External beam radiation therapy
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External Beam Radiation Therapy: Current Applications and Efficacy
Introduction to External Beam Radiation Therapy (EBRT)
External Beam Radiation Therapy (EBRT) is a cornerstone in the treatment of various cancers, utilizing high-energy radiation to target and destroy cancer cells. This article synthesizes recent research on the applications, efficacy, and advancements in EBRT across different cancer types.
EBRT in Hepatocellular Carcinoma (HCC) and Intrahepatic Cholangiocarcinoma (IHC)
Indications and Recommendations
EBRT is recommended as a first-line treatment for patients with liver-confined HCC who are not candidates for curative therapies. It is also used as consolidative therapy after incomplete responses to liver-directed treatments and as a salvage option for local recurrences. For patients with multifocal or unresectable HCC, or those with macrovascular invasion, EBRT is conditionally recommended in combination with systemic or catheter-based therapies. Additionally, EBRT can serve as a bridge to transplant or preoperative therapy in selected patients.
Efficacy and Safety
EBRT has shown promise in managing HCC, particularly in improving intrahepatic tumor control and potentially enhancing survival rates when combined with non-surgical treatments. It also plays a role in palliative care, alleviating symptoms and improving the quality of life for patients with advanced disease .
EBRT in Cervical Cancer
Boost Modalities and Clinical Outcomes
In the treatment of locally advanced cervical cancer, EBRT is often used in conjunction with brachytherapy. However, high-tech EBRT has not shown superiority over image-guided brachytherapy for delivering a boost. Advances in EBRT, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), have improved the precision and reduced the toxicity of treatments.
Combined Therapy Benefits
Combining EBRT with high dose-rate brachytherapy (HDRBT) has been shown to significantly improve dysphagia relief and other symptoms in patients with obstructive squamous cell esophageal cancer, without increasing toxicity.
EBRT in Prostate Cancer
Long-Term Survival and Biochemical Control
A randomized trial comparing EBRT alone to EBRT combined with brachytherapy in node-negative, locally advanced prostate cancer found no significant difference in overall survival or prostate cancer-specific survival between the two groups, despite improved biochemical control in the combined therapy group.
EBRT in Soft Tissue Sarcomas (STS)
Preoperative vs. Postoperative EBRT
EBRT is effective in reducing local recurrence in resectable soft tissue sarcomas, particularly in retroperitoneal tumors. Preoperative EBRT has been associated with fewer local recurrences compared to postoperative EBRT, although it may lead to more wound complications.
EBRT in Choroidal Neovascularization (CNV)
Visual Acuity Outcomes
A study on the use of EBRT for choroidal neovascularization secondary to age-related macular degeneration found that EBRT did not significantly improve visual acuity outcomes compared to a control group, suggesting that this dose of radiation may not be effective for CNV.
Advances in EBRT Technology
Optimization and Precision
Technological advancements in EBRT, such as the development of IMRT, proton therapy, and stereotactic body radiation therapy, have enhanced the precision of radiation delivery, allowing for higher doses to be targeted at tumors while minimizing exposure to surrounding healthy tissues . These innovations have improved the therapeutic index and reduced treatment-related morbidities.
Conclusion
EBRT remains a vital component in the multidisciplinary approach to cancer treatment. Its applications span a wide range of malignancies, from liver and cervical cancers to soft tissue sarcomas and prostate cancer. Ongoing advancements in radiation technology continue to refine its efficacy and safety, offering hope for improved patient outcomes across various cancer types. Future research should focus on optimizing treatment regimens and further integrating EBRT with other therapeutic modalities.
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