October 8 2009  |  News Article 

First HDR brachytherapy treatment for prostate cancer recently performed in Helsinki  

In September 2009, the Docrates Clinic in Helsinki treated its first prostate cancer patient with HDR (High Dose Rate) brachytherapy. This technique, also known as internal radiation therapy, offers new opportunities for treating medium-high-risk and high-risk prostate cancer. The entire process was planned, monitored and modulated using Nucletron’s Oncentra® Prostate treatment planning software and the microSelectron® Digital afterloader.


What is brachytherapy?

HDR brachytherapy involves irradiating the prostate from the inside with a high dose that is precisely targeted to the tumor. 15-20 hollow needles are inserted into the prostate and then a single, highly radioactive iridium-192 source is inserted into the needles one by one. This is a more accurate and more effective way to treat higher risk forms of prostate cancer than LDR (Low Dose Rate) brachytherapy, which until now has been the only internal radiation therapy available in Finland. LDR brachytherapy entails implanting the prostate with seeds containing iodine-125, which release their radiation gradually over a period of several weeks or months. Although LDR or seed implant brachytherapy has been shown to be effective and well tolerated in patients with low risk, localized prostate cancer, HDR brachytherapy can provide greater accuracy and precision, with a short treatment time.


HDR brachytherapy now available at the Docrates Clinic

The availability of a new HDR brachytherapy centre therefore offers fresh treatment options for Finnish patients. With over 4,000 men newly diagnosed each year, prostate cancer is the most common male cancer in Finland. Following good results from HDR brachytherapy in other Nordic countries with a similarly high incidence of this form of cancer, the Docrates clinic is the first facility in Finland to offer this form of treatment.

“We are extremely happy about our collaboration with the Docrates Clinic,” says Michel T. Rudolphie, Vice-President Europe at Nucletron. “I am convinced that the first HDR brachytherapy treatment at the Docrates Clinic is a giant leap forward in improving patient care. The Docrates Clinic has recognized Nucletron as a leader in brachytherapy and together with their clinical team we will be able to further develop HDR brachytherapy in Finland.”


The future of prostate cancer treatment?

Currently, HDR brachytherapy is typically combined with external beam radiation therapy. The aim is to enhance efficacy by using the external beam (which also irradiates tissue adjacent to the tumor) in conjunction with brachytherapy (which is more closely targeted and therefore results in fewer side-effects). Promising interim results from a number of international studies, including the PBIG (Prostate Brachytherapy International Group), indicate that HDR brachytherapy may soon be proposed as the sole treatment for prostate cancer.


Background information:


Prostrate cancer incidence and treatment options

The main group at risk of prostate cancer is men aged over 50 years. Treatment options include the removal of the prostate, external beam radiation or internal radiation (brachytherapy). Due to the location of the prostate, it is a challenge to irradiate tumors without affecting surrounding organs. Side-effects of treatment therefore often include urinary difficulties and impotence, with considerable implications for patients’ quality of life. More accurate treatment methods, such as brachytherapy, minimize these risks.


LDR brachytherapy: effective in localized prostate cancer

LDR (Low Dose Rate) brachytherapy has been used for many years, often replacing surgery for treating local prostate tumors. It was the first step towards targeted radiotherapy for prostate cancer. In LDR the prostate tumor is irradiated from the inside with iodine-125-seeds. The procedure to implant these takes just a few hours, and the patient can usually return home the very next day. Iodine-25's half-life is 60 days, so most of the radiation dose is given during the first two months.

LDR brachytherapy is well tolerated, and a large proportion of patients retain fitness. This type of short-range radiation (about 5 mm) gives a large dose of radiation inside the prostate, while sparing surrounding healthy tissue. This therapy has proven to be effective in localized prostate cancer, rather than in cases where the cancer has spread to surrounding organs. 


HDR brachytherapy: a higher dose of radiation more precisely targeted to the tumor

Unlike LDR brachytherapy, HDR (High Dose Rate) brachytherapy is also suitable for treating cancer that has spread outside the prostate capsule. By using the latest imaging techniques and treatment planning software, it is possible to precisely target the tumor and avoid damage to surrounding tissue. Sometimes the patient can go home the same day, usually the next. It is therefore time-efficient and convenient for the patient.

The main group at risk of prostate cancer is men aged over 50 years. Treatment options include the removal of the prostate, external beam radiation or internal radiation (brachytherapy). Due to the location of the prostate, it is a challenge to irradiate tumors without affecting surrounding organs. Side-effects of treatment therefore often include urinary difficulties and impotence, with considerable implications for patients’ quality of life. More accurate treatment methods, such as brachytherapy, minimize these risks.External beam therapy involves the prostate being irradiated from the outside. Treatment typically involves sessions of 10-15 minutes per day over a 4-week period.

LDR (Low Dose Rate) brachytherapy has been used for many years, often replacing surgery for treating local prostate tumors. It was the first step towards targeted radiotherapy for prostate cancer. In LDR the prostate tumor is irradiated from the inside with iodine-125-seeds. The procedure to implant these takes just a few hours, and the patient can usually return home the very next day. Iodine-25's half-life is 60 days, so most of the radiation dose is given during the first two months.LDR brachytherapy is well tolerated, and a large proportion of patients retain fitness. This type of short-range radiation (about 5 mm) gives a large dose of radiation inside the prostate, while sparing surrounding healthy tissue. This therapy has proven to be effective in localized prostate cancer, rather than in cases where the cancer has spread to surrounding organs.  HDR brachytherapy: a higher dose of radiation more precisely targeted to the tumor.

Unlike LDR brachytherapy, HDR (High Dose Rate) brachytherapy is also suitable for treating cancer that has spread outside the prostate capsule. By using the latest imaging techniques and treatment planning software, it is possible to precisely target the tumor and avoid damage to surrounding tissue. Sometimes the patient can go home the same day, usually the next. It is therefore time-efficient and convenient for the patient.
 

Planning and performing HDR brachytherapy treatment

1) High-quality imaging is the basis of high-quality care
The prostate is first imagined millimeter by millimeter with a transrectal ultrasound probe. This forms a three-dimensional image block that is used for determining the treatment area and the position of underlying healthy tissues (urethra, rectum, bladder).

2) Intensity Modulated HDR brachytherapy is planned in 3-D
Recent innovations in HDR brachytherapy include the development of modern treatment planning software. This allows the intensity to be modulated – a possibility previously available only for external radiation therapy planning. Three-dimensional, inverse dose planning optimizes the radiation source route, target and time, enabling a highly complex and extremely accurate treatment plan to be created.

3) Computer-controlled radiation targeting
15-20 needles are inserted into the prostate through the perineum according to the treatment plan. The final location of each needle is checked in real-time, using ultrasound images, to ensure correct placement. When this is established, their position is fixed and the needles are connected to the afterloader with catheters. A computer-controlled machine pushes a single highly radioactive iridium-192 seed into the catheters one by one.

The Docrates Clinic
Docrates is a private clinic that specializes in the diagnosis, treatment and follow-up of cancer. The patient has access to examinations and treatments without delay. The central goal is to guarantee the quality of life of the patient. Docrates Clinic works in cooperation with the pharmaceutical and the biomedical equipment manufacturers in research and development. This cooperation enables us to utilize the newest medications and methods at the right time, for patients’ benefit. http://www.docrates.com/