scholarly journals Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Iyad Khourdaji ◽  
Jacob Parke ◽  
Avinash Chennamsetty ◽  
Frank Burks
Keyword(s):  
Radiation Therapy ◽  
Radiation Effects ◽  
Treatment Strategies ◽  
High Intensity Focused Ultrasound ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Beam Radiation ◽  
Noninvasive Treatment ◽  
Pelvic Malignancies ◽  
Pelvic Cancer

Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures.

scholarly journals Strategies to Minimize Late Effects From Pelvic Radiotherapy

2021 ◽  
pp. 158-168
Author(s):  
Ammoren Dohm ◽  
Julian Sanchez ◽  
Eden Stotsky-Himelfarb ◽  
Field F. Willingham ◽  
Sarah Hoffe
Keyword(s):  
Radiation Therapy ◽  
Adverse Effects ◽  
Late Effects ◽  
Radiation Treatment ◽  
External Beam Radiation ◽  
High Dose ◽  
Pelvic Radiotherapy ◽  
Beam Radiation ◽  
True Incidence ◽  
Pelvic Malignancies

During the past 30 years, radiation treatment techniques have significantly improved, from conventional external-beam radiation therapy, to three-dimensional conformal radiation therapy, to current intensity-modulated radiation therapy, benefiting patients who undergo treatment of pelvic malignancies. Modern treatment options also include proton beam irradiation as well as low and high dose rate brachytherapy. Although the acute adverse effects of these modalities are well documented in clinical trials, less well known are the true incidence and optimal management of those late adverse effects that can occur months to years later. In a population of survivors of cancer that is steadily increasing, with many such patients receiving radiotherapy at some time during their disease course, these late effects can become a considerable management and quality-of-life issue. This review will examine the range of late toxicities that can occur from pelvic radiotherapy and explore strategies to prevent and mitigate them.

Brachytherapy for Oesophageal Carcinoma: A Comprehensive Review of Literature and Techniques

2021 ◽  
pp. 1-10
Author(s):  
Rashi Kulshrestha ◽  
Anil Gupta ◽  
Daya Nand Sharma ◽  
Kishore Singh
Keyword(s):  
Radiation Therapy ◽  
Poor Performance ◽  
Oesophageal Carcinoma ◽  
External Beam Radiation ◽  
Surrounding Tissue ◽  
Treatment Modalities ◽  
Beam Radiation ◽  
Tumour Control ◽  
Local Tumour Control ◽  
Multimodality Approach

Abstract Introduction: Oesophageal carcinoma is one of the fatal cancers mainly because of its rapid spread and poor prognosis. Treatment modalities involves a multimodality approach, including surgery, radiation therapy and chemotherapy. Radiation therapy includes brachytherapy in the form of intraluminal radiation therapy. Brachytherapy permits delivery of high tumouricidal doses to superficial cancerous growth of the oesophagus while delivering much lower doses to the surrounding tissue. It is mostly given in combination with external beam radiation in patients with poor performance scores not likely to tolerate an aggressive chemoradiation regimen or as a boost to concurrent chemoradiotherapy. It is very effective in terms of local tumour control as well as in relieving symptoms in advanced/recurrent disease. Intraoperative brachytherapy and seed brachytherapy have also been tried to address the nodal disease. Methods: We undertook a review of the available literature and techniques developed in the past three decades to emphasise the role of brachytherapy in curative or palliative settings in the treatment of oesophageal carcinoma. Conclusion: Oesophageal brachytherapy will remain a tangible treatment of oesophageal cancer, although it is less commonly used due to high expertise requirement, lack of established evidence, risk of life-threatening complications and lack of interest in brachytherapy. It offers quick and useful palliation for a prolonged period, along with good quality of life and superior dosimetry. Use of novel applicators may allow dose escalation and lower toxicity. Seed brachytherapy is also emerging as a promising option in nodal recurrences.

scholarly journals Salvage HIFU for biopsy confirmed local prostate cancer recurrence after radical prostatectomy and radiation therapy: Case report and literature review

2015 ◽  
Vol 9 (9-10) ◽  
pp. 671 ◽  
Author(s):  
Rebekah Rittberg ◽  
Tadeusz Kroczak ◽  
Neil Fleshner ◽  
Darrel Drachenberg
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Focused Ultrasound ◽  
Cancer Recurrence ◽  
High Intensity Focused Ultrasound ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Risk Prostate Cancer ◽  
Salvage Hifu

High-intensity focused ultrasound (HIFU) is a treatment option for low- and intermediate-risk prostate cancer and more recently has been used as salvage therapy after failed radiation therapy. We present a case of local recurrence with biochemical failure after radical prostatectomy and salvage external beam radiation therapy with salvage HIFU without biochemical recurrence at 20 months.

scholarly journals Management of post-radiation therapy complications among prostate cancer patients: A case series

2014 ◽  
Vol 8 (9-10) ◽  
pp. 632 ◽  
Author(s):  
Ryan Kendrick Flannigan ◽  
Richard John Baverstock
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radiation Therapy Oncology Group ◽  
Case Series ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Beam Radiation ◽  
Post Radiation ◽  
Tract Infections

Introduction: Treating prostate cancer with radiation therapy (RT) is a viable option, albeit with its own profile of complications. We describe a unique Canadian report of a single surgeon (RJB) experience in the management of complex post-prostate cancer RT complications.Methods: We retrospectively analyzed patients who had previously received external beam radiation (XRT) or brachytherapy (BT) for prostate cancer referred to a single surgeon for persistent urologic related difficulties between 2005 and 2010. We used the Radiation Therapy Oncology Group (RTOG) morbidity grading system to assign each patient a 1 to 5 grade for their greatest complication.Results: In total, 15 patients were identified with a total of 43 RT-related complications. Of these 43 complications, 19 presented with obstruction, 8 with radiation failure or new bladder cancer, 6 with hematuria, 5 with intractable incontinence, and 5 with urinary tract infections. These patients required several investigations prior to treatment. Treatment of these complications used surgical, local and medical approaches. In the end, 1 patient had total incontinence, 3 improved their incontinence, 3 had self-catheterization and dilation, 1 voided well, 3 underwent cystectomy with ileo-conduits, 2 had chronic hematuria, and 2 passed away.Conclusion: These patients are heavily investigated and require significant resources, including patient visits, diagnostics and treatment modalities to optimize their condition. Cure is not always possible, but the aim to improve quality of life should guide management.

