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Laser Interstitial Thermal Therapy in the Focal Treatment of Localized Prostate Cancer (LITT)

hopeful and opt...
Posts: 2218
Joined: Apr 2009

New Technology for low risk patients

It works like this.

Lessions are found using a multiparametric MRI , then a biopsied, either fused to a 3-D biopsy machine, or in real time with using an MRI.

Where the cancers are determined, This techology targets the  lesions found in the prostate.  It is done using an  MRI to guide the to the spots to be  ablalated. 

This is a partial ablalation using an MRI in real time, that is you're actually in the tube while they use the MRI images to insert and position the laser fiber in the lesion. 

You able to target individual areas of cancer as targets as opposed to a standardised hemi-ablation with a resulting reduction of margin around the the cancer....during treatment contrast dye is typically administered before and after the ablation to verify there are no remaining areas of the active lesion

.Conscious sedation.

I do not know if one can have radiotherapy after having had Laser Interstitial Thermal Therapy?...(I've heard of a doc who says yes).

It's said that one can repeat LITT in the future with no side effects, if the cancer is found after the procedure. ..side effects are minimum.

There is a doc in Tx who has done a good amount of these http://radiology.utmb.edu/prostate.asp

There is also another doc in palm desert, CA. Dr. Feller, who has done lots of them.

....................................................

 

Now to cut to the chase

How advanced is current techology so that one can have confidence in this method?

Would another method such as SBRT be a better choice where the whole prostate can be treated where there is a 97% 5 year  biochemical recurrence-free survival for low-risk, 90.7 % for intermediate risk, and 74.1% for high risk patients. 

When will current technology be improved, to include but not limited to higher resolution MRI at the clinical level.

...............................

Hopefully there will be some discussion at the site about this technology

 

 

 

Beau2
Posts: 261
Joined: Sep 2010

i know of one person who underwent focal treatment. He is on the Healingwell site. His focal treatment was cyro. I believe he was treated in 2009 at the University of Colorado Health Center (Anschutz). He thinks focal treatment is the best. Recently he has indicated that non-cryo energy sources are being used.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

LITT using with MRI guidance is  able to target individual areas of cancer as targets as opposed to a standardised hemi-ablation with a resulting reduction of margin around the the cancer. To my knowledge cryo and HIFU are not able to target individural areas.

There is an article in the Sept 2014 hot sheet page 4 http://www.ustoo.org/PDFs/HotSheets/HotSheet092014.pdf where the FDA does not approve HiFU for early stage prostate cancer.

 

As I understand cryo and HIFU are basically  salvage therapies. Full Cyro of the prostate causes ed in 100 percent of cases.

LITT is basically for early stage prostate cancers. The side effects are very minimal and LITT can be repeated.

Beau2
Posts: 261
Joined: Sep 2010

Ziggy9, on the Healingwell site, had focal treatment with cyro in 2009 ( or there about) at the University of Coloado Health Center. Based on what I read of Ziggy's post, UC still does focal treatments but they no longer do it with cyro. Ziggy's swears by focal and feels that radiation, surgery etc is an overkill. Apparently he had no side effects ... the cyro hit only the tumor. I imagine with the new imaging technologies and energy sources (such as laser) focal is a lot better now than it was in 2009.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

For those who are interested, here  are studies about LITT

 

MR Imaging–guided Focal Laser Ablation for Prostate Cancer: Phase I Trial1 - Oto, et al. (2013)
http://pubs.rsna.org/doi/pdf/10.1148/radiol.13121652


Focal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial Experience
Ted Lee, B - Vol. 16 No. 2 • 2014 • Reviews in Urology • 55
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080850/

Beau2
Posts: 261
Joined: Sep 2010

You may be interested in this link. They are discussing Bipolar radiofrequency ablation as focal treatment for PCa. Appears a trial is starting.

http://www.healingwell.com/community/default.aspx?f=35&m=3183655

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Here is information that I found that is not complete.

