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The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Single-Dose Focal Salvage High Dose Rate Brachytherapy for Locally Recurrent Prostate Cancer.

P Chitmanee1, Y Tsang1, H Tharmalingam1

  • 1Mount Vernon Cancer Centre, Northwood, Middlesex, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|November 12, 2019
PubMed
Summary

Focal high dose rate (HDR) brachytherapy shows 46% biochemical control at 3 years for recurrent prostate cancer. Lower PSA nadir post-treatment is linked to better outcomes, with manageable side effects in selected patients.

Keywords:
Brachytherapyhigh dose rateprostate cancerrecurrentsalvage

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • Locally recurrent prostate cancer after initial treatment presents a clinical challenge.
  • Salvage therapies aim to improve outcomes for patients with biochemical relapse.
  • Focal high dose rate (HDR) brachytherapy is an emerging option for localized recurrence.

Purpose of the Study:

  • To evaluate the efficacy and toxicity of focal HDR brachytherapy as a salvage treatment for recurrent prostate cancer.
  • To identify predictors of biochemical control after focal salvage HDR brachytherapy.

Main Methods:

  • Retrospective analysis of 50 patients with biochemically recurrent prostate cancer treated with focal HDR brachytherapy (19 Gy).
  • Tumor localization using template mapping biopsies and multiparametric MRI.
  • Assessment of biochemical relapse-free survival and toxicity (IPSS, CTCAE v4.0).

Main Results:

  • At 3 years, 46% of patients achieved biochemical progression-free survival.
  • A post-salvage prostate-specific antigen (PSA) nadir ≤0.5 ng/ml was the only significant predictor of favorable outcomes (P=.03).
  • Late grade 3 genitourinary toxicities included hematuria, lower urinary tract symptoms, erectile dysfunction, and urethral stricture; no grade 4/5 toxicities were reported.

Conclusions:

  • Focal salvage HDR brachytherapy can achieve biochemical control in a significant proportion of selected patients with recurrent prostate cancer.
  • Achieving a low PSA nadir post-treatment is crucial for long-term success.
  • Further long-term studies are necessary to fully understand the impact on prostate cancer progression.