Remote Afterloading Transurethral Radiotherapy for Prostatic Cancer

From September 1989 to February 1993, 11 patients with localized adenocarcinoma of the prostate were treated with pelvic external-beam radiation therapy followed by high dose rate (HDR) transurethral brachytherapy as a boost dose. External-beam radiation therapy was administered through opposed pelvic fields using a 60Co teletherapy unit to a tumor dose of 46–50 Gy in 23–25 fractions and followed by three fractions of transurethral brachytherapy, delivered using a ⁶⁰Co HDR remote afterloading equipment. The treatment time was calculated using the prostatic capsule as the reference point. The dose calculated to be delivered to the capsule was 5 Gy/fraction, making a total of 15 Gy. The follow-up period ranged from 11 to 65 months, with a median follow-up time of 30 months. Local control was achieved in all patients. The prostate-specific antigen levels were normalized within 3 months of radiotherapy in 9 patients and within 3–6 months in the remaining 2. Transurethral brachytherapy appears to be a simple and feasible form of brachytherapy. Preliminary local control and radiotherapy-related morbidity rates are comparable to those of other forms of brachytherapy. Further follow-up is required for assessment of long-term local control and delayed radiotherapy-related morbidity.

Section: Discussionmentioning

confidence: 99%

High Dose Rate Transurethral Brachytherapy as a Boost Dose for Localized Adenocarcinoma of the Prostate

Serin

Erkal²,

Sak³

et al. 1997

“…The radia tion techniques employed have been external beam RT (EBRT) and brachytherapy using moulds and implants [3]. ILRT has been used with EBRT and surgery in the treatment of bronchogenic, esophageal and prostatic car cinomas [11][12][13]. We have demonstrated successfully, for the first time in available literature, the use of ILRT as an adjunctive modality in the treatment of urethral carcino ma.…”

Section: Discussionmentioning

confidence: 99%

Innovative Treatment of Carcinoma ofthe Male Urethra

Ramamurthi

Sastry²

1995

“…The dose delivered was 50 Gy in 24 h. Tran sient and mild acute toxicity was observed without severe late complications. Another study from Japan [10], de scribed a technique for transurethral brachytherapy for rather advanced staged prostatic carcinoma. Two out of 4 patients showed complete response confirmed by biopsy 6 months after irradiation.…”

Section: Discussionmentioning

confidence: 99%

Transurethral <sup>137</sup>Cs Medium Dose Rate Radiotherapy as a Boost for Small-Sized Localized Prostatic Carcinomas

Skarlatos

Koukourakis²,

Zambatis³

et al. 1994

The aim of this study is to present preliminary experience with ¹³⁷Cs medium dose rate (MDR) afterloading transurethral radiotherapy for small-sized ( < 2.5 cm) prostatic carcinomas. The phase II protocol comprises 46 Gy of external beam radiotherapy, followed by two insertions (1 week apart) of 137Cs MDR transurethral brachytherapy, each one delivering 8 Gy to a point 0.5 cm from the urethral walls. The treatment is completed with a 14-Gy boost to the prostatic area through lateral external beam fields. Up to now, 9 patients have been treated. The transurethral insertion is a simple procedure, requires no anesthesia and the ultrasonographic observation precisely and easily guided the positioning of the applicator. All 9 patients are alive and disease-free 12-––36 months after the end of radiotherapy. One of them presented a mild degree of urethral stricture and none developed chronic proctitis or cystitis. Seven patients were sexually potent before radiotherapy and all of them maintained their potency. Transurethral radiotherapy for prostatic carcinoma requires further investigation. The radiation dose that the procedure delivers to the prostate is higher than the one prescribed for external beam irradiation regimens. Rectal and bladder dose is substantially reduced. Although the prostatic urethra receives a higher dose, the incidence of urethral stricture is low probably because of the small tissue volume (8 cm³) in the high radiation dose area.