Holger L. Gieschen, MD, assistant professor, University of Tennessee Health Science Center, radiation oncologist, West Cancer Center, discusses the toxicities associated with radiation therapy in prostate cancer.

Acute and long-term urinary toxicities are common, says Gieschen. The proximity of the rectum to the prostate can cause rectal toxicities, such as bleeding and radiation proctitis, he adds. However, there are several ways to minimize these events. For example, hydrogel can be placed between the rectum and prostate in order to increase the distance between the 2 areas. If these toxicities do occur, which action to take will depend on severity. Usually a conservative approach is preferable to a surgical intervention in the management of these adverse events.

Not all of these toxicities are reversible, says Gieschen. For example, impotence is something that can occur, with which patients experience a decline over time that eventually becomes irreversible. However, these events are often treatable with different options.

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Dr. Gieschen on Toxicities Associated With Radiation Therapy in Prostate Cancer

Holger L. Gieschen, MD, assistant professor, University of Tennessee Health Science Center, radiation oncologist, West Cancer Center, discusses standard approaches to radiation therapy in prostate cancer.

There are many approaches in terms of radiation delivery, explains Gieschen. Standard external beam treatment is used over a longer period of time, whereas shorter courses of radiation can be given over a duration of 5.5 weeks. Selecting the right method should be individualized to each patient and the state of their disease, he adds. Patient preferences and expectations should also be factored into a treating physician’s decision.

In prostate cancer, radiation can be combined with androgen deprivation therapy (ADT). This approach is most appropriate in intermediate- and poor-risk populations, explains Gieschen. Patients with low-risk disease do not need the addition of ADT. Conversely, ADT should always be incorporated into the treatment course of a patient with high-risk disease if there are no contraindications that state otherwise.

Dr. Gieschen on Standard Approaches to Radiation Therapy in Prostate Cancer

Holger L. Gieschen, MD, assistant professor, Department of Radiology, the University of Tennessee Health Science Center, radiation oncologist, West Cancer Center, discusses patient selection for radiation in the treatment of prostate cancer.

There are several patients who are considered eligible to receive radiation therapy, Gieschen says. Patients ranging from low-risk to high-risk disease can be treated with radiation, but there are competing modalities in this space, such as prostatectomy. Although high-risk patients are usually treated with surgery, Gieschen notes that these patients can also benefit from radiation treatment.

In the definitive setting, the goal of radiation therapy is to shrink the cancer as much as possible and potentially cure the patient, whereas in the palliative setting, this approach is used to stabilize prostate-specific antigen levels that naturally rise after surgery.

Dr. Gieschen on Patient Selection for Radiation in Prostate Cancer

Holger L. Gieschen, MD, assistant professor, Department of Radiology, the University of Tennessee Health Science Center, radiation oncologist, West Cancer Center, discusses the safety profile of radiation therapy in patients with non—small cell lung cancer (NSCLC).

Side effects of radiation may include skin reactions and some irritation of the lung. Physicians will usually differentiate between acute side effects that may occur when the patient is undergoing treatment and long-term side effects that may manifest months or years after the treatment.

The acute side effects are usually transient and are not cause for concern. Long-term side effects can result in lung fibrosis and diminished lung volume and capacity. As in surgery, the concern is a patient’s insufficient lung capacity after treatment.

One of the most significant side effects that can result from radiation therapy is radiation pneumonitis, which is not due to bacteria or infection, but the radiation itself. Some of these patients require steroid treatments which can be difficult to handle.

Holger L. Gieschen, MD, assistant professor, Department of Radiology, the University of Tennessee Health Science Center, radiation oncologist, West Cancer Center, discusses the safety profile of radiation therapy in patients with non–small cell lung cancers (NSCLC).

Holger L. Gieschen, MD

Articles

Dr. Gieschen on Toxicities Associated With Radiation Therapy in Prostate Cancer

Dr. Gieschen on Standard Approaches to Radiation Therapy in Prostate Cancer

Dr. Gieschen on Patient Selection for Radiation in Prostate Cancer

Dr. Gieschen on the Side Effects of Radiation Therapy in NSCLC