High-dose radiation shows benefits for cancer patients

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Dr. Anuj Peddada and Dr. Alan T. Monroe found that brachytherapy for prostate cancer was more easily tolerated by patients with enlarged prostates.

A high-dose radiation treatment for prostate cancer, available at Penrose Cancer Center, has proven to lower side effects, reduce time in the hospital and lower health care costs for patients.
In a study conducted by Dr. Alan T. Monroe and Dr. Anuj Peddada, brachytherapy for prostate cancer was more easily tolerated by patients with enlarged prostates — a finding that contradicts earlier beliefs about the treatment.
“It was always believed that people with large prostates didn’t tolerate the treatment well,” Monroe said. “But using this high-dose procedure, which Dr. Peddada brought to Penrose, showed they actually do tolerate it well.”
The procedure involves temporarily placing high-dose “seeds” of radiation in the prostate during a morning surgery, giving two treatments during the day, and then removing the seeds that the evening. Patients do not stay at the hospital overnight, Monroe said.
“The study dealt mostly with the side effects,” he said. “Fewer people needed catheters; no one had rectal bleeding, which is sometime a problem with these procedures.”
Prostate cancer is the second most common cancer treated at Penrose, said Dennis Bruens, director of the Penrose Cancer Center. The hospital treats about 150 prostate cancer patients every year.
Some patients receive external radiation only, and others receive implanted low-dose radiation seeds that stay in the prostate permanently. Brachytherapy combines the two treatments, Bruens said.
Typically, a patient receives five weeks of external radiation treatment, and then has a single-day dose using brachytherapy.
“This treatment dramatically reduces costs, because there is no hospital stay, and there are fewer side effects,” Monroe said. “Treating the side effects, particularly for prostate cancer, can be very expensive.”
A total of 315 patients participated in the study, and 54 received the high dose brachytherapy. Monroe presented the study at the Prostate Cancer Symposium, and it also will be printed in several medical journals.
“Low-dose rate brachytherapy with permanent radioactive seeds has become a standard treatment for localized prostate cancer over the past decade,” the two doctors reported in the study. “Historically, patients with large volume glands have been considered suboptimal candidates for LDR brachytherapy … High dose rate brachytherapy … offers flexibility of needle trajectory intra-operatively and permits target coverage optimization through control of dwell position times.”
Only six patients required temporary placement of a urinary catheter, according to the study. More than a year later, only a single case of gastrointestinal toxicity occurred and one patient developed a urethral stricture, the study reported.
“That shows they tolerated the treatment very well,” Monroe said. “The study supports the notion that HDR brachytherapy may be a reasonable option for patients with large glands.”
Penrose’s cancer treatment doctors sees 500 patients a year, but in-depth studies concerning their treatments are rare. Bruens said the hospital plans to conduct more research on par with the information coming out of major university research hospitals.
“We’re a community hospital, not a university,” he said. “We’re very interesting in doing more of this kind of research. Part of our standards is to study our patients and make sure the treatment is effective — but we’re planning more of this level of research as well.”
Most patients are treated in community hospitals, Monroe said, not large university hospitals, where much of the nation’s research into major diseases occurs.
“But there’s a disconnect,” he said. “Penrose had a reputation for research 20 or 30 years ago, and we’re going to get that reputation back. We’re doing more experiential treatments in other subsets of prostate patients. I think what we’re doing here definitely compares to what’s coming out of the Dukes and Harvards.”