Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy.

The aim of this study was to investigate the role of 70 Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48 months).

Radiation-induced vascular damage in tumors: implications of vascular damage in ablative hypofractionated radiotherapy (SBRT and SRS).

We have reviewed the studies on radiation-induced vascular changes in human and experimental tumors reported in the last several decades. Although the reported results are inconsistent, they can be generalized as follows. In the human tumors treated with conventional fractionated radiotherapy, the morphological and functional status of the vasculature is preserved, if not improved, during the early part of a treatment course and then decreases toward the end of treatment.

Hypofractionation for radiotherapy of prostate cancer using a low alfa/beta ratio--possible reasons for concerns? An example of five dimensional radiotherapy.

Unlabelled: It is very attractive, due to the assumed low alfa/beta ratio of prostate cancer (PC), to construct new treatment schedules for prostate cancer using only a few large fractions of radiation (hypofractionation). This will widen the therapeutic window since the ratio for PC might be lower than that of the organs at risk (OAR). PC is an extremely variable disease and often contains both highly and poorly differentiated cells.

Four and five dimensional radiotherapy with reference to prostate cancer--definitions, state of the art and further directions--an overview.

Radiotherapy (RT) always requires a compromise between tumor control and normal tissue side-effects. Technical innovation in radiation therapy (RT), such as three dimensional RT, is now established. Concerning prostate cancer (PC), it is reasonable to assume that RT of PC will increase in the future.

Use of the Charlson combined comorbidity index to predict postradiotherapy quality of life for prostate cancer patients.

Purpose: To determine the impact of pretreatment comorbidity on late health-related quality of life (HRQoL) scores after patients have undergone combined radiotherapy for prostate cancer, including high-dose rate brachytherapy boost and hormonal deprivation therapy.

Methods And Materials: Results from the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire survey of 158 patients 5 years or more after completion of therapy were used from consecutively accrued subjects treated with curative radiotherapy at our institution, with no signs of disease at the time of questionnaire completion. HRQoL scores were compared with the Charlson combined comorbidity index (CCI), using analysis of covariance and multivariate regression models together with pretreatment factors including tumor stage, tumor grade, pretreatment prostate-specific antigen level, neoadjuvant hormonal treatment, diabetes status, cardiovascular status, and age and Charlson score as separate variables or the composite CCI.

Undetectable late hepatic sequelae after hypofractionated stereotactic radiotherapy for liver tumors.

Hypofractionated liver stereotactic radiotherapy has produced long-term survival, but the hepatobiliary system is radiosensitive and may be severely damaged by the treatment. We have evaluated long-term radiation effects on hepatobiliary functions in the first long-term survivors reported after radiotherapy to the hepatobiliary system for liver tumors. Eleven patients were followed for up to 13 years after treatment of tumors≤9 cm in size.

Curative stereotactic body radiotherapy for liver malignancy.

Nine patients with 11 primary or secondary liver non-neuroendocrine malignancies with mean and maximum diameters of 4.0 and 7.7 cm became long-term survivors after precision irradiation in a stereotactic body frame.

Is the use of a surrogate urethra an option in prostate high-dose-rate brachytherapy?

Purpose: To investigate the accuracy and the dosimetric consequences of substituting a surrogate urethra assumed to be at the geometric center of the prostate, in place of the true urethra when using high-dose-rate (HDR) brachytherapy for the treatment of prostate cancer.

Methods And Materials: One hundred prostate cancer patients treated with HDR brachytherapy constituted the study group. A pre-plan was made with the urethra visualized.

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: a 6-year follow-up.

To report the long-term results for treatment of localized carcinoma of the prostate using high dose rate (HDR) brachytherapy, conformal external beam radiotherapy (3D EBRT) and neo-adjuvant hormonal therapy (TAB). From 1998 through 1999, 154 patients with localized prostate cancer were entered in the trial. Biologically no evidence of disease (bNED) was defined at PSA levels < 2 microg/l.

The 20-Yr outcome in patients with well- or moderately differentiated clinically localized prostate cancer diagnosed in the pre-PSA era: the prognostic value of tumour ploidy and comorbidity.

Objective: This observational cohort study describes the long-term outcome of patients with clinically localized prostate cancer managed with watchful waiting, the prognostic value of tumour ploidy, and the impact of comorbidity.

Methods: A total of 119 patients with clinically localized (T1-2) prostate cancer consecutively diagnosed from 1978 to 1982 were prospectively managed by watchful waiting, with treatment given if progression occurred.

Results: Median age was 68 yr.

Dosimetry of anal radiation in high-dose-rate brachytherapy for prostate cancer.

Purpose: The objective of this study is to determine the radiation dose to the anus during brachytherapy using high-dose-rate Ir-192 sources.

Methods And Materials: Thermoluminescence dosimeters were used for measuring the dose to the distal part of the anus in 10 patients, and in a prostate phantom to measure the radiation dose during the transport of the radiation source.

Results: The measured dose to the anus in vivo was on average 0.

Prostate displacement kit: reducing the radiation dose to the rectum.

During high dose-rate brachytherapy boost in 20 patients the use of a prostate-water-rectal-displacement-kit contributed to an increase in the distance between the prostate and the rectum, however, the prostate was not totally immobilized by the needles, implying the necessity for an very careful on-line dose-planning dosimetry.

Prostate volume determination: differential volume measurements comparing CT and TRUS.

Purpose: To compare the differences in prostate volume assessed by computerized tomography (CT), step-section transrectal ultrasound (TRUS-step), and TRUS with ellipsoid-formula volume calculation (TRUS-ellipsoid).

Methods And Materials: Thirty-one patients with localized prostate cancer treated with combined external conformal radiotherapy and high dose rate brachytherapy, who had prostate volumes evaluated using CT, TRUS-step and TRUS-ellipsoid according to our clinical routine for dose planning. The measurements were collected retrospectively based on actual dose-plans.

Evidence-based medicine: its effect on treatment recommendations as illustrated by the changing role of postmastectomy irradiation to treat breast cancer.

Purpose: To illustrate the effect that the quality of evidence has on clinical practice, we examined how the role of radiotherapy in treating breast cancer has changed over the years as the quality of evidence evolved from anecdotal evidence based on expert opinion to randomized clinical trials and meta-analyses.

Methods: We searched the medical literature for key randomized studies and meta-analyses that have influenced the clinical use of postmastectomy irradiation since the first randomized trials in breast cancer in the 1950s. We discuss how clinical practice changed based on the outcomes of these trials, and then discuss the quality of those trials based on the criteria currently used to assess evidence from randomized trials (CONSORT) and meta-analysis (QUORUM).