- An 11-month-old boy from Vietnam is the first child to undergo a novel radiation therapy in Singapore to treat a rare cancer in his prostate
- Called interstitial brachytherapy, it allows radiation to be delivered directly inside a tumour through plastic needles or catheters
- Using this internal radiation method, surrounding healthy tissue is spared radiation's harmful side effects
- At one point, 10 catheters were inserted into the baby’s tumour and left there over five days
- The boy’s mother said she came to Singapore because treatment options in Vietnam for babies with cancer are “limited”
SINGAPORE — When he is much older, little Nguyen Hai Dang could possibly tell of how brave he was when he was a mere 11-month-old baby.
While undergoing a new radiation therapy for a cancerous tumour in his prostate, his testicles were relocated for a while and 10 tubings were inserted into his prostate and left there for several days.
It was a sight that would make any adult feel faint. So how did this Vietnamese boy end up there on the hospital bed at KK Women’s and Children’s Hospital (KKH) in June 2020?
The first child of Madam Nguyen Hong Nhung, he kept vomiting after drinking milk, so she thought at first that he had acid reflux, where stomach acid flows backwards from the stomach to the oesophagus. Acid reflux is common even in healthy infants.
An ultrasound scan later showed that nothing was wrong with his stomach but it detected a kidney infection. This was caused by a tumour in his prostate, obstructing urine flow, the mother said.
The baby was later diagnosed with a rare type of soft tissue cancer called embryonal rhabdomyosarcoma of the prostate.
In an email interview with TODAY, Mdm Nguyen, 31, an accountant, recounted the shock and fear that she and her husband Nguyen Ngoc Sanh had gone through, from the time their only child was diagnosed to their desperate search for treatment. Mr Nguyen, 33, works in sales.
She said: “At the time, we felt hopeless. We could not believe that our three-month-old baby had been diagnosed with cancer.”
They decided to have their child treated in Singapore after consulting with doctors in their home country. That was because treatment options in Vietnam for babies with cancer are “limited”, Mdm Nguyen said.
When the Nguyens arrived in Singapore in late-2019 and stayed with a friend, they started Hai Dang on chemotherapy at National University Hospital (NUH) before he was later referred to KKH in June 2020 for consideration of surgery and brachytherapy.
The first Covid-19 wave peaked around that time and it complicated matters.
“What was difficult was that when he had a fever as a side effect of chemotherapy or an infection, he had to go to the hospital. There, he would be isolated and tested for Covid-19, which frightened him,” Mdm Nguyen recounted.
For his cancer, baby Hai Dang underwent interstitial brachytherapy, whichallows radiation to be delivered directly inside a tumour through a delivery device such as plastic needles or catheter.
This is unlike conventional external beam radiation therapy, which delivers radiation to an area of the body and which also often affects the surrounding healthy tissue.
FIRST CHILD PATIENT TO GET TREATMENT
Now three years old, Hai Dang is the first child in Singapore to have received interstitial brachytherapy for childhood cancer treatment.
He was only 11 months old at the time of treatment in June 2020.
A Singaporean girl, Kristal Yong, 12, is the second child to receive the internal radiation therapy for her cancer treatment, which took place last year (see separate report below).
She also had rhabdomyosarcoma, but in her case, the tumour was in her right eye socket (called orbital rhabdomyosarcoma).
Both Hai Dang and Kristal are patients at KKH.
The hospital sees around 100 cases of childhood cancers each year, of which two to three cases are rhabdomyosarcomas.
Due to the complexity of Hai Dang’s and Kristal’s illnesses, their treatments were planned and carried out by multidisciplinary teams from public healthcare group SingHealth, including KKH, National Cancer Centre Singapore, Singapore General Hospital and Singapore National Eye Centre.
Evidently, there was some hesitancy at first for the parents.
“We were very worried because there had never been a case like Hai Dang before for this treatment in Singapore,” Mdm Nguyen said, but she and her husband decided on interstitial brachytherapy because the internal radiation method would target the tumour directly, and there would be fewer side effects than conventional radiation.
