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Strouthos I, Karagiannis E, Zamboglou N, Ferentinos K. High-dose-rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome. Cancer Rep (Hoboken) 2021; 5:e1450. [PMID: 34164950 PMCID: PMC8789612 DOI: 10.1002/cnr2.1450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background High‐dose‐rate brachytherapy (HDR BRT) has been enjoying rapid acceptance as a treatment modality offered to selected prostate cancer patients devoid of risk group, employed either in monotherapy setting or combined with external beam radiation therapy (EBRT) and is currently one of the most active clinical research areas. Recent findings This review encompasses all the current evidence to support the use of HDR BRT in various clinical scenario and shines light to the HDR BRT rationale, as an ultimately conformal dose delivery method enabling safe dose escalation to the prostate. Conclusion Valid long‐term data, both in regard to the oncologic outcomes and toxicity profile, support the current clinical indication spectrum of HDR BRT. At the same time, this serves as solid, rigid ground for emerging therapeutic applications, allowing the technique to remain in the spotlight alongside stereotactic radiosurgery.
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Affiliation(s)
- Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
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Genitourinary System Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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3
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High Dose Rate Brachytherapy as Monotherapy for Localised Prostate Cancer: Review of the Current Status. Clin Oncol (R Coll Radiol) 2017; 29:401-411. [DOI: 10.1016/j.clon.2017.02.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/20/2022]
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Abstract
The past decade has brought an improved ability to precisely target and deliver radiation as well as other focal prostate-directed therapy. Stereotactic body radiotherapy (SBRT), proton beam radiation, high-dose-rate (HDR) brachytherapy, as well as nonradiotherapy treatments such as cryoablation and high-intensity focused ultrasound are several therapeutic modalities that have been investigated for the treatment of prostate cancer in an attempt to reduce toxicity while improving cancer control. However, high-risk prostate cancer requires a comprehensive treatment of the prostate as well as areas at risk for cancer spread. Therefore, most new radiation treatment (SBRT, HDR, and proton beam radiation) modalities have been largely investigated in combination with regional radiation therapy. Though the evidence is evolving, the use of SBRT, HDR, and proton beam radiation is promising. Nonradiation focal therapy has been proposed mainly for partial gland treatment in men with low-risk disease, and its use in high-risk prostate cancer patients remains experimental.
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Affiliation(s)
- William J Magnuson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Amandeep Mahal
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
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Nicolae AM, Venugopal N, Ravi A. Trends in targeted prostate brachytherapy: from multiparametric MRI to nanomolecular radiosensitizers. Cancer Nanotechnol 2016; 7:6. [PMID: 27441041 PMCID: PMC4932125 DOI: 10.1186/s12645-016-0018-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/14/2016] [Indexed: 01/21/2023] Open
Abstract
The treatment of localized prostate cancer is expected to become a significant problem in the next decade as an increasingly aging population becomes prone to developing the disease. Recent research into the biological nature of prostate cancer has shown that large localized doses of radiation to the cancer offer excellent long-term disease control. Brachytherapy, a form of localized radiation therapy, has been shown to be one of the most effective methods for delivering high radiation doses to the cancer; however, recent evidence suggests that increasing the localized radiation dose without bound may cause unacceptable increases in long-term side effects. This review focuses on methods that have been proposed, or are already in clinical use, to safely escalate the dose of radiation within the prostate. The advent of multiparametric magnetic resonance imaging (mpMRI) to better identify and localize intraprostatic tumors, and nanomolecular radiosensitizers such as gold nanoparticles (GNPs), may be used synergistically to increase doses to cancerous tissue without the requisite hazard of increased side effects.
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Affiliation(s)
- Alexandru Mihai Nicolae
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | | | - Ananth Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
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Mollicutes/HIV Coinfection and the Development of AIDS: Still Far from a Definitive Response. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:8192323. [PMID: 27413383 PMCID: PMC4927952 DOI: 10.1155/2016/8192323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/31/2016] [Indexed: 01/06/2023]
Abstract
Background. Mycoplasmas are known to cause various infections in humans, mainly in the respiratory and urogenital tracts. The different species are usually host-specific and cause diseases in well-defined sites. New species have been isolated, including those from HIV-infected persons. Summary. Its in vitro properties, combined with clinical findings, have led to the hypothesis that these microorganisms may act as cofactors of HIV in AIDS development. Even today this point of view is quite polemic among infectious disease specialists and many aspects remain to be clarified, in contrast to what happens, for instance, with HIV/Mycobacterium tuberculosis coinfection. Dozens of papers have been published covering aspects of Mollicutes/HIV coinfection, but they add little to no information about the putative contribution of Mollicutes to the evolution of AIDS. Very few researchers have devoted their efforts to trying to answer this question, which remains open. In this review, we discuss the evidences that may support this statement in the light of current knowledge in the field of mycoplasmology.
