Interstitial hyperthermia of the prostate in combination with brachytherapy
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ełka1 · M. Hetnał1 · P. Brandys1 · T. Walasek1 · T. Dąbrowski1 · E. Pluta1 · D. Nahajowski2 · R. Kudzia2 1 Department of Radiotherapy, Centre of Oncology, M. Skłodowska Curie Institute, Krakow Branch, Krakow 2 Department of Medical Physics, Department of Radiotherapy, Centre of
Oncology, M. Skłodowska Curie Institute, Krakow Branch, Krakow
Interstitial hyperthermia of the prostate in combination with brachytherapy An evaluation of feasibility and early tolerance
There is ongoing controversy over the appropriate treatment for prostate cancer. In patients with early prostate cancer, the standard treatment includes surgery or radiotherapy (RT) combined with hormone therapy [1]. Treatment options depend on risk factors (i.e. the Gleason score), initial prostate-specific antigen (PSA) levels and the stage of disease. D’Amico proposed three risk categories: low (PSA 7 and T3–T4) [2]. Local recurrence-free survival rates can reach 100% in low-risk- and 87% in highrisk patient groups [3, 4]. The rate of biochemical recurrence after RT alone may be as high as 70–80% in the intermediateand high-risk patient groups [4, 5]. Outcomes may be improved by escalating the radiation dose and/or combining it with hormone treatment [6, 7, 8, 9, 10]. Dose escalation should be applied to all irradiated prostate cancer patients, regardless of risk group. It reduces the risk of biochemical failure by about 1.8% per 1 Gy dose increase [9, 10]. Combination with hormone treatment is associated with a survival benefit of 10% or greater [7, 8]. Metastatic or both metastatic and local disease are found in the majority of patients with biochemical progression who have previously undergone RT. The Phoenix definition (a 2 ng/ml increase in ab-
solute PSA nadir) is currently the most commonly applied measure of biochemical failure after RT [11]. Local recurrence is only found in a quarter of patients with biochemical progression. There is no consensus with respect to the optimal treatment for this group of patients. The available options range from watchful waiting to hormone treatment, surgery, brachytherapy and cryoablation [12, 13, 14]. The addition of hyperthermia to RT may enhance the effect of the latter. This has been demonstrated for human prostate cancer cell lines in vitro [15, 16]. The thermal enhancement ratio (TER) was estimated to be about 1.4–2.0 [15] and it has been suggested that the effect is greatest when hyperthermia treatment directly precedes brachytherapy. Promising results have also been observed by combining interstitial hyperthermia (IHT) with external beam radiotherapy (EBRT) [17, 18, 19]. In patients with other cancers, results of randomized studies have shown a benefit of RT combined with hyperthermia over RT alone [20, 21, 22]. Several nonrandomized studies on the use of both methods in the treatment of prostate cancer are also available [17, 23]. We launched our high-dose-rate (HDR) brachytherapy treatment program for prostate cancer at the Centre of Oncology, Krakow in 2006, and began combin-
ing IHT with brachyth
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