SPARING HEALTHY TISSUE
At a media briefing on June 21, Associate Professor Joyce Lam Ching Mei, a senior consultant at KKH’s haematology-oncology service, said that an advantage of using the internal radiation method is that the patient’s surrounding healthy tissue is spared the side effects of radiation.
“Traditionally, interstitial brachytherapy is performed on adult patients with prostate cancer or gynaecological cancers of the breast or cervix. But in highly experienced tertiary centres, brachytherapy is sometimes used on children,” she said.
Assoc Prof Lam explained that due to the location of Hai Dang’s tumour in the prostate, the team devised the treatment plan in the hopes of preserving the child’s fertility while maintaining quality of life, as well as reducing the long-term impact on urinary function.
Mdm Nguyen said that the other proposed treatment option —involving surgery to remove the bladder — would severely affect her son’s quality of life.
“It made sense for us to try (interstitial brachytherapy) before deciding to remove the entire bladder because it would affect his quality of life later on, especially when Hai Dang is so young,” she added.
Dr Amos Loh from KKH, who is one of the doctors caring for Hai Dang, explained that the child would not be able to urinate normally if the bladder was surgically removed.
The senior consultant from the department of paediatric surgery explained: “He would require surgical reconstruction of a neobladder, which is a fabricated bladder fashioned from his own intestine, to store urine. (The urine) would then flow out via an opening on the abdominal wall.
“Often, also, erectile function is affected due to the erectile nerves being removed as part of surgery to remove the bladder.”
“The boy’s testicles were moved back to the normal position in the scrotum, after his cancer treatment was completed. The surgery is unique to our paediatric oncology patients and not commonly performed.
Dr Amos Loh, senior consultant from the department of paediatric surgery at KK Women's and Children's Hospital
To preserve Hai Dang’s reproductive functions from the harmful effects of radiation exposure, Assoc Prof Lam explained that the surgical team temporarily relocated the boy’s testicles “as far away as possible” to the thigh area before radiation was delivered directly into the tumour.
Dr Amos Loh said: “The boy’s testicles were moved back to the normal position in the scrotum, after his cancer treatment was completed. The surgery is unique to our paediatric oncology patients and not commonly performed.”
The way in which interstitial brachytherapy is carried out can be daunting and frightening even for adult patients.
The catheters that deliver the radiation to the tumour are placed and temporarily stay in the patient’s body during their inpatient treatment.
After a surgery to relocate his testes to the thigh, Hai Dang had 10 brachytherapy rods (or catheters) inserted — under general anaesthesia — into his tumour and left there for the entire duration of the treatment over five days.
To prevent the catheters from dislodging, the child’s hips were immobilised in a cast.
Dr Enrica Tan, senior consultant at KKH’s haematology-oncology service, who is also on Hai Dang’s care team, said that painkillers such as paracetamol and morphine were given to help relieve pain and discomfort.
Hai Dang’s parents were heartbroken to hear their baby crying during his treatments to express his pain and discomfort.
“He cried a lot,” Mdm Nguyen recalled.
“I also do not know how I made it through (the difficult days). It’s all thanks to the love I have for my child.”
His parents were counselled before the procedure to help them anticipate the caregiving needs.
Dr Tan said: “His mother who was the main caregiver was well-prepared and played a big role in soothing the child, helping to clean his perineum (the area between the anus and genitals) together with the nurses, deftly positioning herself to breastfeed him to comfort him while he was immobilised and lying down.”
Over two years, Hai Dang’s medical expenses came to about S$250,000, of which more than half was paid through money raised from crowdfunding, the Nguyens said, adding that they are thankful for the financial help.
The sum was for bills paid to KKH and the initial chemotherapy treatments at NUH.
Hai Dang will be back in Singapore at the end of the year for a check-up. There have been no active cancer cells detected after the treatment.
