Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir.

BackgroundPatients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcomes. The purpose of this study was to compare the PSA kinetics between CF-EBRT and SBRT in newly diagnosed localized prostate cancer.Materials/methods75 patients with low to low-intermediate risk prostate cancer (T1-T2; GS 3 + 3, PSA < 20 or 3 + 4, PSA < 15) treated without hormones with CF-EBRT (>70.2 Gy, <76 Gy) to the prostate only, were identified from a prospectively collected cohort of patients treated at the University of California, San Francisco (1997-2012). Patients were excluded if they failed therapy by the Phoenix definition or had less than 1 year of follow-up or <3 PSAs. 43 patients who were treated with SBRT to the prostate to 38 Gy in 4 daily fractions also met the same criteria. PSA nadir and rate of change in PSA over time (slope) were calculated from the completion of RT to 1, 2 and 3 years post-RT.ResultsThe median PSA nadir and slope for CF-EBRT was 1.00, 0.72 and 0.60 ng/ml and -0.09, -0.04, -0.02 ng/ml/month, respectively, for durations of 1, 2 and 3 years post RT. Similarly, for SBRT, the median PSA nadirs and slopes were 0.70, 0.40, 0.24 ng and -0.09, -0.06, -0.05 ng/ml/month, respectively. The PSA slope for SBRT was greater than CF-EBRT (p < 0.05) at 2 and 3 years following RT, although similar during the first year. Similarly, PSA nadir was significantly lower for SBRT when compared to EBRT for years 2 and 3 (p < 0.005).ConclusionPatients treated with SBRT experienced a lower PSA nadir and greater rate of decline in PSA 2 and 3 years following completion of RT than with CF-EBRT, consistent with delivery of a higher bioequivalent dose. Although follow-up for SBRT is limited, the improved PSA kinetics over CF-EBRT are promising for improved biochemical control

Role of Insurance in Post Disaster Recovery Planning in Business Community

The whole world is facing a substantial of natural disasters which brings severe damages throughout the world. Attention must be given to rehabilitate the business community that is affected by these disasters. However, improper planning for recovering damages in business community becomes a major issue when it obstructs the continuation and development of the business community. Therefore, required measures should be taken to avoid collapsing of development of the business community affected by disasters. In this context, insurance plays a vital role to reinstate the business while reducing the financial consequences of the disaster. This study investigates the role of insurance as a provision to recover the disastrous destruction of the business community in Sri Lanka. To achieve this, the survey method was used as the approach and semi structured interviews carried out within five experts from insurance sector and eight experts from the business community. Content analysis was used to analyze the collected data from the empirical study. The analysis of the findings based on two areas of insurers’ and insured’ perception of insurance. One of the major finding was that the insurance is not extended to any frequent disaster prone area of the country unless accepted by the insured with either higher premium amount or higher amount of deductible. As per the insurer’s side, some issues of the current practice are identified as less awareness, dishonesty and fraudulent practice of the insured which leads to less identification of the insurance as a risk management strategy within the business community. According to the insured, main purposes of obtaining insurance are quick recovery of business and to fulfil the borrowing requirements. Recommendations were developed as increase the awareness, educating and the government participation to increase the insurance penetration to the business community