Jump to content

Recommended Posts

Walter

Does anyone have any clinical papers or knowledge of comparing radiation therapy, using linear accelerator, versus brachytherapy. I have been advised that the brachytherapy has advantages in that the radiation is directed directly into the prostate, whereas the linac is broadly focussed through the body, thus requiring multiple treatments.

I would appreciate any information on this subject

 

Share this post


Link to post
Share on other sites
Bruce Kynaston

That was my line of work. Beam therapy takes time with multiple doses.

brachytherapy involves introducing radioactive sources into the tumour area in the prostate, normally through the tissues between the scrotum and the anus.

Needles (hollow) are guided under control ( radiological) to be certain they are correctly positioned) and are held in a rigid plate.

with one system, a strong radioactive source is introduced under computer control.

there may be several sessions In a day or so, then at the end, the equipment is removed ( skids out), be observed and that is it.

As it is 1994 when I retired, things may have changed somewhat.

best wishes,

Bruce.

  • Thanks 1

Share this post


Link to post
Share on other sites
Kezza2

Hi Walter,

Its horses for courses.  Brachy involves implantion of seeds or rods into the prostate and irradiating from the inside, whereas external beam radiation is just that - an external beam.  However, there are multiple types of EBRT, and there is where you really need to rely on your radiation oncologist to pick the treatment that will be most suitable for your condition.

Share this post


Link to post
Share on other sites
Gary Thomas

I have read from a very knowledgeable guy that brachytherapy boost therapy is the best. This is using EBRT and brachy. His name is Tall Allen and he is on Malecare using the Health Unlocked/advanced prostate cancer platform. 

Share this post


Link to post
Share on other sites
Admin

Walter

I happen to be working on a video about this.

In general, Brachy Boost (HDR brachytherapy) beats other forms of treatment.

The problem is finding an experienced pair (Surgeon and Radiation Oncologist).

 

There are tests of other forms of EBRT, but no data on these as yet.

 

Cheers

Jim

JAMA. 2018 Mar 6;319(9):896-905. doi: 10.1001/jama.2018.0587.

Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer.

Kishan AU1, Cook RR2, Ciezki JP3, Ross AE4, Pomerantz MM5, Nguyen PL6, Shaikh T7, Tran PT8, Sandler KA1, Stock RG9, Merrick GS10, Demanes DJ1, Spratt DE11, Abu-Isa EI11, Wedde TB12, Lilleby W12, Krauss DJ13, Shaw GK5, Alam R4, Reddy CA3, Stephenson AJ14, Klein EA14, Song DY8, Tosoian JJ4, Hegde JV1, Yoo SM1, Fiano R10, D'Amico AV6, Nickols NG1,15, Aronson WJ16, Sadeghi A15, Greco S8, Deville C8, McNutt T8, DeWeese TL8, Reiter RE16, Said JW17, Steinberg ML1, Horwitz EM7, Kupelian PA1,18, King CR1.

Author information

 

In Library

Abstract

IMPORTANCE:

The optimal treatment for Gleason score 9-10 prostate cancer is unknown.

OBJECTIVE:

To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013.

EXPOSURES:

Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy.

MAIN OUTCOMES AND MEASURES:

The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes.

RESULTS:

Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer-specific mortality, distant metastasis, or all-cause mortality (≤7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]).

CONCLUSIONS AND RELEVANCE:

Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Comment in

PMID: 29509865

  • Thanks 1

Share this post


Link to post
Share on other sites
Patrick Turner
2 hours ago, Walter said:

comparing radiation therapy, using linear accelerator, versus brachytherapy.

I could be wrong but "radiation using linear accelerator is often known as EBRT, ie, external beam radiation therapy. It is actually high power X-ray beams, and usually from a machine that has X-ray gun that rotates to fire Xrays in 4 directions, east and west, north and south, in a horizontal plane that is centered at middle of a PG. So horizontal rays pass through hips and vertical through bladder and rectum, and beams are shaped to that they conform to the shape of your PG. Where the 4 beams cross over each other as the PG there is a level of radiation equal to about 70Grey. But the beam path ways in and out also accumulate maybe 17Grey. The rectum is very sensitive to EBRT, so 70Grey is usual max for PG. But the PG can take a lot more radiation and one way is to deliver Brachtherapy which is injecting the PG with perhaps 100 tiny gold pellets containing some radioactive isotope with a short half life and radiation is alpha or beta particles that travel only short distance in flesh, So BT can deliver maybe 150Grey to PG but the bladder and rectum are virtually unaffected. From what little I know, BT might be a good way to initially treat Pca in PG and sometimes docs might use a combination of EBRT and BT to get a high level of radiation to PG. But side effects on nerves and maybe on prostatic urethra can be savage with complete ED and incontinence following.

