Editorial: Prostate brachytherapy: Pro-seeding forward

Dr. Suh is the editor-in-chief of Applied Radiation Oncology, and professor and chairman, Department of Radiation Oncology at the Taussig Cancer Institute, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, OH.

Welcome to the September issue of Applied Radiation Oncology, which focuses on prostate cancer, the most common cancer in men after skin cancer. Although the overall use of radiation modalities for prostate cancer has declined significantly since 2004,¹ it remains a very important treatment for this malignancy.

The two review articles featured this month, both of which offer SA-CME credit, examine key issues and approaches surrounding prostate brachytherapy, a very effective and efficient but underutilized treatment option for prostate cancer. Current controversies in prostate brachytherapy for prostate cancer is an insightful article exploring indications for low dose rate (LDR) brachytherapy, evolving guidelines, and criteria for patient selection. It also tackles the value of LDR brachytherapy in high-risk prostate cancer patients based on recent trials and retrospective studies, and provides a dosimetric analysis comparing LDR brachytherapy with external-beam radiation therapy (EBRT).

A second review article, High dose rate brachytherapy for prostate cancer: current techniques and applications to varying disease presentations, offers a comprehensive look at patient selection, use of HDR in conjunction with EBRT, and HDR brachytherapy as monotherapy. The article also assesses the logistics, advantages, and disadvantages associated with various HDR treatment planning approaches, and analyzes dosimetric goals and constraints.

We are also pleased to showcase the research findings in Daily image guidance as a noninvasive technique of rectal emptying in postprostatectomy radiation. This study discusses how rectal emptying serves as an easy intervention when rectal filling is noted on daily cone-beam computed tomography prior to radiation treatment—a practice linked to lower radiation dose to the rectum and potential decreased toxicity.

A final focus article is Protons for prostate cancer: Bragging points, trials and treatment optimization. This Technology Trends piece provides an update on controversies, clinical investigations, contraindications, and issues of uncertainty and motion associated with the modality.

Two case reports are featured this month as well: Volumetric-modulated arc therapy improved heart and lung sparing for a left-sided chest wall and regional nodal irradiation case is a well-written summary of how VMAT was the treatment of choice to spare the heart and lung without sacrificing target coverage, while outweighing the risk of secondary cancer. The second case, An abscopal effect in a case of neuroendocrine atypical carcinoid lung cancer, describes the first reported abscopal effect account of its kind in a 67-year-old never-smoker.

We hope you enjoy our prostate cancer issue and greatly look forward to the 59th Annual ASTRO Meeting, Sept. 24-27. Safe travels, and see you soon in San Diego!

Reference

1. Malouff T, Mathy NW, Marsh S, et al. Trends in the use of radiation therapy for stage IIA prostate cancer from 2004 to 2013: a retrospective analysis using the National Cancer Database. Prostate Cancer Prostatic Dis. 2017;20(3):334-338. doi:10.1038/pcan.2017.15.