Mdm Nguyen said that her son is now very active and likes watching cartoons and horsing around the playground.
“We hope he will always be healthy, grow up well and be happy by our side.”
A CHANCE TO PRESERVE SIGHT FOR 11-YEAR-OLD GIRL
The second child to receive interstitial brachytherapy at KK Women's and Children's Hospital (KKH) for cancer treatment was Kristal Yong.
However, her case is the first time that interstitial brachytherapy is performed in a child with orbital rhabdomyosarcoma in Southeast Asia and Singapore.
Kristal’s cancer was discovered after her parents noticed a small pimple-like but painless swelling near her eye.
Her mother, Madam Lim Hwee Ping recalled that she had to agonise over whether to let her daughter undergointerstitial brachytherapyor go for the more conventional external radiation method.
The 43-year-old homemaker said: “To be honest, we were not keen (at first). Our main concern was, was it safe for her?”
“Second, was the team confident enough to do it because we didn’t want her to be a guinea pig.
“An experiment can fail, you can do another experiment, but she has only that one chance. I only have one daughter.”
Mdm Lim said that they finally decided to choose interstitial brachytherapy.
“We just want her to have the best chance in life because she has a long runway,” the mother said, adding that the doctors’ dedication to Kristal’s case gave her and her husband the confidence to go ahead with their decision.
In Kristal’s case, Assoc Prof Lam said that interstitial brachytherapy was proposed because its advantage of reducing complications to surrounding normal tissue is crucial in preserving the child’s sight.
Clinical Assistant Professor Kiattisa Sommat from National Cancer Centre Singapore (NCCS) said that this “concentrated way” of delivering radiation to a tumour would also minimise the risk of the patient developing a second cancer due to radiation exposure of normal tissue.
Assistant Prof Kiattisa is a senior consultant at NCCS’ division of radiation oncology and one of the doctors involved in Kristal’s treatment and care.
She added that interstitial brachytherapy is not widely available now because it requires a level of technical skills to place the radiation source into the area of treatment. The cost is dependent on the site of treatment.
When asked about the risks of interstitial therapy, Asst Prof Kiattisa said one of the things that could “go wrong” is during the process of inserting the brachytherapy catheters, which requires precision control.
“A difference of a few millimetres may mean injuring the optic nerve,” she said, referring to Kristal’s case.
Kristal’s mother recalled breaking down in tears after seeing the brachytherapy catheters in her daughter’s eye for the first time in February last year.
She had six plastic catheters inserted into the tumour in her right eye.
For a week, radiation doses were delivered at fixed times of the day.
“I was too shocked. I already mentally prepared (myself) but when I saw my daughter, I couldn’t take it. I just cried until I could accept it,” Mdm Lim said.
To avoid causing distress to Kristal, the medical team taped up mirrors in her room.
However, as the days went by, Mdm Lim said that she “got used” to seeing the catheters sticking out of her child’s eye. Kristal’s ability to adapt to the strange situation also made her feel more at peace.
“Kids tend to be more resilient than what we think they are,” the mother said.
The girl, who had shown bravery and maturity beyond her years throughout her cancer ordeal, played games on her iPad while being confined to the hospital bed.
Kristal said: “When I’m scared (during my treatment), I’d play with the soft toy that my mother bought me.”
Now back at school and with no active cancer cells detected, Kristal will be taking her Primary School Leaving Examination this year.
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Generally, about 1 to 4 brief treatments are given over 2 days, and the radioactive substance is removed each time. After the last treatment the catheters are removed. For about a week after treatment, you may have some pain or swelling in the area between your scrotum and rectum, and your urine may be reddish-brown.
External Beam Radiation Therapy (EBRT)
This is the most common type of radiation therapy, and it is painless. Before treatment, your radiation team will use computerized tomography (CT) scans and magnetic resonance imaging (MRI) scans to map out the location of the prostate and tumor cells.
