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Why Oligometastatic Prostate Cancer Is Now More Treatable

Why Oligometastatic Prostate Cancer Is Now More Treatable

… and using stereotactic radiotherapy makes it well tolerated and highly effective

By Amethyst Radiotherapy Vienna

Prostate cancer is one of the most common forms of cancer in men and incidences of it are rising. Across Europe, 30 million men alive now will receive a diagnosis of the disease in their lifetime, with 75,000 dying each year.

The number of diagnoses in the EU and EFTA has doubled since 1995, with the causes of this being uncertain. By 2018 more than a fifth of cancer cases in men were of the prostate, highlighting the need for oncologists to respond.

Curiously, the levels of prostate cancer varied markedly between countries, with Romania lowest at just 63.6 per 100,000 to Sweden’s rate of 211.6. The average figure was 151.2.

In comparison, Austria had a much lower rate of 130.2, but this was still over double that of Romania and higher than neighbours Hungary and Slovakia, though less than Italy, Switzerland, Slovenia, the Czech Republic and Germany.

Even with Austria in the lower half of this grisly table, many men will want to get private stereotactic cancer treatment. The good news is that the capacity of oncologists to treat some forms of the disease has become significantly more advanced in recent years.

This will be good news for men visiting our Amethyst radiotherapy centre in the Vienna Private Clinic Cancer Center , as our oncologist looks back to more than 20 years of experience in high precision stereotactic radiotherapy. Especially by additionally using VMAT and Image guidance technology therapy can be applied with a highly focused precision allowing healthy organs to stay unharmed a lot better so therapy will be tolerated well and to maintain the best possible quality of life next to improving life expectancy. By high precision is meant the resolution of 1 pixel which equals 0.8 mm. And using VMAT reduces dose exposure of adjacent healthy organs within a perimeter of 3 – 5 mm around the tumor to only a fraction of the treatment dose.

As Cure Today reports, this is certainly true with oligometastatic prostate cancer. The term refers to an intermediate form of the disease where it has progressed beyond a localised cancer but is not yet a fully-emerged metastatic disease.

Speaking to the journal, retired US-based urologist Mark Samberg said his diagnosis in 2020 meant his career brought both advantages and disadvantages – the latter being that he knew how such situations often ended for patients. The positive was he knew the “right questions to ask” and understood aspects of his condition.

This included the fact that he was diagnosed as being in the oligometastatic phase, something most patients would not know existed.

However, that was true of oncologists too until the mid-1990s. That is when oncologists Samuel Hellman and Ralph Weichselbaum proposed such a state could exist. Their research focused on prostate cancer because of its high prevalence.

The understanding that has grown since then of oligometastases has enabled more tailored treatment to be carried out, including radiotherapy, as well as other treatments like chemotherapy.

Dr. Neha Vapiwala, professor and vice chair of education, radiation oncology, at the University of Pennsylvania in Philadelphia said oligometastes are usually detected by scans showing metastes in five regions.

“We might be able to intervene with treatment that’s more aggressive, targeting the handful of lesions that are seen, usually in addition to the normal systemic therapy we would give,“ he observed, adding that this could help lower the “tumour burden” and extend the survival time of the patient.

The report also noted that improvements in screening technology mean oligometastic prostate cancer is now easier to identify at an early stage.

Meanwhile latest reports on metastases directed radiotherapy in oligometastatic disease showed that this novel treatment option allows to postpone the use of male hormone depleting therapy (ADT). This allowing  patients to continue their usual sexual life quality.

While Austria may be better off than most of its neighbours when it comes to prostate cancer occurrence, there will still be many men who have it and some will be in an oligometastic stage. That is why it may be good to know that if this is the case, the capacity to treat it with radiotherapy and other means is greater than it was just a few years ago.

Medical Advisory Dr. David Kuczer

 

 

 

 

 

 

PROSTATE CANCER (efpia.eu)

Oncologists Can Now Better Detect and Treat Oligometastatic Prostate Cancer, Leading to Improved Survival (curetoday.com)

Metastasis-Directed Therapy for Prostate Cancer Increases PFS, Time off Hormones

— Radiotherapy led to “dramatic” slowing of progression, increased time with normal testosterone

Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up

Metastasis-directed Therapy Without Androgen Deprivation Therapy in Solitary Oligorecurrent Prostate Cancer

Moderne Bestrahlung bei Krebs der linken Brust – Präzise, effektiv und gut verträglich

Einleitung

Erfahrungsgemäß hat sich gezeigt, dass alle Patientinnen nach einer die Brust erhaltenden Operation von einer Bestrahlung profitieren.