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Prostate: High-Dose Rate Brachytherapy in the Treatment of Clinically Organ-Confined Prostate Cancer. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Stereotactic body radiation therapy: Let’s not give up on progress. Pract Radiat Oncol 2015; 5:193-196. [DOI: 10.1016/j.prro.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022]
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9
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Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol 2013; 10:565-79. [DOI: 10.1038/nrurol.2013.185] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yoshioka Y, Yoshida K, Yamazaki H, Nonomura N, Ogawa K. The emerging role of high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer. JOURNAL OF RADIATION RESEARCH 2013; 54:781-8. [PMID: 23543798 PMCID: PMC3766299 DOI: 10.1093/jrr/rrt027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
High-dose-rate (HDR) brachytherapy as monotherapy is a comparatively new brachytherapy procedure for prostate cancer. In addition to the intrinsic advantages of brachytherapy, including radiation dose concentration to the tumor and rapid dose fall-off at the surrounding normal tissue, HDR brachytherapy can yield a more homogeneous and conformal dose distribution through image-based decisions for source dwell positions and by optimization of individual source dwell times. Indication can be extended even to T3a/b or a part of T4 tumors because the applicators can be positioned at the extracapsular lesion, into the seminal vesicles, and/or into the bladder, without any risk of source migration or dropping out. Unlike external beam radiotherapy, with HDR brachytherapy inter-/intra-fraction organ motion is not problematic. However, HDR monotherapy requires patients to stay in bed for 1-4 days during hospitalization, even though the actual overall treatment time is short. Recent findings that the α/β value for prostate cancer is less than that for the surrounding late-responding normal tissue has made hypofractionation attractive, and HDR monotherapy can maximize this advantage of hypofractionation. Research on HDR monotherapy is accelerating, with a growing number of publications reporting excellent preliminary clinical results due to the high 'biologically effective dose (BED)' of >200 Gy. Moreover, the findings obtained for HDR monotherapy as an early model of extreme hypofractionation tend to be applied to other radiotherapy techniques such as stereotactic radiotherapy. All these developments point to the emerging role of HDR brachytherapy as monotherapy for prostate cancer.
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Affiliation(s)
- Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Corresponding author. Tel: +81-6-6879-3482; Fax: +81-6-6879-3489;
| | - Ken Yoshida
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Oliveira SM, Teixeira NJ, Fernandes L. What do we know about the α/β for prostate cancer? Med Phys 2012; 39:3189-201. [DOI: 10.1118/1.4712224] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Monotherapeutic High-Dose-Rate Brachytherapy for Prostate Cancer: Five-Year Results of an Extreme Hypofractionation Regimen With 54 Gy in Nine Fractions. Int J Radiat Oncol Biol Phys 2011; 80:469-75. [PMID: 20646858 DOI: 10.1016/j.ijrobp.2010.02.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/09/2010] [Accepted: 02/12/2010] [Indexed: 11/22/2022]
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Suy S, Oermann E, Hanscom H, Lei S, Vahdat S, Yu X, Park HU, Chen V, Collins BT, McGeagh K, Dawson N, Jha R, Azumi N, Dritschilo A, Lynch J, Collins SP. Histopathologic effects of hypofractionated robotic radiation therapy on malignant and benign prostate tissue. Technol Cancer Res Treat 2011; 9:583-7. [PMID: 21070080 DOI: 10.1177/153303461000900606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the first histopathologic analysis of prostatic tissue following hypofractionated robotic radiation therapy. A 66 year-old man presented with stage II, low risk adenocarcinoma of the prostate and underwent elective conformal hypofractionated radiation therapy. His pretreatment evaluation revealed T1c adenocarcinoma, Gleason's grade 3 + 3 = 6 and a prostate specific antigen (PSA) level of 4.87 ng/ml. Hypofractionated radiation therapy (37.5 Gy in five daily fractions of 7.5 Gy) was completed on an Internal Review Board approved protocol. One year later, he developed progressive urinary retention. Transurethral prostatic resection was performed to alleviate obstructive symptoms. Bilobar hypertrophy was observed without evidence of stricture. Histolopathologic analyses of resected prostate tissues revealed changes consistent with radiation treatment, including cellular changes, inflammation, glandular atrophy and hyperplasia. There was no evidence of residual cancer, fibrosis or necrosis. The patient's postoperative course was uneventful with post-treatment PSA of 0.5 ng/ml and residual grade 1 stress incontinence.
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Affiliation(s)
- Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital
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Dawson NA, Collins SP. Novel treatment methods for localized prostate cancer: hypofractionated robotic radiation therapy and adjuvant chemotherapy. Expert Rev Anticancer Ther 2009; 9:953-62. [PMID: 19589034 DOI: 10.1586/era.09.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The standard localized therapies for prostate cancer include external-beam radiation therapy, brachytherapy and radical prostatectomy. There are several novel approaches in development aimed at improving local disease control and survival, and reducing post-treatment complications. In low-to-intermediate-risk patients, new radiation approaches are being explored to include hypofractionated robotic radiation therapy. For high-risk patients, the focus is on multimodality approaches, especially the addition of chemotherapy. Recent developments in radiation therapy and adjuvant chemotherapy are the focus of this review.
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Affiliation(s)
- Nancy A Dawson
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
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