A CASE OF CARCINOMA PROSTATE.

 CARCINOMA PROSTATE.

This 65 year old gentleman was found to have an elevated PSA 18 ng/dl, on evaluation , found to have adenocarcinoma prostate (Gleason 3+4). He was treated with a combination of IMRT and Cyberknife. This enabled the delivery of the required dose to the prostate. Follow up PSA was 4 ng/dl and dropped to 1ng/dl during the second follow up. 

 The patient was under treatment with Dr.Rathna Devi, Senior consultant Radiation oncology.

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CYBERKNIFE FOR PROSTATE TREATMENT - WHAT PATIENTS FEEL

CYBERKNIFE FOR PROSTATE CANCER _ WHAT PATIENTS FEEL

Compensating for Prostate Movement: The prostate gland can move unpredictably throughout the course of treatment that makes the ability to track, detect and correct for motion critically important. Unlike any other radiation treatment, the CyberKnife System continually tracks and automatically corrects for the movement of the prostate in real time. This enables the system to correct the beam direction so that it is focused on the prostate throughout the entire treatment. The robot constantly monitors and aligns the real time location of the prostate to ensure any adjustments in the beam delivery match the prepared treatment plan while automatically correcting for any movement during a treatment by relaying critical logistical information to the system software. Safety mechanisms are in place to ensure that the beam of radiation is ‘locked on’ to the intended target should your prostate move out of acceptable range. For example, if a gas bubble is moving through the rectum or the bladder starts to fill during treatment, a system correction compensating for movements of the prostate automatically occurs.



Reduced Treatment Time: Compared to alternative treatments that can take up to 8 - 9 weeks (including relocation in some cases) or 40 - 45 sessions of radiation therapy, an entire CyberKnife® treatment plan can be completed in 4 to 5 sessions. Each treatment session is typically completed in one hour or less. the CyberKnife System is designed to treat with a higher per-fraction dose given its superior accuracy. This substantially reduced treatment timeframe is advantageous for busy men seeking the least amount of disruption to their daily lives.



A Non-Invasive Procedure: Aside from the placement of tiny gold markers called fiducials inside of the prostate, a pre-treatment procedure that assists the imaging system to more accurately target tumors, the CyberKnife treatment process is completely non-invasive. No incisions, anesthesia or hospitalization are required. The CyberKnife robot moves quietly around a patient who lies comfortably on the treatment table. The robot will move in nearly every direction to fully deliver the prescribed treatment dose.This is in contrast to laparoscopic surgery or a traditional prostatectomy that involves incisions and associated risks. Surgical procedures usually involve general anesthesia which may last up to several hours. As with any surgical procedure, potential risks include bleeding and infection and, depending on a patient’s overall health condition, other complications including incontinence and/or erectile dysfunction. In addition, surgery requires mandatory hospitalization and catheterization.

And compared to High-Dose-Rate brachytherapy (HDR) the CyberKnife System delivers the same dose of killing radiation to the prostate, but does so without the insertion of multiple catheters. HDR typically involves a hospital stay, over a 24 hour period, and places 15-20 catheters into the prostate, through the perineum. Through these catheters a machine pushes a single highly radioactive iridium seed into the catheters one by one. Low-Dose-Rate, or LDR brachytherapy (also known as seed brachytherapy) is also an invasive procedure in which dozens of radioactive seeds are permanently implanted in the prostate with needles inserted through the perineum to deliver radiation over many weeks.



WHAT PATIENTS SAY ABOUT PROSTRATE CANCER



A CyberKnife Coalition survey conducted between February – March 2011, 304 participants were asked why they chose CyberKnife SBRT over other treatment options.

Here is what they said:

84% Most comfortable with risk/side effects

81% Seemed like the best options among my choices

66% Offers the latest technology

59% Convenience

59% Most likely to eradicate/eliminate the cancer

36% Least amount of time away from work

18% Not a surgical candidate

Additional results of this survey found that:

99% of patients described their treatment as successful

93% of patients indicated that SBRT did not interrupt their normal life routine

98% of patients indicated they would recommend SBRT treatment to others

99% of patients indicated they would choose to be treated with SBRT again

 

APollo Hospitals has treated more that 70 prostate cases and the results have been very promising. Patient have been under 2-3 year follow up.

