Picking the Optimal Duration of Hormonal Therapy in Men With High-Risk and Locally Advanced Prostate Cancer Treated With Radiotherapy
The optimal duration of hormonal therapy when combined with radiation for men with high-risk and locally advanced prostate cancer remains under active study. Based on the results of randomized controlled trials, durations of androgen suppression therapy of at least 6 months have been shown to prolong survival in men with Gleason score 7 prostate cancer, irrespective of clinical stage. For men with locally advanced prostate cancer and 2 high-risk factors (particularly Gleason 8-10 tumors with evidence of extracapsular extension or seminal vesicle invasion on digital rectal examination) or pelvic nodal involvement, longer du...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: James W. Denham, Allison Steigler Source Type: research
Management of Prostate Cancer in Elderly Men
Elderly men comprise a large percentage of men diagnosed with prostate cancer (PrCa). Although localized PrCa is often indolent, older men tend to be diagnosed with higher-stage disease and are more likely to die from PrCa than younger men. Multiple factors other than age play an important role in determining who will benefit from active treatment, such as comorbid conditions, life expectancy, and tumor characteristics. Careful consideration of such factors can help prevent the overtreatment of elderly men with low-risk disease and undertreatment of elderly men with high-risk disease. Management decisions should be individ...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Shelly X. Bian, Karen E. Hoffman Source Type: research
Hypofractionation for Clinically Localized Prostate Cancer
This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported. Prospective single-arm studies of extreme hy...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Alvin R. Cabrera, W. Robert Lee Source Type: research
Comparing Dosimetric, Morbidity, Quality of Life, and Cancer Control Outcomes After 3D Conformal, Intensity-Modulated, and Proton Radiation Therapy for Prostate Cancer
New radiation technologies have been developed and adopted for clinical use in prostate cancer treatment in response to a need to deliver dose-escalated radiation therapy while minimizing treatment-related morbidity. The goal of this article is to examine the currently available evidence comparing dosimetric and patient outcomes of newer versus older radiation technologies in prostate cancer. Overall, although a body of dosimetry studies have demonstrated the ability of newer versus older technologies (intensity-modulated radiation therapy vs 3-dimensional conformal radiation therapy; proton vs intensity-modulated radiatio...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Kevin A. Pearlstein, Ronald C. Chen Source Type: research
How Can I Help Myself? A Critical Review of Modifiable Behaviors, Medications, and Complementary Alternative Medicine for Men Receiving Radiotherapy for Prostate Cancer
Men receiving radiation for prostate cancer frequently want to know what steps they can take to optimize their chance of cure and reduce their risk of side effects. A variety of modifiable behaviors, medications, and complementary alternative medicine interventions have been investigated in this regard. In this review, we summarize data on tobacco use, exercise, statins and aspirin, and vitamins. There is limited randomized data supporting any of the interventions and additional studies are needed before clinicians can confidently inform their patients regarding what steps to take to improve their outcomes. (Source: Semina...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Yolanda D. Tseng, Neil E. Martin Source Type: research
Prognostic Factors for Newly Diagnosed Prostate Cancer and Their Role in Treatment Selection
Adenocarcinoma of the prostate is extremely heterogeneous, ranging from an indolent chronic illness to an aggressive rapidly fatal systemic malignancy. The classic prognostic factors of tumor stage, prostate specific antigen level, and Gleason score have been used for over a decade to categorize patients at the time of diagnosis into broad risk groups that help to determine appropriate management. Although the grouping of patients into favorable, intermediate, and high-risk categories has become standard, and the categories continue to define distinct prognostic subgroups, considerable heterogeneity exists within each risk...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Juanita Crook, Ana Fernandez Ots Source Type: research
Multidisciplinary Care and Management Selection in Prostate Cancer
The management of prostate cancer is complicated by the multitude of treatment options, the lack of proven superiority of one modality of management, and the presence of physician bias. Care at a multidisciplinary prostate cancer clinic offers patients the relative convenience of consultation with physicians of multiple specialties within the confines of a single visit and appears to serve as a venue in which patients can be counseled regarding the risks and benefits of available therapies in an open and interactive environment. Physician bias may be minimized in such an environment, and patient satisfaction rates are high...
