In a recent publication, Hepel et al. report on the use of intensity-modulated radiotherapy (IMRT) as adjuvant or salvage therapy following cryotherapy in first-line treatment of supposedly localized prostate cancer. Jaroslaw et al. discuss this strategy further in a “ Beyond the Abstract ” commentary on UroToday. However, The “New” Prostate Cancer InfoLink has serious questions about whether cryotherapy with adjuvant radiotherapy is an appropriate first-line treatment stategy for any prostate cancer patient.
In the “Beyond the Abstract” commentary, Jaroslaw et al. themselves observe that “cryotherapy alone appears to have suboptimal results compared with other treatment modalities for localized prostate cancer.” It therefore seems somewhat strange to go on to suggest that one should choose to use a suboptimal technique as a form of first line therapy and then combine it with 8 weeks of adjuvant IMRT in order to offer optimal therapy.
Is it not more appropriate for these patients to receive optimal first-line therapy (probably brachytherapy or surgery) and than add adjuvant IMRT for those believed or clearly shown to have cancer that has extended beyond the prostate?
We would note that the potential roll of IMRT as salvage therapy for those who choose cryotherapy as first line treatment for localized disease but then fail that treatment is not in question here. Such a sequence of care is entirely appropriate. The question that we are raising is whether it is appropriate to plan for (suboptimal) cryotherapy as first-line therapy in combination with adjuvant IMRT. Based on available data, we would postulate that such a treatment strategy was at best potentially effective but inappropriate. It also seems to be excessively costly.
Filed under: Management, Treatment
In a recent publication, Hepel et al. report on the use of intensity-modulated radiotherapy (IMRT) as adjuvant or salvage therapy following cryotherapy in first-line treatment of supposedly localized prostate cancer. Jaroslaw et al. discuss this strategy further in a “ Beyond the Abstract ” commentary on UroToday. However, The “New” Prostate Cancer InfoLink has serious questions about whether cryotherapy with adjuvant radiotherapy is an appropriate first-line treatment stategy for any prostate cancer patient.
In the “Beyond the Abstract” commentary, Jaroslaw et al. themselves observe that “cryotherapy alone appears to have suboptimal results compared with other treatment modalities for localized prostate cancer.” It therefore seems somewhat strange to go on to suggest that one should choose to use a suboptimal technique as a form of first line therapy and then combine it with 8 weeks of adjuvant IMRT in order to offer optimal therapy.
Is it not more appropriate for these patients to receive optimal first-line therapy (probably brachytherapy or surgery) and than add adjuvant IMRT for those believed or clearly shown to have cancer that has extended beyond the prostate?
We would note that the potential roll of IMRT as salvage therapy for those who choose cryotherapy as first line treatment for localized disease but then fail that treatment is not in question here. Such a sequence of care is entirely appropriate. The question that we are raising is whether it is appropriate to plan for (suboptimal) cryotherapy as first-line therapy in combination with adjuvant IMRT. Based on available data, we would postulate that such a treatment strategy was at best potentially effective but inappropriate. It also seems to be excessively costly.
Filed under: Management, Treatment