Posts Tagged ‘CyberKnife’

5 Day Prostate Cancer Treatment

September 26th, 2011

When you are researching prostate cancer there are a lot of treatment options out there and I highlighted them in a previous blog. What I would like to highlight today is a 5 day course of treatment.

What is a 5 day course of treatment? It is a five-day, non-invasive treatment for prostate cancer (called “stereotactic body radiation therapy” or “SBRT”). SBRT is a specialized form of IMRT (intensity modulated radiation therapy) that delivers high doses of radiation over a period of five days. Instead of giving small doses of radiation each day for several weeks, SBRT involves delivery of very focused beams of high-dose radiation. Several beams are aimed at the tumor from different angles. When for other cancers it is delivered in a single fraction it is known as stereotactic body radiosurgery. Like other forms of external radiation, these treatments are painless.

Currently there are nuances determined by which machine you are treated on. Cyberknife is one machine, another is Elekta Infinity which is what we have here at The Farber Center.

TOTAL TREATMENT TIME: 45 minutes on CyberKnife vs. 20 minutes on Elekta Infinity.

TREATMENT PLANNING: Both CyberKnife and Elekta Inifinity use Monte Carlo based dose calculations. Unlike other planning software programs that use theory models to calculate dose, Monte Carlo is statistical planning and the most accurate. Because Elekta Infinity utilizes a multileaf collumater, which can change shape instantaneously we can mimic the shape of the prostate as seen from different beam angles better, compared to the circular aperture in a CyberKnife system. This will reduce the normal tissue being irradiated from various gantry angles. Thus we can achieve better DVH (Dose Volume Histogram) with LINAC based prostate SRT compared to CyberKnife.

TARGETING THE PROSTATE: None of these machines can track the motion of the prostate throughout treatment AND adjust delivery accordingly. The CyberKnife System uses invasively implanted fiducials as reference points to identify the exact location of the prostate. Patients will wait approximately one week after insertion of the fiducials before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

At The Farber Center for Radiation Oncology we have a completely non-invasive approach to targeting the prostate. We use a RadiaDyne balloon. The balloon acts primarily as an immobilizer reducing the daily variations in location of the prostate, and allowing the rectum and prostate to be positioned in a more predictable and reproducible location during the treatment course. Because of the decreased probability of the prostate moving out of the treatment fields, smaller treatment margins around the prostate may be used. This will have the effect of lowering the radiation dose to the normal tissue surrounding the prostate and lowering the incidence of potential side effects to normal tissues. We also take a second Cone Beam CT Scan in the middle of treatment to verify the position of the prostate. This together with the placement of the RadiaDyne ballon ensures consistency in the location and motion of the prostate during the course of treatment. Due to the fact that we can complete a entire treatment including setup and imaging in under 20 minutes, the amount of prostate motion documented from studies (Both, et al) is kept at a clinical minimum.

KEY POINTS with Elekta Infinity:
5 Day Treatment
No need for surgical procedure
No Hormones
Better bladder DVH
Higher Rate of Erectile Function Preservation
CBCT to see prostate/rectum interface

In my opinion, the most important factors in selecting the right team are the reputation, training and experience of the radiation oncologists and their support staff (physicists, dosimetrists, therapists, nurses, etc.) in treating prostate cancer using SBRT.

77WABC’s Prostate Cancer Expert

September 19th, 2011

Dr. Leonard Farber from The Farber Center for Radiation Oncology is now 77WABC’s prostate cancer expert. Please watch as Dr. Farber talks about what a prostate cancer patient should know.

Please go here 77WABC to learn the key statistics for prostate cancer.

Prostate Cancer Treatment

September 13th, 2011

Let’s take a closer look at the most common cancer in American men, prostate cancer. Why, because its prostate cancer awareness month and 1 man in 6 will be diagnosed with prostate cancer in his lifetime.

So you just got diagnosed with prostate cancer and need to know your options: There is a lot to think about when choosing the best way to treat or manage your prostate cancer. You should always get a second opinion, especially if you have many treatments to choose from. Prostate cancer is a complex disease, and doctors may differ in their opinions about the best treatment options. You will want to weigh the benefits of each treatment against its drawbacks, side effects, and risks.

Current Treatment Options include the following:

ACTIVE SURVEILLANCE
The concept of active surveillance, or watchful waiting means watching the patient closely with regular PSA tests and digital rectal exams every 3 to 6 months. Transrectal ultrasound-guided prostate biopsies may be done every year as well. Treatment is started if the cancer seems to be growing or getting worse, based on either a rising PSA, a change in the rectal exam, or biopsy results.

