Dr Mansi Munshi, Consultant Radiation Oncologist, Ruby Hall Clinic talks about the recent technologies for treating prostate cancer in radiotherapy
Prostate cancer is one of the most common cancers amongst men. It is estimated that 1 in 8 men above the age of 60 will have prostate cancer in his lifetime. Serum PSA is a blood test which can catch prostate cancer in the early stages, sometimes even before symptoms start.
Radiation therapy is a painless and non-invasive treatment which can be used to treat and cure prostate cancer and several clinical studies support its equivalence to surgery in terms of outcomes. It is very well tolerated with a low probability of side effects. Longer survival with least side effects and good quality of life is always the aim.
Like surgery, radiotherapy is a local therapy but it is very different from chemotherapy or targeted therapy in which medicines are administered through IV or orally.
Several techniques such as 3D conformal, IMRT, IG-IMRT, Rapid Arc, SBRT and brachytherapy are available in India. At Ruby Hall Clinic, Pune all the above treatments are available and special care is taken to ensure highest level of quality and precision in delivery of radiation at our institute.
Technological advances in external beam radiotherapy such as Rapid Arc available on Truebeam Stx allows precise and accurate delivery of radiation with minimal damage to the neighboring normal organs. Treatment is delivered in a few minutes only while the patient does not experience any sensations such as pain or burning. Image guided radiotherapy allows 3-dimensional visualisation of the treatment area prior to each treatment and this verifies utmost accuracy. This is vital for protecting sensitive structures like the rectum.
The IGRT linac called Halcyon at Ruby Hall, Pune allows extremely fast imaging and treatment – giving maximum patient comfort.
Due to this leap in precision radiotherapy, higher doses can be safely delivered and routine treatment duration has been reduced from 7-8 weeks to just 4-5 weeks by “hypo-fractionation”. This is cost effective for both patients as well as institutions in terms of time and resources.
Further, extreme hypofractionation or Stereotactic body radiotherapy (SBRT/SABR) can be used in select cases which can be completed in as short as 1 week. Outcomes in terms of cancer control and side effects are comparable to regular radiotherapy in such patients.
Dose painting is a specialised technique in which sub volumes of the prostate gland can be given differentially higher dose of radiation if required.
It is especially useful in certain scenarios such as curative radiotherapy for recurrences post primary surgical or previously radiated patients. PSMA PET-CT a specialised form of PET CT for prostate cancer patients is sometimes fused with radiotherapy planning to understand tumor biology. Such technology takes us a step closer towards personalised radiotherapy driven by tumor biology- which is the future.
These advances in radiotherapy in combination with hormone deprivation therapy (ADT), chemotherapy, targeted therapy and treatment vaccines has led to improved outcomes in the last decade.
Patients with limited Stage IV prostate cancer, too may be sometimes considered for curative treatment owing to SBRT/SABR. A term called oligometastatic or oligoprogressive disease implies a small volume of metastatic or progressive cancer which could be potentially eradicated with high dose SBRT, especially if present in favorable sites such as bone, lung or liver.
Painful bone lesions which can be troublesome in metastatic prostate cancer can be effectively palliated with radiotherapy too.
As the incidence of cancer increases I would like to alleviate the fear and anxiety in peoples mind by painting an optimistic picture. A combination of highly sensitive diagnostics, early and accurate detection and excellent treatment options like radiotherapy has changed the landscape of prostate cancer from a dreaded disease into one in which the patient could potentially lead a long and good quality of life after being cured or controlled.
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