 

Source. www.cyberknifeforprostate.com/

 

 

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Stereotactic body radiotherapy for low-risk prostrate cancer

Stereotactic body radiotherapy for
low-risk prostate cancer:
five-year outcomes
Debra E. Freeman1 and Christopher R. King2
1 Naples Radiation Oncology, PA, USA
2 Department of Radiation Oncology, UCLA School of Medicine, CA, USA
Radiation Oncology 2011, 6:3doi:10.1186/1748-717X-6-3
Purpose
Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT.
Method and Materials
Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed.
Results
At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated
urologic instrumentation.
Conclusion
Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

Source: www.accuray.com

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CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER

CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER

DR.MAHADEV Senior Consultant, Radiation Oncology

71 Yrs old Mr.Birendra Singh from Gopalganj, Bihar was devastated when he was diagnosed to have Prostate cancer. He had gone to his urologist for just a routine checkup because he was having difficulty in passing urine for the last couple of months. A routine PSA done was in the range of 15ng/ml. A transrectal biopsy revealed grade 2 adenocarcinoma of the prostate gland with a Gleason’s score of 3+4.

Mr.Singh went to Delhi for an opinion. He consulted various doctors which included several urologists, surgical oncologists and radiation oncologists.The options given to him included wait and watch, bilateral orchidectomy(removal of both testis), Radical prostatectomy, Brachytherapy(seed /HDR implant).The opinions were so varied that the family could not take a decision for 3 months.

Patient also consulted Apollo Hospitals at Ranchi in Jharkhand where he was advised to go to Apollo Speciality Hospital Chennai as all the treatment options were available there and he was also told that a full team of doctors decide on a treatment in the tumor board.

Mr Birendra Singh’s nephew who lives in the United States, meanwhile contacted his uncle from there and told him about a new treatment called the cyberknife which he had read on the internet. His nephew was very impressed by what he had read on the net- outpatient treatment, non-invasive, very precise radiation delivered robotically and just 5 sittings with practically no side effects. He asked his uncle to come to US for treatment as he thought it was unlikely that this treatment option would be available in India.

After going through all the treatment options Mr.Birendra Singh decided he would go in for Cyberknife as he found that to be the best treatment modality in his opinion. He visited Chennai in March 2009 to take a final decision. We had just then started using Cyberknife and we told him that the latest version of Cyberknife is now available here. He was told that the cost of cyberknife would be around 40,000 US dollars in US. We told him that the cost of treatment here would be Rs 400,000.

As we had just started Cyberknife Mr Singh was anxious about our technical capability. But when he came to know that the entire team was trained at the Stanford University, California, where actually the cyberknife was invented, he immediately decided to have the treatment here.

The first step in the treatment process was counselling him about the various treatment aspects.This included explaining to him the various stages of the treatment preparation ,planning and execution.The expected benefits and the various side effects that can be expected was explained to him in detail.The side effects that are normally seen with this treatment can be increased frequeny of micturition and bowel movemens.Very rarely, rectal bleeding can be seen as a late effect of radiotherapy.

The second step was placing 5 gold fiducials into the prostate gland transperinealy under transrectal guidance which took about half an hour. These fiducials are necessary for the machine to track the prostate gland during the entire course of treatment. Normally, we have to wait for a week after placing the fiducials for doing the planning CT scan. This is necessary because in the first couple of days, the seeds can migrate.

The third step in his planning was the making of a special type of bed called Vacloc for immobilization of the patient during treatment. Vacloc is a vacuum bed which takes the shape of the patient so that daily reproducibility of the patient in the same position can be achieved easily. This took about 10 minutes following which a CT scan was done with the patient lying in the vacloc in the treatment position.


Next, the Radiation oncologist contours the prostate gland, bladder and rectum. Then, the medical physicist puts on the treatment beams. The treatment plan was ready the next day and was reviewed by the oncologist and urologist.The treatment plan was finalized and the patient was asked to come for treatment the following day which happened to be a Tuesday. Patient was asked to have a light breakfast before 8 am and report for treatment at 10am.He was also asked to take a laxative the previous night and antacids.This preparation is a very important part of the treatment as improper bowel evacuation and gas in the bowel can interfere with the accuracy of the treatment.As cyberknife can achieve submillimeter target accuracy and continuously tracks the target while treatment ,it is absolutely essential that patients follow this preparatory regimen very carefully.Mr Singh was prescribed 5 treatment sittings on consecutive days.

Each treatment lasted for about 45-50 minutes and Mr.Birendra Singh completed his treatment on schedule on Saturday.He had initially booked his tickets for Sunday but as he did not have any side effects he preponed his journey to Saturday night.He was advised to have a PSA after 3 months which confirmed that the PSA had come down to normal values.

MR. BIRENDRA SINGH AFTER COMPLETING 5 TREATMENT SITTINGS

Mr.Singh Reported back to us in the first week of December. His PSA which was repeated was less that 1ng/ml which shows excellent response to treatment. There were practically no side effects during and after the treatment.



FOR MORE INFORMATION ON CYBERKNIFE TREATMENT IN PROSTATE CANCER< YOU MAY BLOG YOUR COMMENTS OR WRITE TO  lakshmipriya_b@apollohospitals.com