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Ultrasound aids in delivery of brachytherapy in prostate cancer patients

by John W. Mitchell , Senior Correspondent
Physicians at a Spanish hospital reported their success in treating men with prostate cancer in one ultrasound-guided outpatient radiation session, rather than several lower dose treatments.

Patients report they prefer the one-time brachytherapy treatment. They did not experience any worse side effects compared to the standard multiple-treatment protocol or need to return to the hospital at a greater frequency.

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"There is a great interest in the prostate cancer field to try to reduce treatment times, avoid toxicity and maintain quality of life for the patient," Dr. Alfonso Gomez-Iturriaga, with the Department of Radiation Oncology at Hospital Universitario Cruces Bizkaia in Spain, told HCB News. "Of note, [the one dose treatment] is done as an outpatient procedure. Patients come to the hospital in the morning and go back home at evening with the treatment of the prostate cancer done."

The findings were reported at the ESTRO 36 conference in Vienna, an interdisciplinary meeting of radiation oncologists, medical physicists, radiobiologists, brachytherapists, and radiologists.

In the study, 45 consecutive men received HDR brachytherapy over an 18-month period ending in July 2016. The patients had low- or intermediate-risk prostate cancer, with moderate symptoms and had not yet had other treatments, such as surgery. The median follow-up time for the patients was 16 months. No adverse side effects were reported, other than a half dozen cases of moderate bowel (diarrhea) or bladder (frequency) problems.

"So far, the results are good, but it is too soon to talk about cancer control," said Gomez-Iturriaga. "We have to wait at least three years more to find out how efficacious this novel treatment is. It is also unknown whether the dose administered in our trial is enough or we have to increase the dose in the future."

HDR brachytherapy involves the very precise positioning of catheters, with the aid of ultrasound, at the site of the tumor while the patient is under spinal or general anesthetic. A radioactive source (iridium-192) is delivered via the catheters to the target, avoiding other organs such as the bladder and the bowel. The treatment usually takes about 30 minutes.

According to Gomez-Iturriaga, the treatment involves real-time 3-D visualization of the target with the ultrasound. All of this, he explained, allows for extraordinary control over the dose administration.

"Our study has demonstrated (this method) to be safe and great for maintaining quality of life," he said. "But it is too soon to know if it is as curative as other treatments such as IMRT or seed brachytherapy."

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