Radiotherapy for patients with prostate cancer

Advances in treatment options for the most common form of tumour among men in the UK

Radiotherapy is the most commonly used treatment for patients with localised prostate cancer in the UK. It works by damaging a cell’s deoxyribonucleic acid (DNA) so that it can no longer survive. External beam radiotherapy uses linear accelerators to deliver small daily fractions of radiotherapy to the prostate gland. In brachytherapy, radioactive sources are implanted into the prostate gland.

Stereotactic ablative body radiotherapy is a method of delivering precise radiotherapy in fewer, higher dose fractions than conventional radiotherapy. The main short-term side effects of prostate radiotherapy include dysuria, urinary retention or diarrhoea. In the longer term, a minority of patients have difficulties with urinary or faecal urgency or incontinence or rectal bleeding. Fatigue can also have a significant effect on patients’ quality of life during and after treatment. Newer methods of delivering radiotherapy such as intensity modulated and stereotactic ablative body radiotherapy have been developed to deliver the maximum dose to the tumour while reducing side effects.

Full reference:Cancer Nursing Practice, 2016, 15(1):27-33 Radiotherapy for patients with prostate cancer Kathryn Banfill, Aileen Duffton, and David Dodds

 

Adjuvant Chemotherapy in Rectal Cancer after Chemoradiotherapy

Abstract

The aim of this overview was to investigate whether adjuvant chemotherapy has a favourable effect on the outcome of patients with rectal cancer who had preoperative (chemo)radiotherapy.

A review of randomised clinical trials that allocated patients between fluorouracil-based and observation or between fluorouracil-based and oxaliplatin-based adjuvant chemotherapy after preoperative (chemo)radiotherapy was carried out, including their corresponding meta-analyses.

None of the five randomised trials has shown a significant benefit of fluorouracil-based adjuvant chemotherapy for overall survival or disease-free survival. Also, the three corresponding meta-analyses failed to show a benefit of adjuvant treatment. Of three randomised trials – two phase III and one phase II with a 3-year disease-free survival end point – two showed a small benefit of adding oxaliplatin to fluorouracil, one failed. The corresponding meta-analyses showed that the pooled difference was not significant.

In conclusion, the use of postoperative 5-fluorouracil-based chemotherapy with or without oxaliplatin in patients with rectal cancer after preoperative (chemo)radiotherapy is not scientifically proven.

Radiotherapy did not increase thyroid cancer risk among women with breast cancer: A nationwide population-based cohort study

International Journal of Cancer: Volume 137, Issue 12, pages 2896–2903, 15 December 2015

Abstract

The aim of this study was to evaluate whether an increased risk of thyroid cancer exists among women with breast cancer in Taiwan, particularly among those receiving RT. We used data from the National Health Insurance system of Taiwan for the investigation.

The breast cancer cohort contained 55,318 women (including 28,187 who received RT and 27,131 who received no RT), each of whom was randomly frequency matched according to age and index year with three women without breast cancer from the general population. Cox’s proportion hazards regression analysis was conducted to estimate the effects of breast cancer with or without RT treatment on subsequent thyroid cancer risk.

We found that women with breast cancer exhibited a significantly higher risk of subsequent thyroid cancer (adjusted hazard ratio [aHR] = 1.98, 95% confidence interval [CI] = 1.60–2.44). The two groups (with or without RT) in the breast cancer cohort exhibited significantly increased risks. However, in the breast cancer cohort, the risk of thyroid cancer among women who received RT was not significantly higher than that of women who received no RT (aHR = 1.28, 95% CI = 0.90–1.83). Stratified analysis according to age revealed that only younger women with breast cancer (20–54 y) had a significantly higher risk of developing thyroid cancer.

This study determined that Taiwanese women with breast cancer had a higher risk of developing thyroid cancer; however, RT seems to not play a crucial role in this possible relationship.

via Radiotherapy did not increase thyroid cancer risk among women with breast cancer: A nationwide population-based cohort study – Sun – 2015 – International Journal of Cancer – Wiley Online Library.

A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

European Journal of Cancer: November 2015 Volume 51, Issue 16, Pages 2345–2367

Background
Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.

Methods
A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included.

Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.

Results
Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12–1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function.

There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.

Conclusions
Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices.

via A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer – European Journal of Cancer.

A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

European Journal of Cancer: Available online 5 August 2015

Network diagram showing all survival-related relative effects

Background

Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.

Methods

A search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included.

Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.

Results

Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12–1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function.

There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.

Conclusions

Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices.

via A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer.