness Incremental Cost Effectiveness of Proton Therapy American Association of Physicists in Medicine May 9, 2009 Justin Bekelman, MD Department of Radiation Oncology Leonard Davis Institute for Health Economics

More information

A thesis submitted in partial fulfillment of the requirements for the degree in Master of Science

A thesis submitted in partial fulfillment of the requirements for the degree in Master of Science Western University Scholarship@Western Electronic Thesis and Dissertation Repository August 2014 Overall survival and biochemical failure-free survival comparison of brachytherapy treatment options versus

More information

Prostate MRI for local staging and surgical planning in prostate cancer

Prostate MRI for local staging and surgical planning in prostate cancer Prostate MRI for local staging and surgical planning in prostate cancer 15th Annual Floyd A. Fried Advances in Urology Symposium June 23, 2017 Ray Tan, MD, MSHPM Assistant Professor Disclosures None Objectives

More information

Updated Results of High-Dose Rate Brachytherapy and External Beam Radiotherapy for Locally and Locally Advanced

Updated Results of High-Dose Rate Brachytherapy and External Beam Radiotherapy for Locally and Locally Advanced Clinical Urology High-Dose Rate Brachytherapy for Prostate Cancer International Braz J Urol Vol. 34 (3): 293-301, May - June, 2008 Updated Results of High-Dose Rate Brachytherapy and External Beam Radiotherapy

More information

Vascular Targeted Photodynamic Therapy for Prostate Tumors

Vascular Targeted Photodynamic Therapy for Prostate Tumors Vascular Targeted Photodynamic Therapy for Prostate Tumors Which of the following is true about focal therapy (FT)? 1. FT for prostate cancer is FDA approved in men with unilateral Gleason Grade Groups

More information

MORE THAN 140,000 men in the United States annually

MORE THAN 140,000 men in the United States annually Time Course and Predictors of Symptoms After Primary Prostate Cancer Therapy By James A. Talcott, Judith Manola, Jack A. Clark, Irving Kaplan, Clair J. Beard, Sonya P. Mitchell, Ronald C. Chen, Michael

More information

c) Do you think radiation treatment for my cancer is better than surgically removing my gland, and if so, why?

c) Do you think radiation treatment for my cancer is better than surgically removing my gland, and if so, why? QUESTIONS TO ASK A RADIATION ONCOLOGIST IF CONSIDERING RADIATION THERAPY FOR DIAGNOSED PROSTATE CANCER For the patient: You should review these questions and determine if the answers would satisfy a better

More information

8/3/2016. Outline. Site Specific IGRT Considerations for Clinical Imaging Protocols. Krishni Wijesooriya, PhD University of Virginia

8/3/2016. Outline. Site Specific IGRT Considerations for Clinical Imaging Protocols. Krishni Wijesooriya, PhD University of Virginia Site Specific IGRT Considerations for Clinical Imaging Protocols Krishni Wijesooriya, PhD University of Virginia Outline Image registration accuracies for different modalities What imaging modality best

More information

Oligometastasis. Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie?

Oligometastasis. Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie? Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie? Daniel M. Aebersold 09. Dezember 2016 Oligometastasis JCO, 1995 1 Oligometastasis: Chance for

More information

Prognostic Factors for Overall Survival and Risk Stratification of Prostate Cancer Patients with Biochemical Failure

Prognostic Factors for Overall Survival and Risk Stratification of Prostate Cancer Patients with Biochemical Failure Western University Scholarship@Western Electronic Thesis and Dissertation Repository September 2015 Prognostic Factors for Overall Survival and Risk Stratification of Prostate Cancer Patients with Biochemical

More information

Case histories in Urological cancers

Case histories in Urological cancers Case histories in Urological cancers Dr Alison Tree Consultant Clinical oncologist, The Royal Marsden and Institute of Cancer Research 2 The Royal Marsden Outline of talk Case histories for: Localised

More information

Accuracy Requirements and Uncertainty Considerations in Radiation Therapy

Accuracy Requirements and Uncertainty Considerations in Radiation Therapy Departments of Oncology and Medical Biophysics Accuracy Requirements and Uncertainty Considerations in Radiation Therapy Introduction and Overview 6 August 2013 Jacob (Jake) Van Dyk Conformality 18 16

More information

Proton Therapy: Where Are We Now and Where Are We Going? Erin Davis MSN, CRNP, ACNP BC Lead Nurse Practitioner

Proton Therapy: Where Are We Now and Where Are We Going? Erin Davis MSN, CRNP, ACNP BC Lead Nurse Practitioner Proton Therapy: Where Are We Now and Where Are We Going? Erin Davis MSN, CRNP, ACNP BC Lead Nurse Practitioner Genevieve Hollis MSN, CRNP, ANP-BC, AOCN Oncology Nurse Practitioner Advanced Senior Lecturer-B

More information