- Frequent urination.
- Difficult or painful urination.
- Blood in the urine.
- Urinary leakage.
- Abdominal cramping.
- Painful bowel movements.
- Rectal bleeding.
The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area. Late side effects can take months or even years to develop.
Recent studies have shown that for optimal results, PSA levels should be lower than 1 ng/ml, and even lower than 0.5 ng/ml. Levels that are above 1 or 2 ng/ml 12 to 18 months following completion of radiation treatments are very worrisome, because they indicate that the cancer may not have been eradicated.
Median follow-up time for this report was 41 months (range=14.6-59.0). Following treatment with stereotactic radiation, more than eight in ten patients (84%) survived at least 1 year, and four in ten (43%) survived 5 years or longer. The median overall survival (OS) time was 42.3 months.
However, you may have to limit contact with other people for up to one week after treatment. It is especially important to avoid close contact with children and women who are pregnant. Be sure to ask your treatment team what precautions you need to take.
How will I know if the treatment is working? Serial PSA blood tests will be used to monitor your progress after definitive treatment of your prostate cancer. Following radiation therapy, your PSA will fall but will not reach its lowest value, or nadir, immediately after treatment.
|Part of the body being treated||Possible side effects|
|Head and Neck||Fatigue Hair loss Mouth problems Skin changes Taste changes Throat problems, such as trouble swallowing Less active thyroid gland|
Tiredness and weakness
It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to. Tiredness can carry on for some weeks after the treatment has ended but it usually improves gradually.
Defining biochemical recurrence
This is because after radiation therapy the prostate gland remains intact and can recover some function. This is also true if you received hormone therapy as part of your radiation treatment: As you recover, testosterone levels rise, and so does your PSA.
After treatments like chemotherapy, radiation, immunotherapy, and targeted therapy, your doctor will examine you for any new growths. You'll also get blood tests, X-rays, and other imaging tests. These tests will measure your tumor and see if your treatment has slowed or stopped your cancer.
You will meet with your radiation oncologist about 3 to 6 weeks after you complete your radiation treatments. Your radiation oncologist may ask you to have another scan (CT, PET, or MRI) before the follow-up appointment. You will meet with your doctor 3 to 6 weeks after you complete your radiation treatment course.
The total dose of external radiation therapy is usually divided into smaller doses called fractions. Most patients get radiation treatments daily, 5 days a week (Monday through Friday) for 5 to 8 weeks. Weekend rest breaks allow time for normal cells to recover.
New research from Roswell Park Comprehensive Cancer Center, to be presented at the American Association for Cancer Research (AACR) Annual Meeting 2019 in Atlanta, reports that administering radiation treatments in the morning as opposed to later in the day can significantly reduce severity of mucositis and its related ...
2.5-3.5: Normal for a man 50-60 yrs. 3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.
Salvage radical prostatectomy is the most commonly performed curative treatment for clinically localized prostate cancer after radiation therapy. This procedure is capable of eradicating the local lesion and providing long-term disease-specific survival.
Researchers concluded that when PSA levels remain low (less than 2 ng/mL) five years after external beam radiation therapy, the great majority of patients will be biochemically disease-free at 10 years.
“When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.
If radiotherapy doesn't kill all of the cancer cells, they will regrow at some point in the future. We have more information about radiotherapy treatment. Some immunotherapies or targeted cancer drugs may get rid of a cancer completely. Others may shrink the cancer or control it for some months or years.
Avoid raw vegetables and fruits, and other hard, dry foods such as chips or pretzels. It's also best to avoid salty, spicy or acidic foods if you are experiencing these symptoms. Your care team can recommend nutrient-based oral care solutions if you are experiencing mucositis or mouth sores caused by cancer treatment.
Children are at a greater risk than adults to develop cancer after being exposed to radiation. Increases in the rates of leukemias and thyroid cancers associated with childhood exposure to radiation from A-bomb explosions, nuclear power plant explosions, and medical procedures have been well documented.