Sinn der Bestrahlung ist es eine unnötige Amputation der ganzen Brust zu vermeiden und dennoch die gleiche Sicherheit zu bekommen das der Krebs in der Brust nicht wieder zurückkommt. Dadurch konnte die Lebensqualität der betroffenen Patientinnen bei gleichem Therapieerfolg deutlich verbessert werden.

Denn durch die Bestrahlung werden mikroskopisch kleine Tumorherde die sich meist in der Umgebung des sichtbaren Tumors verstecken (aber auch an anderen Stellen in der Brust sein können) abgetötet.

Eine der großen Herausforderungen hierbei ist jedoch der Krebs der linken Brust, da sich hier das Herz in der Nähe des Bestrahlungsgebietes befindet und man auf alle Fälle Schäden am Herzen durch die Bestrahlung vermeiden möchte.

Was bisher geschah…

Eine in den letzten Jahren oft angewandte Methode ist die Bestrahlung in der Phase der tiefen Atmung mit angehaltener Luft. Dadurch hebt sich die Brust und der sehr wichtige Abstand zum Herzen wird größer und dadurch die Schonung besser.

Die Erfahrung hat jedoch gezeigt, dass diese Methode von vielen Patientinnen als anstrengend empfunden wird und die Umsetzung nicht immer gelingt.

Die neue Methode…

Eine neue Methode, die für die Patienten sehr angenehm in der Umsetzung ist, ist die VMAT – Modulierung der Bestrahlungsfelder über eine spezielle Planungssoftware. Bei dieser sehr rechenintensiven Vorbereitungsmethode wird die Verteilung der Strahlendosis sehr genau an Form der Brust angepasst. Dadurch kann die Belastung am Herzen optimal verringert werden.

Zusätzlich wird im Verlauf dieser Vorbereitung auch die Formveränderung der Brust bei der Atmung berücksichtigt. Das ermöglicht eine stabile Behandlung bei normaler Atmung und macht die korrekte Umsetzung der geplanten Therapie sicher und bequem.

So dauert eine Behandlungssitzung selbst lediglich 5 – 10 Minuten während der man entspannt auf dem Behandlungstisch liegt und normal atmet. Die Behandlung ist schmerzfrei und wird gut vertragen.

Eine Behandlungsserie erfolgt über eine kontinuierliche Folge von 15-20 Sitzungen. ( 1 Sitzung pro Tag, 5 Sitzungen pro Woche am Mo-Fr, insgesamt 3-4 Wochen in Folge). Die Aufteilung auf mehrere Sitzungen ist erforderlich um die Behandlung gut verträglich zu machen.

Übliche Nebenwirkung ist ein vorrübergehendes Gefühl leichter Erschöpfung und eine Erwärmung und Anschwellung der Brust am Ende der gesamten Behandlungsserie ähnlich einem Sonnenbrand. All diese Nebenwirkungen sind in der Regel nach einigen Tagen abgeklungen.

Ein Beispiel aus der Praxis

Doch was bedeutet diese moderne Methode konkret für die Schonung des Herzens?

Die gültige Empfehlung für die Schonung des Herzens [1] lautet das das Herz im Durchschnitt weniger als 26 Gy Dosis bekommen sollte um möglichst keinen Schaden zu erleiden (Herz mean < 26 Gy).

Aus Erfahrung spricht man von einem guten Plan, wenn die Dosis am Herzen geringer als 9 Gy ist (Herz mean < 9 Gy) und von einem sehr guten Plan, wenn die Dosis kleiner als 3 Gy ist (Herz mean < 3 Gy).

Nun wie sieht es konkret mit der Belastung des Herzens mit Hilfe der neuen Methode aus?

Ein Bild sagt mehr als 1000 Worte…

Die hier gezeigte Graphik zeigt die Dosisverteilung bei einer Patientin mit Brustkrebs links die mit der modernen Methode behandelt wurde.

Der rote Anteil zeigt die Behandlungsdosis in der Brust, je mehr sich die Farbe wie beim Regenbogen Richtung blau verändert, desto niedriger ist die Dosis (Rot 100%, Blau 10%). Anhand der Graphik erkennt man das sich die Dosis an die Form der Brust schmiegt und nur wenige Zentimeter weiter kaum Strahlung ankommt.

 

 

Quelle Amethyst Radiotherapy Wien

Und wie sieht es nun mit der Strahlenbelastung am Herzen aus? Kann eine Dosis unter 9 Gy oder gar unter 3 Gy erreicht werden?

