To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ARS: Intensity Modulated Radiation Therapy For Prostate Cancer Has Fewer Side Effects URL: http://www.pslgroup.com/dg/1959CE.htm Doctor's Guide April 4, 2000
HACKENSACK, NJ -- April 4, 2000 -- Patients undergoing therapy for organ confined prostate cancer no longer have to suffer from side effects such as rectal bleeding and diarrhea, a study has found. The study was presented April 3 by Dr. Glen Gejerman at the 82nd annual meeting of the American Radium Society in London. Dr. Gejerman, clinical director of the Department of Radiation Oncology at Hackensack University Medical Center in New Jersey, heads a team of specialists that has been studying the effects of using a technique called intensity modulated radiation therapy, or IMRT, which subjects the prostate to more conformal radiation than standard radiation treatment. IMRT is often used in combination with brachytherapy, also known as seed implantation. The study is an analysis of 65 prostate cancer patients treated with IMRT and seed implantation. Treatment plans for IMRT and three-dimensional conformal radiotherapy (3DCRT) were compared and IMRT delivered a 7 percent higher dose to the prostate target while delivering a 9 percent lower dose to the bladder and a 12 percent lower dose to the rectum. "The importance of this study is that IMRT is not just a theoretical tool anymore," Dr. Gejerman said. "IMRT and palladium implantation is in clinical use. Patients are already benefiting from it. Curative doses of radiation are being delivered to the prostate without the typical side effects." Data shows when compared with 3DCRT, IMRT in conjunction with palladium seed implantation, delivers better dosimetric coverage of the prostate gland with significantly less dose to the bladder and rectum. Since palladium radioactive seeds are placed directly in to the prostate gland the surrounding rectum and bladder receive very little radiation dose. The prostate is a walnut-shaped organ nestled between the bladder, rectum and pubic bone. What the study means is that prostate cancer patients can get a higher dose to the prostate and a lower dose to the bladder and rectum with fewer side effects, according to Dr. Gejerman. "With IMRT and seed implantation what we are doing is giving the patient the confidence to know that he can receive aggressive cancer treatment and not have to worry that he won't be able to cope with the toxicity." "That is the overwhelming concern for patients when they are faced with cancer. The first thing they worry about is whether they can be cured. Once they are assured of that, the next step is how is it going to impact their lifestyles." "They ask, 'Am I going to have to constantly run to the bathroom to urinate? Will I have diarrhea? Can I do my job? Am I going to be embarrassed?'" "These are the very real thoughts that go through patients' minds. With IMRT and palladium seed implantation therapy there is a confidence that you are not going to have problems with bowel functions. You are going to be able to function normally." Prostate cancer, excluding skin cancer, is the most commonly diagnosed cancer in American men. According to the American Cancer Society, in the year 2000 an estimated 180,400 new cases of prostate cancer will be diagnosed and approximately 31,900 men will die of this disease in the United States. African-Americans, have the world's highest rate of prostate cancer and are widely considered the greatest at-risk group. Dr. Gejerman said that while today's reported study was limited to the initial 65 patients treated, a total of 200 patients have been treated without showing any rectal side effects. "We have essentially eliminated diarrhea and rectal bleeding," he said. "IMRT is a landmark advance in cancer therapy, said Dr. Stephen Strum, an oncologist/hematologist in Marina Del Ray, California. "IMRT will rapidly become the standard radiation therapy approach, not only for prostate cancer, but also for all tumor types." Dr. Gejerman said there are a number of things that the IMRT and the Theraseed(R) palladium seed implant have achieved. "First, we can maximize the dose to the prostate," he said. "Dose escalation has been shown to increase the chances of cure." Dr. Gejerman said that many cancer centers are treating prostate cancer with the combination of external beam therapy and a palladium seed implant. "A number of patients do have diarrhea and a subset of patients do have rectal bleeding. Hackensack is the only facility in the country doing IMRT and seed implantation in large numbers." Dr. Jack Vitenson, a urologist in the Department of Urology at Hackensack University Medical Center, said he hasn't seen any side effects of the therapy with his patients. "My early experience has been extremely favorable for the patients' well being," he said. "They are being treated with minimal toxicity and that has been helpful for their emotional health." There are a limited number of physicians experienced at treating prostate cancer with IMRT. Over 200 patients have been treated with IMRT at the Prostate Cancer Institute of Hackensack University Medical Center. The Institute has treated more patients with IMRT in combination with brachytherapy than any other program in the country. Daily treatments are Monday through Friday over an eight-week period. Treatments take 20 minutes to deliver and have no immediate after effects. During radiation seed implant treatment, doctors implant tiny Theraseed palladium radioactive seeds, each about the size of a grain of rice, directly into the prostate gland using ultrasound guidance. Once inside, the seeds target and destroy cancerous cells, while minimizing exposure to surrounding tissues. Palladium-103, a newer isotope, releases radiation more quickly than Iodine-125 (about two to three times faster), which may result in a shorter duration of those side effects, such as urinary discomfort, which may occur during the period in which the radiation is delivered. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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