I had standard EBRT to a Gleason 9 with lots of Pca outside capsule in 2010 at age 62 and after 6 months ADT which reduced the PG target volume. It was almost totally ineffective. I had more IMRT in 2016, same as EBRT but with bean directions that could be altered to be different original 4 directions. I had 31Grey. So total to PG was 101Grey. But docs used gel pad between PG and rectum to prevent excessive RT to rectum.

I had non permanent bowel bleeding 18 months after initial 70Grey EBRT. But I had radiation colitis after the 30Grey, for 2 months, where I could spray liquid shit propelled by gas. 

Now, I have no continence problems with bladder, but have some trouble emptying rectum fully, and if I have to go, I Have To Go, asap, but so far, have only shit in pants once.

I think my Pca is quite immune to EBRT, or Xrays, ie, I am radiation resistant. But I just had 4 x Lu177 after failed chemo and that reduced Psa from PG and many mets from 25 to 5 after first 3 shots. So my Pca could not withstand targeted beta and alpha particles. Look up Theranostics Australia where there is more to know about this and trials of Lu177 as initial treatment are being done at Peter Mac. The docs don't know all there is to know about Lu177, or its use with other drugs such as enzalutamide. But its been around now for maybe 9 years since the time it was used first in Germany. Ac 225 is another more powerful Nuclide than Lu177. and then there is Ra223, but this is used mainly for bone cancers, not always Pca that has gone to bones.

Cheapest and most available is EBRT. I met men who said they had the standard EBRT treatment as I had, ten years before I had mine, and they were fixed, ie, cancer was all killed, but definitely not in my case.

There is no way to confine a beam of high power Xrays to being thin as a pencil because the rays spread out, like light rays from a torch in fog. If docs used 70Grey to all of your pelvic area you might die. BT is more localised RT and guided while pellets are installed by some sort of applicator. All these EBRT, IMRT, BT are to local areas only, and if many mets are widespread these RTs cannot kill cancer at all sites because the total level would be too high for healthy tissues. But Lu177 is targeted RT where a nuclide with short half life is anchored to Pca tumours which produce PsMa and while anchored the tumours are killed. But as the Lu177 circulates around a body in the blood stream it never lingers long in healthy tissues so little damage is done. The exceptions tear and saliva glands which attract nuclides so you may end up with a dry mouth and eyes needing replacement fluids from a bottle with a spray. But you are alive and Lu177 has less other side effects than BT, EBRT, IMRT.

There are many scholarly papers online about all this stuff. Maybe try Google, and ignore much BS.

Patrick Turner. 

Share this post


Link to post
Share on other sites
Admin

Patrick

There are two types of brachytherapy.

There is the one you speak of with tiny seeds that stay in the body. It is sometimes called 'low dose brachytherapy'. It is not usually used for more aggressive or more advanced cancer.

The other is 'high dose rate brachytherapy' or HDR brachytherapy. If it is used in conjunction with standard radiation treatment (highly focused high power X-rays, as you say) it is often referred to as 'HDR brachy boost' or 'HDR boost'.

In high dose rate brachytherapy, a tiny, highly radioactive, bead is allowed to pause for fractions of a second in various parts of the prostate. The bead in on the end of a cable (like an accelerator cable) and it is controlled by a computer to travel through hollow needles that are placed through the prostate (15-18 of them). The needles are placed under anaesthetic by a surgeon. MRI scans are taken with the needles in place, and a physicist calculates where the bead should stop to give the pattern of radiation asked for by the radiation oncologist.

HDR brachy delivers an extraordinarily accurate dose where it is needed, lower in places where it is not needed, and from inside the prostate.

These days the needles are removed after the procedure, which may be repeated in a week.

When I had mine done, the needles were not removed for 36 hours, and I went back to the theatre every 12 hours for a repeat performance of the computer dancing the bead in and out the needles.

Sounds like a medieval torture, but it is painless. Spending 36 hours trying not to roll on the thin knitting needles sticking in you was not a wonderful experience, but, as I said, I think that may be a thing of the past.

