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      Interstitial high-dose-rate brachytherapy as a boost in synchronous prostate and rectal cancer treatment: case report and literature review

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          Abstract

          Purpose

          Prostate and colorectal cancers are the first and the third most popular malignancies in male population, in which some patients may develop these tumors metachronously or synchronously. At present, there are no standard recommendations, and oncologists need to provide an optimal management for two different cancers with an acceptable risk of possible treatment of adverse effects.

          Material and methods

          This case report presents the treatment of a 61-year-old patient suffering from synchronous prostate and rectal cancer. Both malignancies were locally advanced, histologically proven, and defined as cT2cN0M0 stage prostate and cT3N2M0 stage rectal adenocarcinoma.

          Results

          Multidisciplinary treatment team decided on synchronous radical treatment of both malignancies. The patient was qualified to long-term androgen deprivation therapy (ADT) and preoperative chemoradiation, with a total dose of 50.4 Gy in 28 fractions delivered with intensity modulated radiation therapy/image-guided radiation therapy (IMRT/IGRT) to a proper prostatic and rectal gross and nodal clinical target volume (CTV) with concurrent 5-fluorouracil. Additional dose of 15 Gy in a single fraction was delivered to prostate with interstitial HDR brachytherapy within a week after external beam radiotherapy (EBRT). After 8 weeks, the patient underwent sphincter-sparing surgery, with total mesorectal excision. Treatment tolerance was good, and genitourinary toxicity was not observed until now. At present, the patient is 45 months after completion of chemoradiation and surgery. Current prostate specific antigen (PSA) level is < 0.003 ng/ml, with no evidence of locoregional recurrence or distant metastases. Patient completed long-term ADT.

          Conclusions

          High-dose-rate (HDR) brachytherapy as a boost seems to be well-tolerated and effective option for delivering proper treatment dose to prostate in case of simultaneous treatment of rectal and prostate cancer.

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          Most cited references21

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          Use of normal tissue complication probability models in the clinic.

          The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review summarizes the currently available three-dimensional dose/volume/outcome data to update and refine the normal tissue dose/volume tolerance guidelines provided by the classic Emami et al. paper published in 1991. A "clinician's view" on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly used normal tissue complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included. Copyright 2010 Elsevier Inc. All rights reserved.
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            ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer

            Delineation of clinical target volumes (CTVs) remains a weak link in radiation therapy (RT), and large inter-observer variation is seen. Guidelines for target and organs at risk delineation for prostate cancer in the primary setting are scarce. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists.
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              ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer.

              To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer.
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                Author and article information

                Contributors
                Role: Prof.
                Journal
                J Contemp Brachytherapy
                J Contemp Brachytherapy
                JCB
                Journal of Contemporary Brachytherapy
                Termedia Publishing House
                1689-832X
                2081-2841
                30 April 2020
                April 2020
                : 12
                : 2
                : 181-187
                Affiliations
                [1 ]Wroclaw Comprehensive Cancer Center, Poland,
                [2 ]Department of Oncology, Wroclaw Medical University, Poland,
                [3 ]Brachytherapy Department, Greater Poland Cancer Center, Poznan’, Poland
                Author notes
                Address for correspondence: Katarzyna Konat-Bąska, MD, Brachytherapy Department, Wroclaw Comprehensive Cancer Center, 12 Hirszfeld Sq., 53-413 Wrocław, Poland, phone: +48 71 36 89 422, e-mail: konat.katarzyna@ 123456dco.com.pl
                Article
                40414
                10.5114/jcb.2020.94585
                7207231
                a6b2fea4-1a91-4fc7-996a-aa90af33ab6d
                Copyright © 2020 Termedia

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

                History
                : 06 December 2019
                : 16 March 2020
                Categories
                Case Report

                Oncology & Radiotherapy
                prostate cancer,rectal cancer,synchronous cancers,multidisciplinary treatment,chemoradiotherapy,brachytherapy

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