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Physician Resource

High-Dose Rate Brachytherapy: Part of a Proven Approach to Treating Intermediate- and High-Risk Prostate Cancers

At a Glance:

  • UVA radiation oncologists are ushering in the next generation of brachytherapy applications
  • Brachytherapy has been shown especially effective in the treatment of intermediate- and high-risk prostate cancers
  • UVA offers an updated, more conformal version of the combination therapy using a three-pronged approach that includes high-dose rate brachytherapy, intensity-modulated radiation therapy and use of a prostate-rectal spacer

As part of a well-established brachytherapy program that has seen an ever-increasing volume of patients in recent years, UVA radiation oncologists are well beyond the learning curve when it comes to brachytherapy. Through participation in clinical trials, adoption of the latest technology and procedures, and active participation in national leadership organizations, UVA specialists are ushering in the next generation of brachytherapy applications.

“We have long used brachytherapy at UVA for prostate, breast and gynecological cancers, including cervical and endometrial cancer,” says UVA radiation oncologist Timothy Showalter, MD, a co-author of American College of Radiation guidelines for prostate brachytherapy and high-risk prostate cancer and a board member of the American Brachytherapy Society. “We are able to offer a full range of services not widely available elsewhere. Since 2013, we have been offering high-dose rate brachytherapy at UVA with ultrasound image guidance, which has become the gold standard; it is the most precise form of high-dose radiation therapy available.”




Axial ultrasound image shows isodose lines from high dose-rate brachytherapy treatment plan. Note that doses to the urethra and rectum are reduced during the treatment planning process to prevent toxicity.





Three-Pronged Approach to Prostate Cancer

Brachytherapy has been shown especially effective in the treatment of intermediate- and high-risk prostate cancers. So much so that American Society of Clinical Oncology and Cancer Care Ontario put out a joint statement recommending that all prostate cancer patients treated with radiation therapy be offered brachytherapy as a component of their treatment, says Showalter.

Findings from a landmark clinical trial revealed that incorporating prostate brachytherapy into a combination treatment regimen that includes hormone therapy and external beam radiation improves cure rates by as much as 20 percent compared to treatment without brachytherapy. One of the few organizations to offer this treatment nationally, UVA has treated over 100 men utilizing these advanced methods.

At UVA, Showalter and colleagues offer an updated, more conformal version of the combination therapy using a three-pronged approach that includes:

  • High-dose-rate brachytherapy
  • Intensity-modulated radiation therapy
  • The use of a prostate-rectal spacer that has been shown to dramatically reduce risk of radiation injury to the rectum.

“For select prostate cancer patients, this overall approach is the best course of action. It is more aggressive and offers the ability to deliver better outcomes with fewer side effects by offering an ideal form of brachytherapy combined with prostate-rectal spacer,” says Showalter.

UVA was the first center in Charlottesville to offer treatment with prostate-rectal spacer, having treated approximately 150 men with prostate-rectal spacer since starting the program in 2016. Candidates for this three-pronged approach of high dose-rate brachytherapy, prostate-rectal spacer and intensity-modulated radiation therapy include men with:

  • A Gleason score between 7 and 10
  • Locally advanced, intermediate- to high-risk prostate cancer

The treatment consists of one outpatient procedure followed by three to five weeks of radiation therapy. It is not only quicker than standard radiation therapy, which can last 8 to 9 weeks, it’s also safer. “The dose is more targeted, better sparing the urethra and rectum, and there are no concerns about radiation exposure to family members after this treatment because the radioactive source is only implanted temporarily, in contrast to permanent seed implants,” says Showalter.

If you have questions about this prostate cancer treatment or brachytherapy in general, feel free to email Dr. Showalter. Or, to refer a patient to UVA Cancer Center, call 800.552.3723.




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