CANCER INSIGHT: HALLMARKS AND THERAPEUTIC STRATEGIES

2021 ◽  
Vol 5 (1) ◽  
pp. 4-5
Author(s):  
Muhammad Sulaiman Yousafzai
Keyword(s):  
Radiation Therapy ◽  
Targeted Therapy ◽  
Cancer Cells ◽  
Cell Biology ◽  
Cancer Metastasis ◽  
Cytotoxic Agents ◽  
Host Cells ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Beam Radiation

Cancer metastasis is a complex, multistep process responsible for > 90% of cancer-related deaths. Cancer is the second leading cause of death globally and about 8.8 million people worldwide died from cancer (Liver (788 000), Lung (1.69 million) Colorectal (774 000), Stomach (754 000), Breast (571 000)) in 20151. That is nearly 1 in 6 of all global deaths. Lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervix and stomach cancer are the most common among women. During metastasis, the primary tumor seeds pioneer cells that move out, invade adjacent tissues, and then travel to distant sites where they may succeed in founding new colonies called secondary tumors . In the last few decades, a rich and complex body of knowledge has been generated in cancer, revealing cancer to be a disease involving dynamic changes in the genome. In 2000, Douglas Hanahan and Robert A. Weinberg reported six hallmarks of cancer. They include sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, and activating invasion and metastasis. Underlying these hallmarks are genome instability, which generates the genetic diversity that expedites their acquisition, and inflammation. Cancer Initiation, detachment and organ-specific affinity of cancer cells to host cells in terms of the above mentioned hallmarks helped devise new potential therapies. To date, five cancer treatment modalities have been defined. Currently available cancer treatments include the traditional surgery (Cryosurgery, Lasers,Hyperthermia), radiotherapy (External Beam Radiation Therapy, Internal Radiation Therapy), and conventional chemotherapy (Oral, Intravenous (IV), Injection, Intrathecal, Intraperitoneal (IP), Intraarterial (IA), Topical), approaches and have been extended with two new modalities in recent decades: molecularly targeted therapy (MTT) ( Small -molecule drugs, antibodies ) and immunotherapy Monoclonal antibodies,, Adoptive cell transfer, Cytokines, Treatment Vaccines, Bacillus Calmette-Guérin (BCG)). The most important goal of targeted therapy or more advanced immune-based strategies is to eradicate cancer cells more specifically than traditional theraphies while maintaining an acceptable level of side effects and quality of life. Unfortunately, the newly developed targeted agents or techniques show a similar incidence and severity of toxicities as traditional cytotoxic agents do. With a full clarity of mechanism, cancer prognosis  and treatment will become a rational science. It's a dream that one day the patchwork quilt of major fields like cell biology, genetics, histopathology, biochemistry, immunology, pharmacology and physics will detect and identify all stages of cancer progression and will be able to prevent incipient cancers from developing and will cure preexisting cancers.

scholarly journals Treatment Outcomes in Spinal Metastatic Disease With Indeterminate Stability

2020 ◽  
pp. 219256822095660
Author(s):  
Brian L. Dial ◽  
Anthony A. Catanzano ◽  
Valentine Esposito ◽  
John Steele ◽  
Amanda Fletcher ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Metastatic Disease ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Spinal Instability ◽  
Time Of Death ◽  
Beam Radiation ◽  
Spinal Stabilization ◽  
Kaplan Meier ◽  
Ambulatory Ability

Study Design: Retrospective cohort study. Objective: The purpose of this study was to compare outcomes between different treatment modalities for metastatic disease with indeterminate instability (Spinal Instability Neoplastic Score [SINS] 7-12). Methods: We retrospectively reviewed neurologically intact patients treated for spinal metastatic disease with a SINS of 7 to 12. The cohort was stratified by treatment approach: external beam radiation therapy alone (EBRT), surgery + EBRT (S+E), and cement augmentation + EBRT (K+E). Kaplan-Meier analysis was used to assess differences in length of survival (LOS) and ability to ambulate at time of death. Multivariate analysis was performed to assess adjusted LOS and ability to ambulate at time of death. Results: The cohort included 211 patients, S+E (n = 57), EBRT (n = 128), and K+E (n = 27). In the S+E group, the median LOS was 430 days, which was statistically longer than the median LOS for the EBRT group (121 days) and the K+E group (169 days). In the S+E group, 52 patients (91.2%) and in the K+E group 24 patients (92.3%) retained the ability to ambulate at their time of death compared to 99 patients (77.3%) of the EBRT patients ( P = .01). The overall rate of revision treatment at the spinal level initially treated was 17.5%, S+E (15.8%), EBRT (20.3%), and K+E (7.7%). Conclusions: The length of survival, ability to maintain ambulatory ability, and revision treatment rates were all improved following surgical management and radiation therapy compared to radiation therapy alone. The authors’ conclusion from these results are that patients with indeterminate spinal instability should be discussed in a multidisciplinary setting for the need of spinal stabilization in addition to radiation therapy.

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