Not knowing much about prostate cancer, I really wanted to have surgery myself, but the surgeons I consulted said this was best for my large, aggressive, locally advanced cancer. I am glad they knew what they were talking about, and now long term results are confirming their wisdom.

Unfortunately experienced surgeon-radiation oncologist pairs are usually only found in large centres.

Jim

  

  • Thanks 1

Share this post


Link to post
Share on other sites
Walter
3 hours ago, Bruce Kynaston said:

That was my line of work. Beam therapy takes time with multiple doses.

brachytherapy involves introducing radioactive sources into the tumour area in the prostate, normally through the tissues between the scrotum and the anus.

Needles (hollow) are guided under control ( radiological) to be certain they are correctly positioned) and are held in a rigid plate.

with one system, a strong radioactive source is introduced under computer control.

there may be several sessions In a day or so, then at the end, the equipment is removed ( skids out), be observed and that is it.

As it is 1994 when I retired, things may have changed somewhat.

best wishes,

Bruce.

 

8 minutes ago, Admin said:

Patrick

There are two types of brachytherapy.

There is the one you speak of with tiny seeds that stay in the body. It is sometimes called 'low dose brachytherapy'. It is not usually used for more aggressive or more advanced cancer.

The other is 'high dose rate brachytherapy' or HDR brachytherapy. If it is used in conjunction with standard radiation treatment (highly focused high power X-rays, as you say) it is often referred to as 'HDR brachy boost' or 'HDR boost'.

In high dose rate brachytherapy, a tiny, highly radioactive, bead is allowed to pause for fractions of a second in various parts of the prostate. The bead in on the end of a cable (like an accelerator cable) and it is controlled by a computer to travel through hollow needles that are placed through the prostate (15-18 of them). The needles are placed under anaesthetic by a surgeon. MRI scans are taken with the needles in place, and a physicist calculates where the bead should stop to give the pattern of radiation asked for by the radiation oncologist.

HDR brachy delivers an extraordinarily accurate dose where it is needed, lower in places where it is not needed, and from inside the prostate.

These days the needles are removed after the procedure, which may be repeated in a week.

When I had mine done, the needles were not removed for 36 hours, and I went back to the theatre every 12 hours for a repeat performance of the computer dancing the bead in and out the needles.

Sounds like a medieval torture, but it is painless. Spending 36 hours trying not to roll on the thin knitting needles sticking in you was not a wonderful experience, but, as I said, I think that may be a thing of the past.

Not knowing much about prostate cancer, I really wanted to have surgery myself, but the surgeons I consulted said this was best for my large, aggressive, locally advanced cancer. I am glad they knew what they were talking about, and now long term results are confirming their wisdom.

Unfortunately experienced surgeon-radiation oncologist pairs are usually only found in large centres.

Jim

  

 

Share this post


Link to post
Share on other sites
Walter
8 minutes ago, Admin said:

Patrick

There are two types of brachytherapy.

There is the one you speak of with tiny seeds that stay in the body. It is sometimes called 'low dose brachytherapy'. It is not usually used for more aggressive or more advanced cancer.

The other is 'high dose rate brachytherapy' or HDR brachytherapy. If it is used in conjunction with standard radiation treatment (highly focused high power X-rays, as you say) it is often referred to as 'HDR brachy boost' or 'HDR boost'.

In high dose rate brachytherapy, a tiny, highly radioactive, bead is allowed to pause for fractions of a second in various parts of the prostate. The bead in on the end of a cable (like an accelerator cable) and it is controlled by a computer to travel through hollow needles that are placed through the prostate (15-18 of them). The needles are placed under anaesthetic by a surgeon. MRI scans are taken with the needles in place, and a physicist calculates where the bead should stop to give the pattern of radiation asked for by the radiation oncologist.

HDR brachy delivers an extraordinarily accurate dose where it is needed, lower in places where it is not needed, and from inside the prostate.

These days the needles are removed after the procedure, which may be repeated in a week.

When I had mine done, the needles were not removed for 36 hours, and I went back to the theatre every 12 hours for a repeat performance of the computer dancing the bead in and out the needles.

Sounds like a medieval torture, but it is painless. Spending 36 hours trying not to roll on the thin knitting needles sticking in you was not a wonderful experience, but, as I said, I think that may be a thing of the past.

Not knowing much about prostate cancer, I really wanted to have surgery myself, but the surgeons I consulted said this was best for my large, aggressive, locally advanced cancer. I am glad they knew what they were talking about, and now long term results are confirming their wisdom.