SURGERY
A surgical approach toward the treatment of prostate cancer is called a prostatectomy. There are several prostatectomy options:

1. Radical Retropubic Prostatectomy: The most common type of prostatectomy involves making an incision in the abdomen and removal of the prostate from behind the pubic bone.
2. Nerve-sparing prostatectomy: The surgeon cuts very close to the edges of the prostate. Care is taken to spare the nerves responsible for erections that run alongside the prostate. In cases when the nerves cannot be spared it may be possible to perform a surgical grafting procedure.
3. Laparoscopic Radical Prostatectomy (LRP): minimal invasive surgery. Very small incisions are made in the abdomen, into which the surgeon inserts narrow instruments fitted with cameras (laparoscope) and/or surgical tools, allowing the surgeon to visualize and operate on the internal structures without cutting open the entire abdomen.
Side effects of prostatectomy
 include urinary incontinence (stress and total), erectile dysfunction (ED) and impotence, and post-operative complications.

RADIATION THERAPY
There are several radiation options for the treatment of prostate cancer.
1. External beam radiation therapy involves focusing a beam of ionizing radiation to the tumor while sparing the surrounding tissue. Treatments are given Monday through Friday and last less than 30 minutes.
2. 3-Dimensional Conformal Radiotherapy (3D-CRT) is a method of treatment delivery that combines multiple radiation treatment fields using 3-Dimensional computer planning to produce a high-dose area of radiation that conforms to the shape of the area to be treated.
4. Intensity modulated radiation therapy (IMRT) is an advanced form of 3D-CRT that modifies the intensity or strength of each radiation beam. It utilizes a sophisticated system of treatment delivery that allows a precise adjustment of the radiation beam intensity to the tissue within the target area while minimizing effects on surrounding tissue.
5. IGRT or Image Guided Radiation Therapy is another technology that can also be used to ensure better targeting of daily radiation treatments.
5. The Newest Technique is Stereotactic body radiation therapy (SBRT) is a specialized form of 3D-CRT that delivers high doses of radiation over a period of five to ten days.
6. Brachytherapy refers to the technique of implanting small radioactive sources directly into the prostate gland. This procedure takes place under anesthesia, usually in the operating room. Brachytherapy is generally used only in men with early stage prostate cancer that is relatively slow growing. There are two methods of delivering this type of radiation to prostate cancer:

HORMONE THERAPY
is also called androgen deprivation therapy (ADT) or androgen suppression therapy. Often hormone therapy will be used in addition to other treatment. It may consist of a combination of injections and oral tablets. Therapy typically begins at least two months prior to radiotherapy and may be recommended for up to three years depending on the clinical situation.

To find out more or speak directly to Dr. Leonard Farber, please visit The Farber Center for Radiation Oncology

Gay Men Face Extra Burden with Prostate Cancer

June 21st, 2011

Researchers at the American Urological Association Annual Meeting reported that Gay men have a tougher time dealing with the aftermath of prostatectomy than heterosexual men do.

Prostate cancer is one of the most common cancers in men. Gay men with prostate cancer have some additional social and sexual challenges that are rarely addressed adequately by their oncologists and social workers. For example, prostate cancer treatment can have some distinct effects on gay sexual behavior and relationships. In fact David M. Latini, PhD, Assistant Professor of Urology & Psychiatry at Baylor College of Medicine used a battery of studies to determine the health-related quality of life for gay men compared with a historical control group. He found that the results showed that gay men fared consistently worse than the comparison group.

Dr. Latini also noted that many gay men, had severe sexual quality-of-life disturbances because the aftermath of prostatectomy was not helped as much by phosphodiesterase-5 inhibitor medication that allows men with erectile dysfunction to function sexually.

“For gay men this is a particularly difficult area,” he explained. “The phosphodiesterase-5 inhibitors were created with an endpoint in the trials of vaginal penetration. We know that an erection has to be firmer to penetrate someone anally. So for sexual intercourse between two males, these medications are usually not sufficient.”

To download the study and full article as it appeared in the June 2011 Oncology times click here: PDF File Oncology Times.

For support services and more information on cancer risk and gay men please visit Malecare.org America’s largest volunteer men’s cancer support group and advocacy national nonprofit organization. Malecare, Inc. is a 501(c) (3) nonprofit organization, founded in 1997. Malecare develops practical, life saving programs to address the problem of men dying sooner than women. Since 2005, they have expanded their programs to include services and research regarding the effects of cancer on Lesbian, Gay, Bisexual and Transgender people via our new nonprofit organization, the National LGBT Cancer Project-Out With Cancer.

Below is a video on Prostate Cancer: