Brachy therapy for prostate cancer - Essay Example

Brachy Therapy for Pro Cancer (Literature Review) Overview of Brachytherapy for Prostrate Cancer The need to have a therapy that would cater for prostrate cancer became necessary when medical treatment seemed obviously unworkable for scientists who worked their way to getting a cure for prostrate cancer. Writing on Brachytherapy as a medical therapy, Hoskin et al (2007) explain that has to do with “Brachytherapy is well established as a treatment for localised prostate cancer.” This means that branchytherapy has its basis from radioactive seed implantation therapy. The kind of dose needed for the treatment of a particular cancer case is dependent on several factors as Pieters et al (2009) explain that “the treatment of intermediate to high-risk prostate cancer with radiotherapy high doses are needed for high tumor control.” The use of branchytherapy for the treatment of prostrate cancer has been through a lot of evolutions. Primarily, researchers have looked at the effect of using the therapy alone as against using it together with other external medical aids. The evolution did not however happen without any challenges as the early days of the invention was characterized with dampened morale and enthusiasm to integrate the therapy to regular medical practice. Indications with the use of Brachytherapy Like all other scientific and medical discoveries, the use of brachytherapy has been taken through several empirical and evidence based protocols to proof the authenticity of the brachytherapy for the treatment and care of prostrate cancer. Such indications have brought about a number of interesting facts, findings and conclusions about brachytherapy. For instance in 2008, the Agency for Healthcare Research and Quality (AHRQ) conducted a research, which concluded that no randomized controlled trials had compared brachytherapy alone with other existing treatment options for clinically restricted prostate cancer treatment (Agency for Healthcare Research and Quality, 2008). There has also being controversial discussions on the dose of treatment. For instance in their research findings, Pieters (2006) et al reported that “high dose radiotherapyis necessary to control prostate cancer, especially in intermediate and high risk cancers.” This is not withstanding of the fact that the same research concluded that “increasing dose with external beam radiotherapy leads to a higher risk of normal tissue damage.” Variations in the indications for the use of brachytheraphy emanates from differences in research modalities. For instance Pieters et al (2008) made a revelation on the α/β ration used for prostrate. Their research found that “modeling studies suggest that the α/β -ratio for prostate could be as low as 1.5 Gy, while other studies show higher α/β –ratios” (Pieters, 2008). Presently, patients who receive treatment with brachytherapy are patients with stage T1-T2a, PSA level of 10 ng/mL or less, and Gleason score of 6 or lower in this category. Most of these patients are treated with brachytherapy along with no other form of treatment. Even with the brachytherapy, Theodorescu (2011) notes that “the recommended prescription doses for monotherapy are 145 Gy for iodine (I)–125 and 120-125 Gy for palladium (Pd)–103.” Efficacy of the use of brachytherapy with an without external therapy The efficacy rate of brachytherapy is not 100%. This cannot however be regarded as a major weakness of the therapy as the rescue rate identified by Hoskin et al. (2007) is relatively higher. Hoskin et al. (2007) however discover that depending on the variable of the population used, the results achieved were different. Regardless of the differences in results however, there has always been an improvement when analyzing the PSA, Gleason score and T stage for the exclusive use of brachytherapy. This means that the efficacy or rate of reoccurrence of the disease is more dependent on other factors such as type of disease and previous therapy received rather than the efficiency of the therapy on its own. Comparatively, Grado et al (1999) observes in a research that brachytherapy offers better hope and serves as a better alternative to other remedies for treating prostrate cancer such as radiotherapy. Because of this, modern practitioners advocate salvage brachytherapy alone. This however does not suggest that no other form of salvage therapy works because Grado et al (1999) found in their research that “the incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures.” The baseline of argument remains that salvage brachytherapy should always stand tall as