Usually, the fetus receives less radiation than the mother. The mother's abdomen partially protects the baby. However, if you swallow or breathe in radiation, it can cross over into the baby. The baby is most sensitive to radiation from 2 to 18 weeks of pregnancy.
With internal radiation, you may need to avoid touching the patient until the implant is removed or limit the time you spend very close to them. With systemic radiation therapy, you may also have to avoid the person's bodily fluids for a few days after treatment.
How long does radiation therapy take to work? Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before cancer cells start to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.
Weight changes during the radiotherapy were as follows: 78.7% of patients lost weight, 8.5% gained weight (0.7 −3.6 kg), and 12.8% had no weight change. Weight loss was significant (t-test two-paired, p-value <0.001) and ranged from 1.1% to 18.9%.
Fatigue is the most common acute side effect of radiation therapy. It is believed to be caused by the large amount of energy that is used by the body to heal itself in response to radiation therapy. Most people begin to feel fatigued about 2 weeks after radiation treatments begin.
You may need anesthesia to block the awareness of pain while the radioactive sources are placed in the body. Most people feel little to no discomfort during this treatment. But some may experience weakness or nausea from the anesthesia. You will need to take precautions to protect others from radiation exposure.
They're very small and rarely cause pain, so doctors usually leave them in your prostate after they stop giving off radiation. Temporary brachytherapy. Your doctor may also call this “high dose rate” brachytherapy.
Both radiation and surgery are equally effective treatments to cure prostate cancer." The choice of which treatment is best is up to individual patients and their care teams, Dr. King says. "Make sure you talk with a surgeon and a radiation oncologist before you make your decision.
A rise in your PSA level may suggest that you still have some prostate cancer cells. After radiotherapy or brachytherapy, your PSA should drop to its lowest level (nadir) after 18 months to two years. Your PSA level won't fall to zero as your healthy prostate cells will continue to produce some PSA.
Most people have 5 treatments each week (1 treatment a day from Monday to Friday, with a break at the weekend). But sometimes treatment may be given more than once a day or over the weekend.
Treatment for cancer, including radiation and chemotherapy, can also cause sleep problems because it can throw off patients' sleep cycles, possibly due to hospitalizations (which can interfere with regular sleep patterns) or because of physical symptoms (such as pain) that can make it difficult to sleep.
You may have pain after treatment. In some cases, it is caused by the treatment itself. Types of pain you may feel following cancer treatment include: Skin sensitivity where you received radiation.
Your radiographer uses the tattoos to line up the radiotherapy machine for each treatment. This makes sure that they treat exactly the same area each time.
Wear loose, soft, cotton clothing over the area being treated. Avoid stiff or starched clothing near the area being treated. Do not put anything but mild soap (such as Dove) and lukewarm water on the skin in the treated area, unless the doctor or nurse says that it is safe to do so.
After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and help fight infection. Good sources of protein include fish, poultry, lean red meat, eggs, low-fat dairy products, nuts and nut butters, dried beans, peas and lentils, and soy foods.
Preparing for prostate radiotherapy treatment - YouTube
Good sources of protein include lean meat, fish, poultry, dairy products (cheese, Greek yogurt, milk, cottage cheese), eggs, nuts, beans & lentils, soyfoods (tofu, soymilk, tempeh, edamame), commercial nutrition beverages (like Ensure® , Boost®, or Orgain™, Enu™) and protein powders.
Prostate cancer can come back, even after you've had treatment and your doctor declared you cancer-free. Prostate cancer that returns after treatment is called recurrent prostate cancer. Prostate cancer returns for a couple of reasons: Some cancer cells were left behind after surgery or radiation therapy.
Gray (Gy) is the unit used to measure the total amount of radiation that the patient is exposed to. This can also be recorded as centigray (cGy), which is 0.01 of a single Gy unit. Adjuvant therapy doses typically range from 45 to 60 Gy for the treatment of breast, head, and neck cancers.
Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.
After completing external beam radiation therapy (EBRT), urinary and bowel side effects may persist for two to six weeks, but they will improve over time. You may need to continue some medications. Some patients report continued, though lessening fatigue for several weeks after treatment.
The treatment, called 177Lu-PSMA-617, uses a molecule that selectively seeks out and attaches to a specific protein on the cancer cell surface called PSMA (prostate-specific membrane antigen). The technology delivers radiation that damages DNA and destroys the cancer cell.
There is no cure for metastatic prostate cancer, but it is often treatable for quite some time. Many people outlive their prostate cancer, even those who have advanced disease. Often, the prostate cancer grows slowly, and there are now effective treatment options that extend life even further.
Both radiation and surgery are equally effective treatments to cure prostate cancer." The choice of which treatment is best is up to individual patients and their care teams, Dr. King says. "Make sure you talk with a surgeon and a radiation oncologist before you make your decision.
Baby endured 10 tubes in prostate for cancer radiation therapy at KKH, done first time for a child ›
When it comes to feeding your baby, you have two options: homemade baby food or store-bought baby food.. If you have the time and energy to make your baby food, go for it!. At KKH, a novel cancer treatment called interstitial brachytherapy was used for the first time in Singapore for cancer in children.. FIRST CHILD PATIENT TO GET TREATMENT Now three years old, Hai Dang is the first child in Singapore to have received interstitial brachytherapy for childhood cancer treatment.. Both Hai Dang and Kristal are patients at KKH.. “We were very worried because there had never been a case like Hai Dang before for this treatment in Singapore,” Mdm Nguyen said, but she and her husband decided on interstitial brachytherapy because the internal radiation method would target the tumour directly, and there would be fewer side effects than conventional radiation.. Photos courtesy of Nguyen Hong Nhung and Nguyen Ngoc Sanh Nguyen Hai Dang, at three years old in 2022, no longer has active cancer cells detected two years after undergoing interstitial brachytherapy.
While the benefit of androgen deprivation therapy (ADT) has been demonstrated for the adjuvant setting in a randomized trial by the Eastern Cooperative Oncology Group (ECOG 3886) and for the definitive setting in subgroup analyses of randomized trials by the Radiation Therapy Oncology Group (RTOG 85-31) and Granfors et al, there has not been a randomized trial published that specifically evaluates the benefit of adding radiation therapy to ADT for node-positive patients.. Clinicians who feel optimistic about the benefits of RT will cite the Surveillance, Epidemiology and End Results (SEER) studies by Tward et al and Rusthoven et al, that showed that treatment with radiation was associated with significantly improved survival.. Radiation pessimists may also point out that the study by Kaplan et al from SEER-Medicare did not find a PCSM benefit to postoperative radiation after prostatectomy.. The role of radiotherapy for node-positive prostate cancer.. Int J Radiat Oncol Biol Phys.. Int J Radiat Oncol Biol Phys.. We are in urgent need of a randomized trial comparing radiation plus ADT vs ADT alone for men with node-positive prostate cancer.
Radiation therapy uses invisible, high-energy radiation to destroy cancer cells.. The two main types of radiation therapy used in prostate cancer treatment are: external beam radiation and internal radiation therapy (often called brachytherapy ).. Whether a prostate cancer patient receives external or internal radiation therapy generally depends on several factors, including the type, size, and location of the tumor.. As a stand-alone treatment, especially in cases where the disease is confined to the prostate In combination with other treatments, such as hormone therapy If the cancer recurs after surgery As a palliative treatment for advanced cancer to help shrink tumors that may be causing pain by pressing against bone or organs. If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the person’s overall health and well-being through the process.. The therapy may also be an option for patients with recurrent prostate cancer who have received radiation therapy for their cancer in the past.. This type of radiation therapy may be a treatment option for patients with early-stage prostate cancer .. Many of the possible side effects of radiation therapy for prostate cancer involve the bladder and bowel—the prostate is very close to both.. The SpaceOAR ® System may also be incorporated during radiation therapy for prostate cancer to reduce the radiation dose to the rectum.. Patients who receive radiation therapy for prostate cancer may experience a wide range of short-term and long-term side effects.
A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.. Radiation therapy can treat many different types of cancer.. There are many different types of radiation therapy, and they all work a little bit differently to destroy cancer cells.. Before other treatments.. After other treatments.. For some cancers, radiation therapy alone is an effective treatment.. This type of radiation therapy is when radioactive material is placed into the cancer or surrounding tissue.. However, some radiation may exit the patient's body.. Patients swallow or receive an injection of radioactive material that targets cancer cells.. Radioprotectors are substances that protect healthy tissues near the treatment area.. Like other cancer treatments, radiation therapy causes side effects .. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered.. Permanent implants remain radioactive after the patient leaves the hospital.. How often will I have radiation therapy?
A Patterns of Care Study was performed throughout Japan to examine the patterns of radiation therapy for prostate cancer.. Detailed information was collected on a total of 311 prostate cancer patients without evidence of distant metastases, who were treated by radiation therapy between 1996 and 1998.. Japan Medicine & Life Sciences 100% Prostatic Neoplasms Medicine & Life Sciences 95% Radiotherapy Medicine & Life Sciences 83% Androgens Medicine & Life Sciences 31% Photons Medicine & Life Sciences 18% Prostate-Specific Antigen Medicine & Life Sciences 17% Duration of Therapy Medicine & Life Sciences 16% Prostate Medicine & Life Sciences 14%. Radical radiation therapy for prostate cancer in Japan: A patterns of care study report .. Nakamura, K, Teshima, T, Takahashi, Y, Imai, A, Koizumi, M, Mitsuhashi, N & Inoue, T 2003, ' Radical radiation therapy for prostate cancer in Japan: A patterns of care study report ', Japanese Journal of Clinical Oncology , vol.. title = "Radical radiation therapy for prostate cancer in Japan: A patterns of care study report",. A Patterns of Care Study was performed throughout Japan to examine the patterns of radiation therapy for prostate cancer.. Detailed information was collected on a total of 311 prostate cancer patients without evidence of distant metastases, who were treated by radiation therapy between 1996 and 1998.. A Patterns of Care Study was performed throughout Japan to examine the patterns of radiation therapy for prostate cancer.. A Patterns of Care Study was performed throughout Japan to examine the patterns of radiation therapy for prostate cancer.
First of all, I think the most common metastatic disease is the disease that you don't see.. One is that if you give hormone therapy before radiation and you radiate the pelvic lymph nodes, the patients have a better disease-free survival than if you give hormone therapy before and just radiate the prostate.. So the other thing that was a bit surprising was that their traditional dogma, if you survey 100 radiation oncologists and you asked them, does it matter if you're going to just radiate the prostate, does it matter whether you give the hormone therapy before the radiation or after the radiation, they'll say you should give it before.. With a median follow up of 14 years in surviving patients, the patients who got the hormone therapy after the radiation did better than those who got it before the radiation.. Charles Ryan : I've known about the original data from 9413 for a long time and thought about it as I talked to patients and whatnot.. And I always wonder if hormone therapy, even of a short duration, can eradicate some of that disease that's out there in the circulation that would otherwise potentially lead to PSA relapse or even metastases and that the hormone therapy is actually doing systemic therapy, having a systemic eradicating function in addition to its radiation sensitizing function in the lymph node compartment and in the prostate compartment.. Mack Roach : Well except that then how do you explain the fact that hormone therapy plus radical prostatectomy doesn't work?. Mack Roach : We're talking about four months of hormone therapy.. In the patients that receive radiation alone at five years, 40% of these patients had metastases.. We allow longer-term hormone therapy because we know that's better for high-risk patients so we're stratifying by that.. Mack Roach : Great wine takes a long time to make.