Die Antwort ist: Ja. Im Falle dieser Patientin beträgt die Dosis lediglich 1,34 Gy (Herz mean = 1,34 Gy)

 

 

 

Quelle Amethyst Radiotherapy Wien

Literatur

  • Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC), “Use of normal tissue complication probability models in the clinic.” (Marks LB, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9.)

Autor Dr. David Kuczer, Facharzt für Radioonkologie und Strahlentherapie

Globaler Strahlentherapiemarkt wird voraussichtlich boomen

October 26, 2022

Die Zahl der Menschen, die eine Krebsbehandlung mit Strahlentherapie suchen,  ist in den letzten Jahren deutlich gestiegen, da neue Techniken und verbesserte Technologien sie effektiver gemacht haben. Jetzt hat die neueste Forschung gezeigt, dass es mehr Wachstum auf dem Weg geben wird.

Markets and Markets Research hat prognostiziert, dass der globale Wert des Marktes von 6,3 Milliarden US-Dollar in diesem Jahr auf 8,1 Milliarden US-Dollar bis 2027 steigen wird, bei einer durchschnittlichen jährlichen Wachstumsrate (CAGR) von 5,1 Prozent.

Der Bericht hob mehrere verschiedene Faktoren für dieses Wachstum hervor. Erstens gibt es die fortschreitende Technologie, die eine solche Behandlung effektiver machen kann. Zweitens ist auch die steigende Inzidenz von Krebs ein Schlüsselfaktor.

Damit einher geht ein zunehmendes Bewusstsein für die Vorteile, die die Strahlentherapie bringen kann, und zusätzlich zu all dem gibt es mehr Investitionen in das Gesundheitswesen, sowohl im Allgemeinen in Entwicklungsländern als auch durch öffentlich-private Partnerschaften auf der ganzen Welt, um weitere Fortschritte in Forschung und Behandlung zu erzielen.

Im Jahr 2021, so der Bericht, war die externe Strahlentherapie die am häufigsten verwendete Behandlung bei vielen Krebsarten, wobei die Verwendung von bildgeführten Behandlungen häufig bei Hirntumoren eingesetzt wurde, obwohl der am häufigsten auf diese Weise behandelte Krebs Prostatakrebs war, der eine der am häufigsten auftretenden Krebsarten bei Männern ist.

Der Bericht ist nicht der einzige, der diese Woche veröffentlicht wurde und einen starken Anstieg der Strahlentherapie auf der ganzen Welt vorhersagt. Reportlinker.com hat eine neue Studie veröffentlicht,  die ein noch größeres Wachstum bei einer CAGR von 6,1 Prozent zwischen 2022 und 2028 prognostiziert. Damit steigt der globale Marktwert auf 9,3 Milliarden US-Dollar.

Wie im anderen Bericht wurden technologische Fortschritte, ein größeres Bewusstsein und höhere Investitionen in das Gesundheitswesen als Gründe für das Wachstum angeführt. Während Nordamerika voraussichtlich eine Vorreiterrolle übernehmen wird, kann auch Europa, einschließlich Österreich, dank dieser Faktoren mit einer Expansion des Marktes rechnen.

Czech Republic Marks 30 Years Of Gamma Knife Surgery

July 2, 2022

The use of Gamma Knife surgery to treat otherwise incurable brain tumours has been a life-saver for many thousands of patients – and it has been around for longer than many imagine.

For example, over the border in the Czech Republic the technique of using gamma knife surgery has been going on for 30 years, Radio Prague International reports.

The first one used in the country was funded by a nationwide fundraising campaign, focused on the case of a 12-year-old boy called Misa, who had already suffered brain damage through one haemorrhage and was at risk of another without a gamma procedure.

The Gamma Knife used on Misa was subsequently modernised twice and then replaced with a more modern version in 2009, but the benefits of gamma knife radiosurgery have been felt by some 24,000 patients. Misa himself died in 2018, but this meant his life had been extended by nearly 30 years.

For a country with a poor economy that had only just left behind decades of Communism to have raised CZK 160 million Crowns via public subscription was a huge effort. The good news here in neighbouring Austria is that the same procedure is available in Vienna, with the prospect of saving thousands of lives and extending others.

According to one new report about the market for the procedure, central Europe will be one of the places where it is used most in the 2020s.

The study by Future Market Insights titled ’Gamma Knife Market: Global Industry Analysis and Opportunity Assessment 2015-2025’ predicted that between 2021 and 2031 Germany alone would account for a fifth of procedures in Europe.

