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103 oral Prostate brachytherapy toxicity: Leeds experience
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Saturday, May 15, 2004 Proffered papers Prostate Cancer: side effects 103 oral
Prostate brachytherapy toxicity: Leeds experience
D. Bottomley ~, B. AI-Qaisieh 2, J. Joseph ~, D. Ash ~, B. Carey3, S. St ClaiF ~Cookridge Hospital, Radiation Oncology, Leeds, United Kingdom 2Cookridge Hospital, Medical Physics, Leeds, United Kingdom 3Cookridge Hospital, Radiology, Leeds, United Kingdom A retrospective analysis was undertaken of the first 667 patients treated with permanent 1-125 seed prostate implant as a sole treatment for Iocalised prostate cancer. Treatment took place between 1995 and 2001. Each patient was sent a questionnaire assessing toxicity. Additionally, a detailed analysis of case notes took place.
Results: Urinary: 1.4% of patients reported urinary incontinence prebrachytherapy. 2.3% and 1.8% of patients reported incontinence at six and twelve months respectively. In all cases this was intermittent. 14.5% of patients required catheterisation following the procedure. Catheterisation was required for a median of two months (range 0.2-48). There was significant correlation between catheterisation and increased prostate volume. Urethritis was reported in 13.5% of patients at six months, 8.1% at twelve months and 2.5% at 24 months. Bowel frequency increased in 6.4% in patients at six months and 5.7% at twelve months. Rectal bleeding for all causes occurred in 8.1% of patients at some point following treatment. Pretreatment 90.4% of patients were able to get an erection. Following treatment 62.9% of the whole group were able to maintain an erection. Major complications associated with brachytherapy were a rectal prostatic fistula in one (0.2%), ileal conduit in one (0.2%), TURP in three (0.5%), prolonged urine retention requiring suprapubic catheterisation in seven (1.1%), urethral stricture in four (0.6%), infective endocarditis in one (0.2%).
Conclusion: Analysis of the outcome of the first 667 patients treated in Leeds reveals an acceptable level of toxicity 104 oral Chronic toxicity profile and biochemical outcome in favorable-stage prostate cancer patients undergoing monotherapy with HDR or LDR (Pdl03) brachytherapy at William Beaumont Hospital
M. Ghi/ezan, C. Vargas, G. Gustafson, L. Kestin, P. Chert, D. Brabbins, F. Vicini, E. Sebastian, G. Edmundson, A. Martinez William Beaumont Hospital, Radiation Oncology, Royal Oak, U.S.A. Purpose: to report our experience with HDR and LDR brachytherapy as monotherapy in the treatment of early-stage prostate cancer. Material and methods: from June 1996 to August 2003, 253 patients (pts) with early-stage prostate cancer were treated with brachytherapy alone at William Beaumont Hospital. 92 pts had HDR brachytherapy with Iridium ~92 and 161 pts had LDR brachytherapy with Pd 1°3. All patients had clinical stage II, protreatment PSA <12, and a Gleason score <7. HDR minimum prostate dose was 38 Gy delivered in 4 fractions with a single implant over 36 hours. For Pd ~°3 seeds implant the dose was 120 Gy employing a selective peripheral weighted dose distribution. Neoadjuvant hormonal therapy was used in 31% of
patients in each group, for gland downsizing. Treatment was based on pts preference after pre-treatment transrectal ultrasound. Toxicity was quantified using the NCI Common Toxicity Criteria 2.0. Impotency rates were not used for the analysis. Median follow-up for all 263 cases was 2.9 years (3.3 years for LDR and 2.2 years for HDR).
