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Higher Doses of Radiation Urged for Higher-Risk Prostate Cancer: Presented at NCCN By Ed Susman HOLLYWOOD, Fla -- March 7, 2008 -- Patients undergoing radiation therapy for treatment of intermediate- to high-risk prostate cancer should receive higher doses of radiation than those used for low-risk prostate cancer, and should be treated with conformal radiation or intensity-modulated radiation therapy. Doctors suggested that radiation doses of 70 to 79 Gy are sufficient to treat individuals with low-risk prostate cancer, and radiation therapy to the lymph nodes can be avoided in these patients. Androgen deprivation therapy is also unnecessary for these men, said Michael R. Kuettel, MD, PhD, Professor and Chairman, Radiation Medicine and Molecular and Cellular Biophysics, Roswell Park Cancer Institute and State University of New York at Buffalo, Buffalo, New York. "For doses above 75 Gy, extra attention should be taken to daily prostate localisation, since the position of the gland can vary by up to 2 cm due to conditions that include the fullness of the bladder or the bowel," Dr. Kuettel said on March 6 in presenting the updated guidelines for prostate cancer at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care. In patients who have intermediate- or high-risk prostate cancer, doses of 75 to 80 Gy are needed and doctors should consider pelvic lymph node radiation therapy as well, he said. In these patients, the new NCCN guidelines also suggest that 4 to 6 months of adjuvant androgen deprivation therapy should be considered. Dr. Kuettel said that several retrospective studies conducted between 1997 and 2001 indicated that use of higher radiation doses improves disease control. Randomised trials in 2002 and 2007 also showed better control rates at higher radiation doses. However, he said that doctors have to remember that the challenge of radiation therapy for prostate cancer using conformal or intensity-modulated techniques is making sure that clinicians are actually irradiating the entire prostate. "Interfraction motion occurs between fractions," Dr. Kuettel demonstrated with a series of x-rays of the same patient. "Intrafraction motion occurs within a fraction, which is even more difficult to manage." Intrafraction motion can occur due to a patient's respiration, cardiac motion, bowel motion, swallowing, sneezing, and other actions, he said. Dr. Kuettel said that management of the motion is critically important when delivering higher doses because if the radiation misses the prostate target, it can have detrimental consequences on other nearby tissues, such as the rectum. [Presentation title: 2008 Update Prostate Cancer Guidelines.] E-mail this page to a friend or colleague! To print, use this version