complications associated with the use of salvage brachytherapy has always been minimal as compared to the hazard ratio (HR) associated with biochemical reoccurrence for most external procedure like radical prostatectomy and cryoablation (Vicini et al, 1998). Contraindications to Brachytherapy; with and without external therapies Medically, potency of a therapy such as the brachytherapy is judged by the positive impact it makes on beneficiaries though it is never denied that even in cases where therapies and medicines achieve needed results, they at times leave patients with dreadful side effects. For instance whether brachytherapy is used all alone or it is used in partnership with other therapies, there are some contraindications that are commonly experienced or identified. Some of these have been briefly discussed below. Prior transurethral resection of the prostate: Theodorescu (2011) alleges that initially treatment of prosprate cancer that relied on the use of external sources of treatment in addition to brachytherapy left transurethral resection of the prostate. The long term effect was that the situation led to increased urinary incontinence. In their research, Pieters et al (2006) ranked the percentage for this as 50%. However as modern scientific investigations encouraged the use of brachytherapy as a solitude treatment, incontinence rates have dropped to less than 10%. Pubic arch interference: Generally when the treatment of prostrate cancer is made to stand alone with the use of brachytherapy, there is bound to be interference but this interference depends on the size of the prostrate of gland >40 g(Aus, Hugosson and Norlen, 1995). More threatening is the fact that “this interference may preclude adequate placement of seeds” (Theodorescu (2011). High-Dose-Rate Brachytherapy: This is a more alarming contraindication with the use of brachytherapy on a temporary basis. This is because temporary brachytherapy comes with iridium (Ir) of192, which results in higher dose of iodine-125 radiation than ordinary and normal permanent implants. The risk becomes even more with the introduction of a third party or external therapy because such therapy or treatment also comes with its own radiation effects (Franks and Duch, 1999). Conclusion The beauty of science and for that matter medicine is the ability to discover, implement, improve and disprove where necessary. It is therefore very important that discoveries such as the brachytherapy exists. However, constant research and studies on the upgrading and modification of the therapy to meet modern standards and needs should not seize. With constant improvements, brachytherapy will come to be more and more useful in the treatment of prostrate cancer because all factors that are associated as risk factors will be identified and eventually eradicated. REFERENCE LIST Agency for Healthcare Research and Quality, 2008, ‘Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer. AHRQ: Agency for Healthcare Research and Quality’, Accessed November 23, 2011 Aus G, Hugosson J, Norlen L. Need for hospital care and palliative treatment for prostate cancer treated with noncurative intent. J Urol. 1995;154(2 pt 1):466-469. Chodak GW,Thisted RA, Gerber GS, et al. Results of conservative management of clinically localized prostate cancer. N Engl J Med. 1994;330:242-248. Franks L, Duch M. Latent progression in tumors: the natural history of prostate cancer. Lancet. 1956;2:1037-1039. Grado et al., 1999, ‘Salvage brachytherapy for localized prostate cancer after radiotherapy failure’ Urology. 1999 Jan;53(1):2-10. Hoskin et al., 2007, ‘High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial’ Radiotherapy and Oncology 84 (2007) 114–120. Pieters et al., 2009, ‘Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review’ Radiotherapy and Oncology 93 (2009) 168–173. Pieters et al., 2006, ‘Minimal displacement of novel self-anchoring catheters suitable for temporary prostate implants’ Radiotherapy and Oncology 80 (2006) 69–72. Pieters et al, 2008, ‘Comparison of biologically equivalent dose–volume parameters for the treatment of prostate cancer with concomitant boost IMRT versus IMRT combined with brachytherapy’, Radiotherapy and Oncology 88 (2008) 46–52 Vicini FA, Horwitz EM, Kini VR, Stromberg JS, Martinez AA. Radiotherapy options for localized prostate cancer based upon pretreatment serum prostatespecific antigen levels and biochemical control: a comprehensive review of the literature. Int J Radiat Oncol Biol Phys 1998;40:1101–10. Theodorescu D., 2011, ‘Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy)’, Medscap, Accessed November 23, 2011 Read More