Results: for all pts, the 4-year genito-urinary (GU) toxicity grade ->2 was 28.3% and grade ->3 was 6.9%. The 4-year GU toxicity grade ->2 and ->3 by treatment modality were not significantly different, 34.2% and 5.7% for the HDR pts vs. 23% and 7.7% for the LDR pts (p=0.28 and p=0.38, respectively). The 4-year grade 2 rectal toxicity was 0.8% with no grade 3 or higher rectal toxicity. No cancer related deaths had occurred and the 4-year overall survival was 99% for HDR and 93% for LDR (p=0.35). 4-year biochemical control (ASTRO CP) was 98% for LDR and 99% for HDR. Log rank test (Table) revealed a significantly lower frequency of chronic GU toxicity for patients <70 years, pre-implant prostate volumes -<38cc, prostate length <4cm, use of ->14 needles, <100 seeds (Pdl°3), and no neoadjuvant hormonal therapy. Cox multivariate analysis identified that a greater number of needles (p=0.02, HR=I.3) and hormonal therapy (p=0.02, HR=2.2) were significantly associated with chronic GU toxicity, while age (p=0.8) and prostate volume (p=0.3) were not. Conclusions: chronic GU toxicity (excluding potency) is comparable between HDR and LDR treatment groups. Use of a greater number of needles and use of hormonal therapy were significantly associated with increased chronic GU toxicity on Cox multivariate analysis. While hormonal therapy improved the percentage of patients achieving a PSA nadir <0.5 ng/ml, it was associated with increased chronic GU toxicity. 105 oral
Analysis of acute and late morbidity, and biochemical control for intermediate to high risk prostate cancer treated with androgen deprivation, HDR and 3D/IMRT: 4 year results of a phase I-II dose escalation trial
A. Raben, A. Grebler, S. Sim, J. Geltzeiler, I. Keselman, S. Litvin, M. Geltzeiler, D. Raben, D. Crawford, J. Yang ~Christiana Med Cntr/Monmouth Med Cntr, Radiation Oncology, Newark, DE, U.S.A. =Monmouth Med Cntr, Urology, Long Branch, NJ, USA ~Monmouth Med Cntr, Radiation Oncology, Long Branch, NJ, USA 4Univ of Colorado Health Science Center, Radiation Oncology, Denver, CO, USA SUniv of Colorado Health Science Cntr, Urology, Denver, CO, USA Background: Prostate tumors exhibit a high sensitivity to fractionation due to low alpha/beta ratios and may be radioresitant to convention fractionation. HDR regimens may provide superior or equal tumor control over other approaches with possibly lower late sequelae. Purpose: To evaluate GU and GI morbidity and biochemical control (bNED) of intermediate-high risk prostate cancer patients treated with androgen deprivation (AD), transrectal ultrasound assisted High Dose Rate (HDR) brachytherapy and conformal external radiotherapy as part of an HDR dose escalation trial. Material and methods: from April 1999 to October 2002, a total of 127 patients with intermediate or high-risk prostate cancer were enrolled on a dose escalation trial. Criteria included one or more of the following: PSA > 10, Gleason > 6, Bulky T2-T3 clinical stage, 4-6 core biopsies with bilobar
Saturday, May 15, 2004 Proffered papers Prostate Cancer: side effects 103 oral
Prostate brachytherapy toxicity: Leeds experience
D. Bottomley ~, B. AI-Qaisieh 2, J. Joseph ~, D. Ash ~, B. Carey3, S. St ClaiF ~Cookridge Hospital, Radiation Oncology, Leeds, United Kingdom 2Cookridge Hospital, Medical Physics, Leeds, United Kingdom 3Cookridge Hospital, Radiology, Leeds, United Kingdom A retrospective analysis was undertaken of the first 667 patients treated with permanent 1-125 seed prostate implant as a sole treatment for Iocalised prostate cancer. Treatment took place between 1995 and 2001. Each patient was sent a questionnaire assessing toxicity. Additionally, a detailed analysis of case notes took place.
Results: Urinary: 1.4% of patients reported urinary incontinence prebrachytherapy. 2.3% and 1.8% of patients reported incontinence at six and twelve months respectively. In all cases this was intermittent. 14.5% of patients required catheterisation following the procedure. Catheterisation was required for a median of two months (range 0.2-48). There was significant correlation between catheterisation and increased prostate volume. Urethritis was reported in 13.5% of patients at six months, 8.1% at twelve months and 2.5% at 24 months. Bowel frequency increased in 6.4% in patients at six months and 5.7% at twelve months. Rectal bleeding for all causes occurred in 8.1% of patients at some point following treatment. Pretreatment 90.4% of patients were able to get an erection. Following treatment 62.9% of the whole group were able to maintain an erection. Major complications associated with brachytherapy were a rectal prostatic fistula in one (0.2%), ileal conduit in one (0.2%), TURP in three (0.5%), prolonged urine retention requiring suprapubic catheterisation in seven (1.1%), urethral stricture in four (0.6%), infective endocarditis in one (0.2%).