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Ayal A. Aizer, Jonathan J. Paly, Jason A. Efstathiou Source Type: research
Prostate Cancer: Where We Have Been, Where We Are, and Where We Are Going
In this issue of Seminars in Radiation Oncology, experts provide systematic reviews of evidence and clarifying discussion on clinically relevant issues in prevention, detection, and staging, and prognosis, management of nonmetastatic newly diagnosed and recurrent prostate cancer. It is a privilege for me to be able to serve as the guest editor for this issue where the contributors are personal friends, colleagues, and outstanding physician scientists. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 10, 2013 Category: Cancer & Oncology Authors: Anthony V. D'Amico Source Type: research
Place of Proton Radiotherapy in Future Radiotherapy Practice
We describe the steps in health technology assessment and the potential design of preclinical and clinical trials to define the role of proton therapy in the future. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Daniel Zips, Michael Baumann Source Type: research
Evolution of Technology to Optimize the Delivery of Proton Therapy: The Third Generation
The evolution of proton therapy technology will lead to a new generation of systems that allow for greater accuracy and precision of the dose delivery and will be more compact. We envision that over the next 10-15 years, the quality of deliverable proton dose distributions in the patient will be pushed nearly toward the physical limit of proton therapy. Those future proton therapy systems will fit into treatment rooms of similar size as today's conventional radiation treatment rooms. At the same time, due to technological advancements, the cost of proton therapy will come down to the cost of advanced photon therapy. We dis...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Jacob Flanz, Thomas Bortfeld Source Type: research
Health Economic Controversy and Cost-Effectiveness of Proton Therapy
Owing to increasing healthcare costs, there is a need to examine whether the benefits of new technologies are worth the extra cost. In proton therapy, where the evidence in favor is limited, it is heavily debated whether the expected benefit justifies the higher capital and operating costs. The aim of this article was to explore the existing methodologies of economic evaluations (EEs) of particle therapy and recommend an approach for future data collection and analysis. We reviewed the published literature on health economics of proton therapy using accepted guidelines on performing EE. Different cost strategies were asses...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Yolande Lievens, Madelon Pijls-Johannesma Source Type: research
Controversies in Clinical Trials in Proton Radiotherapy: The Present and the Future
Proponents of proton radiotherapy have cited the dose distribution characteristics of proton beams as evidence of its superiority over photon radiotherapy. Outcomes after photon radiotherapy remain suboptimal owing to poor local control and normal-tissue toxicity in many clinical indications. Critics of proton radiotherapy have noted the relative lack of prospective data from clinical trials showing a benefit for proton radiotherapy despite its theoretical advantages. Questions remain with regard to physical uncertainties in proton dose delivery and variations in their radiobiological effect in different tissues and tumors...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Robert C. Miller, Mark Lodge, Mohammad Hassan Murad, Bleddyn Jones Source Type: research
Clinical Controversies: Proton Radiation Therapy for Brain and Skull Base Tumors
Proton radiotherapy offers distinct physical properties that could lead to an improvement of dose distribution with subsequent reduction of integral dose to the patient. This supports the potential use of proton beams in tumors close to sensitive structures, such as the skull base and the brain. In the present manuscript, the literature on proton therapy for brain and skull base tumors is critically reviewed and compared with results obtained with modern photon techniques. Treatment planning comparisons demonstrate that dose distributions within the target are comparable. In terms of normal tissue dose distribution, proton...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Stephanie E. Combs, Normand Laperriere, Michael Brada Source Type: research
Clinical Controversies: Proton Therapy for Thoracic Tumors
Photon and proton therapy techniques have both improved dramatically over the past decade. As a result, high radiation doses can be delivered while sparing organs at risk. However, in many series, older proton techniques have been compared with contemporary photon techniques, hampering a fair comparison. By virtue of their physical properties and because of modern 4-dimensional and imaging evolution, protons show theoretical superiority compared with photons. Current nonrandomized studies suggest that protons may indeed spare organs at risk much better that the best available photon techniques, leading to fewer side effect...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Dirk De Ruysscher, Joe Y. Chang Source Type: research
Clinical Controversies: Proton Therapy for Prostate Cancer
Proton therapy has been used in the treatment of prostate cancer for several decades, and interest surrounding its use continues to grow. Proton-based treatment techniques have evolved significantly over this period, and several centers now routinely use technologies such as pencil-beam scanning. However, whether the theoretical dosimetric advantages of the proton beam translate into clinically meaningful improvements for prostate cancer patients is unknown, and outcomes from single-arm experiences using whole courses of proton beam therapy in the treatment of early-stage prostate cancer have shown mixed results when compa...
Source: Seminars in Radiation Oncology - April 1, 2013 Category: Cancer & Oncology Authors: Kent W. Mouw, Alexei Trofimov, Anthony L. Zietman, Jason A. Efstathiou Source Type: research