It also said the worldwide market for the procedure would see compound annual growth of 5.9 per cent, with the global value of the market rising from US$287.3 million to US$507 million.

Ultimately, however, it is not all about money, whether it is the funds raised by the Czechs 30 years ago or the future value of the market. It is about saving the lives of people with brain tumours and other otherwise inoperable conditions and giving them many more years of life.

How Does Radiotherapy Help Relieve Pain?

July 19, 2022

Radiotherapy and radiosurgery and primarily used in a highly targeted way to help remove malignant tumours and other cancerous cells before they can spread and cause considerable harm.

In particular, the precise nature of Gamma Knife radiosurgery allows for the treatment of brain tumours and complex neurological conditions such as trigeminal neuralgia.

However, whilst it is primarily used for the eradication of tumours, radiosurgery techniques can also be used to assist with pain relief for certain types of cancer that are untreatable or have become untreatable.

This is known as palliative radiation therapy and is primarily used for managing the debilitating pain that some people suffering from bone cancer can feel, although it can be used to manage the pain of skin cancer and other forms as well.

To explain how radiotherapy helps with pain relief, we need to understand why cancer cells can cause pain to begin with.

Tumours, lesions and growths associated with cancer can grow, and as they grow they can start to press against nerves, organs and bones. This pressure can feel painful and is compounded by the pain caused by tumours destroying healthy tissue surrounding them.

In the case of bone cancer, this is compounded by bone cells being weakened, increasing the chance of painful breaks.

Radiotherapy kills cancer cells and shrinks tumours, which can help ease the pressure on parts of the body the cancer is affecting, and increase the viability of surgery to remove tumours, even if not every growth can be operated on.

Whilst in some cases radiotherapy takes the form of radiation drugs that are injected into a target area, the main form of radiotherapy is external, which uses a machine such as a gamma knife to aim beams of radiation to target cancer cells.

After the course of treatment, it can take a few weeks, but the majority of people who have had palliative radiotherapy have claimed it has reduced or removed pain caused by the cancerous cells.

World Brain Tumour Day Marked

June 15, 2022

June 8th was World Brain Tumour Day, an event established to raise awareness of brain tumours, dispel misunderstandings, help people spot the signs that indicate they need to seek a scan and highlight the array of treatments that are available.

For this reason, a plethora of articles has been published on the topic to increase understanding and help generate better health outcomes, not least among those who might not otherwise have spotted early signs that something is amiss.

Indian news provider the Economic Times, for example, published a series of tips on what to look out for, with these ranging from milder and less unusual symptoms like headaches to more specific problems like seizures, changes in personality, clumsiness and cognitive impairment.

In the past, developing a brain tumour would normally have been a death sentence. But that is anything but the case now. For one thing, many tumours are benign and non-cancerous; treatments for them will prevent excess pressure building on the brain, which will then ensure they are no longer dangerous.

Cancerous tumours are another matter, of course. They can be the result of specific brain cancer, or another form of cancer spreading across the body including the brain. Either will be deadly unless successfully treated and often once it is very advanced there is often little or nothing that can be done, as is so often the case with cancer. That’s why early diagnosis matters.

As Healthshot notes, the good news is that if a cancerous tumour is detected, the chances of survival are now far greater than they used to be. It stated: “The days of mutilating and incapacitating surgeries are long gone, and modern neurosurgery is really rather safe and successful,” adding that Gamma Knife Surgery is now a key tool in the “modern day” arsenal available to neurosurgeons.

It added: “The post-surgery outcomes have also been revolutionised by radiosurgery. The mortality and morbidity rates have decreased significantly, and we now add life to years rather than just years to life.”

Knowing this can make a crucial difference in more ways than one. The most obvious is that gamma knife treatment offers the hope of a life-changing operation that leaves no scars, no rehabilitation period and potentially a complete recovery.

Secondly, there is the behavioural implication of this. Fir some who might suspect there is a problem, there will be a reluctance to get checked out for fear of what the diagnosis might be. This fear is bound to be greater for any condition that is either incurable or for which the treatment can be arduous and traumatic.

Therefore, knowing that a treatment can be both effective and not come with a lot of side-effects and pain may help some people go forward and get themselves examined if they start to show possible symptoms.

With the medical world both knowing more than ever about brain tumours and the treatments available being more effective and now non-invasive, there is far more hope for patients than there ever was – something that warrants lots of awareness on the other 364 days of the year too.