Conclusion: Analysis of the outcome of the first 667 patients treated in Leeds reveals an acceptable level of toxicity 104 oral Chronic toxicity profile and biochemical outcome in favorable-stage prostate cancer patients undergoing monotherapy with HDR or LDR (Pdl03) brachytherapy at William Beaumont Hospital
M. Ghi/ezan, C. Vargas, G. Gustafson, L. Kestin, P. Chert, D. Brabbins, F. Vicini, E. Sebastian, G. Edmundson, A. Martinez William Beaumont Hospital, Radiation Oncology, Royal Oak, U.S.A. Purpose: to report our experience with HDR and LDR brachytherapy as monotherapy in the treatment of early-stage prostate cancer. Material and methods: from June 1996 to August 2003, 253 patients (pts) with early-stage prostate cancer were treated with brachytherapy alone at William Beaumont Hospital. 92 pts had HDR brachytherapy with Iridium ~92 and 161 pts had LDR brachytherapy with Pd 1°3. All patients had clinical stage II, protreatment PSA <12, and a Gleason score <7. HDR minimum prostate dose was 38 Gy delivered in 4 fractions with a single implant over 36 hours. For Pd ~°3 seeds implant the dose was 120 Gy employing a selective peripheral weighted dose distribution. Neoadjuvant hormonal therapy was used in 31% of
patients in each group, for gland downsizing. Treatment was based on pts preference after pre-treatment transrectal ultrasound. Toxicity was quantified using the NCI Common Toxicity Criteria 2.0. Impotency rates were not used for the analysis. Median follow-up for all 263 cases was 2.9 years (3.3 years for LDR and 2.2 years for HDR).
Results: for all pts, the 4-year genito-urinary (GU) toxicity grade ->2 was 28.3% and grade ->3 was 6.9%. The 4-year GU toxicity grade ->2 and ->3 by treatment modality were not significantly different, 34.2% and 5.7% for the HDR pts vs. 23% and 7.7% for the LDR pts (p=0.28 and p=0.38, respectively). The 4-year grade 2 rectal toxicity was 0.8% with no grade 3 or higher rectal toxicity. No cancer related deaths had occurred and the 4-year overall survival was 99% for HDR and 93% for LDR (p=0.35). 4-year biochemical control (ASTRO CP) was 98% for LDR and 99% for HDR. Log rank test (Table) revealed a significantly lower frequency of chronic GU toxicity for patients <70 years, pre-implant prostate volumes -<38cc, prostate length <4cm, use of ->14 needles, <100 seeds (Pdl°3), and no neoadjuvant hormonal therapy. Cox multivariate analysis identified that a greater number of needles (p=0.02, HR=I.3) and hormonal therapy (p=0.02, HR=2.2) were significantly associated with chronic GU toxicity, while age (p=0.8) and prostate volume (p=0.3) were not. Conclusions: chronic GU toxicity (excluding potency) is comparable between HDR and LDR treatment groups. Use of a greater number of needles and use of hormonal therapy were significantly associated with increased chronic GU toxicity on Cox multivariate analysis. While hormonal therapy improved the percentage of patients achieving a PSA nadir <0.5 ng/ml, it was associated with increased chronic GU toxicity. 105 oral
Analysis of acute and late morbidity, and biochemical control for intermediate to high risk prostate cancer treated with androgen deprivation, HDR and 3D/IMRT: 4 year results of a phase I-II dose escalation trial
A. Raben, A. Grebler, S. Sim, J. Geltzeiler, I. Keselman, S. Litvin, M. Geltzeiler, D. Raben, D. Crawford, J. Yang ~Christiana Med Cntr/Monmouth Med Cntr, Radiation Oncology, Newark, DE, U.S.A. =Monmouth Med Cntr, Urology, Long Branch, NJ, USA ~Monmouth Med Cntr, Radiation Oncology, Long Branch, NJ, USA 4Univ of Colorado Health Science Center, Radiation Oncology, Denver, CO, USA SUniv of Colorado Health Science Cntr, Urology, Denver, CO, USA Background: Prostate tumors exhibit a high sensitivity to fractionation due to low alpha/beta ratios and may be radioresitant to convention fractionation. HDR regimens may provide superior or equal tumor control over other approaches with possibly lower late sequelae. Purpose: To evaluate GU and GI morbidity and biochemical control (bNED) of intermediate-high risk prostate cancer patients treated with androgen deprivation (AD), transrectal ultrasound assisted High Dose Rate (HDR) brachytherapy and conformal external radiotherapy as part of an HDR dose escalation trial. Material and methods: from April 1999 to October 2002, a total of 127 patients with intermediate or high-risk prostate cancer were enrolled on a dose escalation trial. Criteria included one or more of the following: PSA > 10, Gleason > 6, Bulky T2-T3 clinical stage, 4-6 core biopsies with bilobar