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Palliative external radiation therapy for prostate cancer


Medical editor Oslo University Hospital

General

In palliative radiation therapy toward locally advanced hormone resistant prostate cancer or metastases from prostate cancer, external radiation is used. Radiation therapy is performed to reduce pain and decrease the tumor size thereby reducing or removing locoregional problems.

Goal

  • Palliative treatment

Indications

  • Locally advanced hormone resistant tumor (with possible invasion into the bladder and/or bowel)
  • Symptom from skeletal metastases
  • Compression of the spinal cord
  • Other local symptom caused by metastasis 

Definitions

 

Target Volume

 

Target volume definitions from ICRU
(International Commission on Radiation Units and Measurements)

GTV (= Gross Tumor Volume)

Tumor volume

Palpable or visible/demonstrative area of malignant growth.

CTV (= Clinical Target Volume)

Clinical target volume

Tissue volume which contains GTV and/or subclinical microscopic malignant disease.

ITV (= Internal Target Volume)

Target volume

Volume containing CTV and one inner margin taking into account inner movements and revisions of CTV. 

PTV (= Planning Target Volume)

Planning volume

Geometric volume containing ITV and one Setup margin taking into account patient movement, variation in patient positioning, and field modeling.


Preparation

Primary spreading has, in most cases, already occurred in this patient group. Further examinations will therefore depend on the symptoms, and can include the need for X-ray, bone scan, and MRI investigations.

Preparation for the patient

For palliative radiation treatment of the prostate area see: preparation of primary curative radiation therapy.

For other palliative radiation treatment, the preparation will depend on the situation.


Implementation

Locally advanced hormone resistant tumor

Usually, 2 Gy x 25 is given, with one treatment per day for 5 days a week.

Target Volume

Adjustment of target volume in the pelvis must take into consideration multiple factors:

  • Identified macroscopic tumor
  • Assumed microscopic disease
  • Variations in positioning of the patient (systematic and coincidental)
  • Inner movements (systematic and coincidental) of target volume and risk organ

Field Limitations

Currently, 2 radiation fields (from the front and back) with 2 cm margins around the prostate.

Bone metastases

  • For pure pain reducing treatment, standard fractioning 8Gy x 1. This treatment can be repeated once
  • For spinal cord  lesion, danger of fracture, postoperatively, neurological symptoms and base of  the scull: 3 Gy x 10
  • Half-body radiation: In elderly and frail patients with advanced hormone resistant disease and complications from more surrounding and diffuse metastases to half of the body radiation with a high single fraction (upper 6Gy x 1, lower 8Gy x 1) may achieve good pain reduction.

Follow-up

Acute complications

  • Cystitis
  • Ureterititis
  • Diarrhea
  • Dermatitis
  • Nausea

Chronic complications

  • Proctitis
  • Ureteritis
  • Urethra strictures (especially if the patient has inlaid Foley catheter during the treatment period)

Check

Examination by doctor every 14 days during the treatment period, thereafter to see the GP or local hospital.


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