Unfortunately experienced surgeon-radiation oncologist pairs are usually only found in large centres.

Jim

  

Hi Jim,

Thank you for your advice and to the other 6 replies, I have metastatic prostate cancer with the main secondary in my spine L4-5, this was treated 4 years ago with Linac and has been quite successful as the pain was reduced substantially. I also had chemo and Lucrin for the prostate. It has now been 4 years since I was diagnosed. My psa has now started to increase and have been looking at what is the next step. It was originally going to be Enzalutamide but it wasn't continued, I then had a PetCT scan which showed the prostate was the most serious area and I should have radiation. but then I was told that in Europe a paper was submitted at an Oncology meeting saying that Brachytherapy had superior results due to it being able to be positioned more accurately and that the treatment was 1 day rather than 5 weeks for Linac.Unfortunately I haven't been able to find any reference to this paper, hence my question.

I would like to thank all of the respondents as it has provided me with a better understanding of each technique so I can discuss this with my Oncologist

Share this post


Link to post
Share on other sites
deanbatt

https://youtu.be/q5UwHLDC9xE

 

hope this helps

Share this post


Link to post
Share on other sites
Paul
On 6/6/2019 at 2:08 PM, Walter said:

Does anyone have any clinical papers or knowledge of comparing radiation therapy, using linear accelerator, versus brachytherapy. I have been advised that the brachytherapy has advantages in that the radiation is directed directly into the prostate, whereas the linac is broadly focussed through the body, thus requiring multiple treatments.

I would appreciate any information on this subject

 

 

Back in 2011 when I was diagnosed 

My urologist gave me a web link of all the recorded data for each prostate procedure and it’s success rate 

Some of the data has been compiled and updated for 30 years old so it’s quite comprehensive 

 

Just ask your urologist and it will be provided 

Share this post


Link to post
Share on other sites
Barree

Hi Walter, I hope the attached comparative data is the sort of information you are seeking. It’s a few years old now but it is still reasonable indicative of the outcome one can expect from the various treatments being used for treating Prostate Cancer, although it’s not quite as indicative when it comes to evaluating post prostatectomy salvage therapy.If you radiation oncologist feels brachytherapy boost therapy is suitable in your case for salvage RT, it has been shown to be an effective treatment with minimal side effects.

There are some salvage therapy trials coming up using the new combination Magnetic Resonance Linear Accelerator machines. I am not sure if there is one of these machines in Brisbane as yet, but if there is one of these combination machine available,it is more accurate than the cone beam linacs (CBRT).DR PETER GRIMM SEE Comparative analysis of TREATMENTS.pdfDR PETER GRIMM SEE Comparative analysis of TREATMENTS.pdfDR PETER GRIMM SEE Comparative analysis of TREATMENTS.pdf
 

Share this post


Link to post
Share on other sites
alanbarlee

G'day Walter,

 

My only contribution on the basics is to mention conformal 'external beam radiation therapy' (EBRT) vs the more precise and higher energy 'intensity modulated radiation therapy' (IMRT). To further protect sensitive nearby rectal tissue from radiation scatter, a spacing gel can be used. You may want to explore these aspects with your radonc.

 

Low-dose and high-dose brachytherapy are well covered in Jim's response. One advantage of HD brachy for some men (e.g. where travel or personal commitments are an issue) is that it doesn't require multiple treatments. 

 

One distinction between RT and surgery (RP) is that in the case of the latter, the pathologist gets to have a good look at the gland after removal (especially Gleason grade), which can be helpful in prognosis and selecting treatment if needed down the track. This is obviously not possible after RT.

 

The efficacy of RT in general seems to be  similar to RP (surgery), although the side effects are different (e.g. brachy MAY be associated with better erectile dysfunction outcomes), but these can be specific to the individual, and the pros and cons  of all this should be discussed with your docs.   

 

Stereotactic radiation (SABR) is highly precise high energy radiation via a linac or Cyberknife, and is usually reserved for treatable metastatic tumours (generally 5 or less).

 

That's about all I can offer. Good luck with whichever treatment you and your docs settle on.

 

Cheers,

 

Alan

   

Share this post


Link to post
Share on other sites
Walter

H Alan,

Thank you for your advice, my oncologist has recommended EBRT in my case as the first approach, so I am going through 5 weeks of radiation with total of 25 grey.

I hope it is successful and keeps my Psa low

Regards

Walter

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...