Intensity modulated radiation therapy (IMRT) is a specialized form of external beam radiotherapy. A device called a linear accelerator is used to administer high-energy photon beams to the prostate. IMRT is delivered in small, daily doses over a course of 7 to 9 weeks. Each treatment usually takes only a few minutes. When undergoing IMRT, it is imperative that the patient be in the exact same position for each radiation treatment, so a lot of time and attention is paid to ensuring accuracy.
Why Choose IMRT?
IMRT has the longest track record and the largest supporting body of evidence in the scientific literature. In contrast to surgery, IMRT is non-invasive and has a much lower risk of bleeding, pain, infection, urinary leakage, and shortening of the penis. In contrast to seed implants, IMRT can treat a larger border around the prostate, which is more advantageous for High-Teal patients. In some clinical studies IMRT has also been suggested to have lower toxicity than Stereotactic Body Radiation Therapy (SBRT) (Chapter 21) or combined external radiation and seed implants (Chapter 19).
Is Hormone Therapy Necessary for Teal Patients Receiving IMRT?
The benefit of combining hormone therapy, also known as testosterone inactivating pharmaceuticals (TIP), with radiation for Tealand Azure is arguably the most well validated treatment strategy in all prostate cancer. Clinical trials show that the addition of TIP to radiation prolongs survival and decreases the risk of prostate cancer recurrence. If TIP is recommended, most patients require only 4 to 6 months of treatment, beginning 2 to 3 months prior to radiation. TIP can cause its own unique spectrum of side effects, though most side effects wear off with time after TIP is discontinued. Chapter 29 discusses TIP’s potential side effects and how to manage them.
ABOUT THE AUTHORS
Zachary S. Zumsteg, MD completed a residency at Memorial Sloan Kettering Cancer Center and is presently a faculty member in the Department of Radiation Oncology at Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. In addition to his clinical practice, he is actively engaged in research spanning epidemiology, health services, clinical trials and translational applications. Through this work, Zumsteg has developed a novel risk stratification system for patients with intermediate risk prostate cancer that is currently widely used by oncologists in clinical practice and cited in National Comprehensive Cancer Network Guidelines. He is the author of numerous peer reviewed publications, with articles appearing in journals such as Lancet Oncology, Journal of Clinical Oncology, JAMA Oncology, European Urology, Clinical Cancer Research, Cancer, and the International Journal of Radiation Oncology, Biology and Physics.
Howard Sandler, MD graduated from the University of Connecticut, Summa Cum Laude, where he also received his doctorateM.D. and Master’s degree in Physics. He is the Newman Family Professor of Radiation Oncology at Cedars-Sinai Medical Center and Chair of Ronald H. Bloom Family Chair Cancer Therapeutics. He is the Principal investigator for a national Radiation Therapy Oncology Group study examining radiotherapy and chemotherapy for prostate cancer. He is coauthor of more than 200 peer-reviewed scientific articles.