 I wonder about the precision of this method. How much of the prostate would be treated, (hemispere)? Are there past studies? I wonder how safe this method is for localized cancer, do the side effect risks outway potential benefits (For example HIFU is not recommended for focal treatment pf  PCa in the USA...see hot sheet from USTOO). Can there be radiation after this treatment type?

http://www.cancercenter.com/treatments/radiofrequency-ablation/?source=GOOGLEWE&channel=paid%20search&c=paid%20search:Google:Google%20-%20Western%20Core%20Terms:Procedures%3A+Surgical+Oncology%7CRadiofrequency+Ablation:radiofrequency+ablation+cancer:Broad&OVMTC=Broad&site=&creative=4341136671&OVKEY=radiofrequency%20ablation%20cancer&url_id=129372569&adpos=1t2&device=c&devicemodel=&gclid=Cj0KEQjw-dSgBRDb0oOl9MzxqMEBEiQAkHqy-fcLTQz8YTCzl45Jh0kRDfQLcNnu5VLwaIwW-uk42mMaAt_K8P8HAQ

http://www.focaltherapy.org/2012/PostersAbstracts/P-31.pdf

 

 

VascodaGama's picture
VascodaGama
Posts: 2890
Joined: Nov 2010

I have mailed Hopeful my thoughts on this treatment and I decided to paste here (sorry Ira) my comments about the Laser Interstitial Thermal Therapy.
“LITT was FDA approved for brain cancer treatment, in 2009. Logically the system may be proper for application in other cancers. The principle is to heat (burn) and kill tissues at its reach (cancerous and benign). This means that success depends in knowing previously the right location of the tissue to be treated, otherwise one sees lesser healthy flesh, the risk and the side effects and a latter recurrence.

They do the job using live MRI images (real-time MR-thermography) to help in reaching pre-established targets which in PCa means the whole prostate gland. Cancer is microscopic and cannot be detected even with that thermal capability. The monitoring is done live so that the surgeon can avoid hitting tissue out of the treatment scope. They use a cooling technique in the marginal areas. Imagine one rod (the arm that is inserted into the gland through a “keyhole”) with two sides, one delivers the heat and the other the cool. You can move it up and down along the gland’s walls turning the heat (side) to the internal part. What this tells is that without proper visualization no proper treatment can be expected. Most of the job is done by guessing. Experiences by the acting professional and past results statistics (not yet available) are necessary for a good outcome.
Radiation treatment may require similar details to be successful but it is here with loads of existing experiences and statistics. The difference is that one burns for good (thermal) and the other destroys the DNA for worse or good”.

Well this is my franc opinion and you know that I do not answer “in circles”. I am straight forward but not a medical professional so these are just lay opinions. I think it possible to radiate on top of LITT if the affected field can be focal to the organ alone.

 

Best wishes.

VGama

hopeful and opt...
Posts: 2218
Joined: Apr 2009

New technologies for focal treatment of the prostate are now being developed, mainly, I believe, because the side effects of these treatments are generally less than full prostate treatments. 

A patient of this treatment type must still be in an Active Surveillance program, and needs to be evaluated on a regular basis. They say that one can have LIRR again if a lession is found in the future.

There are various kinds of focal treatments; LITT is the one that is MRI guided, and there is less ablation than the other focal  o treatments that are not focal guided, so less of the prostate is ablated in the treatment. There may be other focal treaments on the horizon that are MRI guided or equivilent. Medical expertise for focal treatments are currently being developed.

At this time there are also improvements being made in technology. For example at the Univeristy of Minnesota there is a T7 MRI that is being clinically evaluated . Focal treatment for LITT has been around for a few years. One of the pioneers of this method, Dr. Feller, has been using an MRI with a T1.5. There are a few doctors now who are using an MRI with a T3.0 for focal treatments.

When will a patient want to have a focal treatment. This is individualistic...there will be many who will have treatment before the results will be optimum. 

The question is , " when will the results of treatment reach a point where one can be most confident of success?"

Beau2
Posts: 261
Joined: Sep 2010

Thought you might be interested in another article on Focal Treatment of PCa.

This one covers the use of another energy source, cyro.

http://www.medscape.com/viewarticle/808363

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