Radiation therapy can cure many cancers (see also Overview of Cancer Therapy Overview of Cancer Therapy Curing cancer requires eliminating all cells capable of causing cancer recurrence in a person's lifetime.. Radiation therapy plus surgery (for head and neck, laryngeal, or uterine cancer) or combined with chemotherapy and surgery (for sarcomas or breast, esophageal, lung, or rectal cancers) improves cure rates and allows for more limited surgery.. Radiation therapy may be given before surgery or chemotherapy ( neoadjuvant therapy Adjuvant and Neoadjuvant Therapies Systemic cancer therapy includes chemotherapy (ie, conventional or cytotoxic chemotherapy), hormone therapy, targeted therapy, and immune therapy (see also Overview of Cancer Therapy).. The number... read more ) or after surgery or chemotherapy ( adjuvant therapy Adjuvant and Neoadjuvant Therapies Systemic cancer therapy includes chemotherapy (ie, conventional or cytotoxic chemotherapy), hormone therapy, targeted therapy, and immune therapy (see also Overview of Cancer Therapy).. Proton therapy has advantages over gamma radiation therapy in that it deposits energy at a depth from the surface, whereas gamma radiation damages all tissues along the path of the beam.. In conformal radiation therapy, imaging technology allows the radiation beam to be shaped to conform to the dimensions of the tumor, allowing more precise targeting.
Commentary (Valicenti): Integrating Hormonal Therapy With External-Beam Radiation and Brachytherapy for Prostate Cancer ›
 Important Related Issues In light of the benefit of hormonal therapy with EBRT, the authors address central questions about patient selection for combined-modality therapy, the biologic interaction between hormonal therapy and EBRT, the optimal sequence of hormonal therapy, the volume to be irradiated, and finally, the optimal duration of hormonal therapy.. In the absence of prospective randomized trials testing hormonal therapy and permanent prostate implants, it is essential to raise these important questions when considering the use of hormonal therapy or EBRT with permanent prostate implants..  According to the RTOG system, low-risk patients do not benefit from hormonal therapy, intermediate-risk patients benefit from short-duration hormonal therapy, and high-risk patients (groups 3 and 4) have an overall survival benefit with long-duration hormonal therapy..  Thus, if there is a plateau in improved local tumor control with neoadjuvant hormonal therapy and EBRT in the 70- to 80-Gy range, it is unlikely that neoadjuvant hormonal therapy would result in an observable benefit in dose-escalated prostate-targeted therapy, whether via permanent prostate implants or intensity-modulated radiation therapy.. This trial randomized patients to four treatment arms that included 4 months of neoadjuvant hormonal therapy and whole-pelvic irradiation, 4 months of neoadjuvant hormonal therapy and prostate-only radiotherapy, whole-pelvic irradiation and 4 months adjuvant hormonal therapy, or prostate-only irradiation and 4 months of adjuvant hormonal therapy.. In selected patients, the combination of EBRT, short-duration neoadjuvant hormonal therapy, and permanent prostate implants is justifiable, and it is perhaps necessary to use neoadjuvant hormonal therapy and pelvic- field irradiation with permanent prostate implants to fully maximize improved outcomes.. However, this approach should be tailored to carefully address the possibility of additional acute and late toxicity by combining neoadjuvant hormonal therapy or adjuvant hormonal therapy with EBRT or permanent prostate implants.. [7,8] Unfortunately, previous retrospective studies evaluating neoadjuvant hormonal therapy, EBRT, and permanent prostate implants did not routinely tailor the EBRT to pelvic nodal sites or uniformly use a certain sequence or duration of hormonal therapy.. Recently, RTOG 92-02 demonstrated an improvement of disease-specific survival and overall survival (in patients with Gleason score 8 or higher) after long-duration adjuvant hormonal therapy (28 months) and EBRT compared with neoadjuvant hormonal therapy (4 months) and EBRT.