External beam radiotherapy for prostate cancer patients in Radiotherapy

External beam radiotherapy for prostate cancer patients in Radiotherapy

Resume

We use in our department: cobalt unit Th100 , Theraplan treatment plan and Simulix , since 2002.

External radiotherapy ( ERT) is indicated in :

1.Radical ERT to prostate +- seminal vesicles

2.Radical ERT to prostate and pelvic lymph nodes

3.Radical ERT following prostatectomy

4.Palliative ERT to prostate +- pelvis

5.Palliative ERT to distant metastases

Objectives

1.Can be used as definitive treatment usually in combination with hormonal therapy for patients with localized prostate cancer.

2.For patients with high predicted risk of microscopic pelvic lymph node involvement: Lymph node risk (%) = 2/3 x PSA + [(Gleason score - 6 )x10].

Pelvic ERT improved the PFS at five years but has not yet been shown to improve overall survival and the effect was confined to the group of patients who had neoadjuvant/concurrant hormonal therapy in addition to ERT , we include the high risk patients(Gleason 8 - 10 , cT3 -4 tumors or lymph node risk > 30 % ).

3.Prostate bad irradiation is better if : pre - ERT PSA < 1 ng/l , PSA doubling time > 9 months and positive surgical margins were demonstrated.

4.For patients with locally advanced disease with or without evidence of distant spread.

5.Is used for palliation of bone pain from metastatic disease.We use a single fration of 8 Gy for symptom relief and 20 Gy/5 fractions/5 days if we have spinal cord compression or at risk of pathological fracture.

Material and methods

We present the patients who were irradiated by us in 2002 - 2006 , by stage, dose delivery and treatment association.   

Conclusions

The acute and late side effects are the most discussed subjects between us and our colleagues from the Clinic of Urology in Oradea.

The future developments in prostate ERT can be divided into three general categories : improved target definition , improved ERT delivery and image-guided therapy.

Our great expectations are related to a new liniar MLF colimator accelerator with brachytherapy unit incorporated.

Bibliography

[1 WASHINGTON, CHARLES, " INTRODUCTION TO RADIATION THERAPY " , EDITURA MOSBY 1996

[2] HOSKIN, PETER , " RADIOTHERAPY IN PRACTICE: EXTERNAL BEAM THERAPY " , OXFORD UNIVERSITY PRESS - 2006

[3] CERNEA , VALENTIN , " ELEMENTE DE RADIOBIOLOGIE " EDITURA UNIVERSITARA CLUJ 2003

[4] GHILEZAN NICOLAE , "ONCOLOGIE GENERALA " EDITURA MEDICALA , BUCURESTI , 1992

[5] GHILEZAN , NICOLAE , " COBALTOTERAPIA " , EDITURA MEDICALA BUCURESTI 1983

In extenso

In Departamentul Radioterapie Oradea am iradiat in perioada 2003 - 2006 urmatorii bolnavi cu neoplasm prostata ,pe grupe de virsta,mediu de provenienta ,stadiu de boala ,tip histopatologic , tip de tratament efectuat :

12 pacienti ,virsta 60-85 ani ,7mediu urban +5rural ,toti au efectuat TURP+orhiectomie bilaterala ,adenocarcinom -1scor Gleason ,hormonoterapie asociata 6 pacienti.Au efectuat RTEla TH100 ,scop curativ:8pacienti cu doze intre 46-70 Gy,1 pacient a efectuat prostatectomie radicala si iradiere postoperatorie,4pacienti au efectuat iradiere pliativa

antialgica pe coloana lombara cu doze 8-18-20Gy

19 pacienti,virsta 51-80ani ,14 mediu urban+5rural ,toti au TURP+orhiectomie bilaterala , histologic adenocarcinoame -2 scor Gleason ,hormonoterapie asociata 5 pacienti.

RTE la TH100 ,scop curativ cu doze 46-70 Gy ,11 pacienti ,1 cu radioterapie postoperatorie dupa prostatectomie radicala ,8 pacienti cu iradiere paliativa ,pe coloana lombara si bazin ,doze 8-18-20Gy

15pacienti,58-85 ani ,11 urban+4rural ,toti auTURP+orhiectomie bilaterala

Histologic adenocarcinoame ,GI-III ,hormonoterapie 2pacienti

RTE curativ 9 persoane ,doze 50-74Gy ,1 postoperator prostatectomie radicala ,6 iradiere paliativa pt meta os doza8-18-20Gy ,2 persoane cu RTE pe ggl. Lomboaortici

18 pacienti , virsta 60-82 ani , 9urban+9rural ,TURP+orhiectomie bilaterala,histologic adenocarcinoame ,1 Gleason 7 ,hormonoterapie asociata 3 pacienti

RTE curativ 4 pacienti cu doze 50-74 Gy ,1 postoperator prostatectomie radicala ,radioterapie paliativa antialgica 14 pacienti ,doze 8-18-20Gy ,localizari osoase multiple ,5 pacienti

De mentionat importanta organizarii depistarii acestei neoplazii in stadii incipiente prin generalizarea screening , stadiile avansate reprezentind majoritatea cazuisticii , in care ,prin tratament multidisciplinar si colaborarea sustinuta ,am obtinut imbunatatirea calitatii vietii pacientilor..