- Email: [email protected]
64 Analysis of pretreatment factors predictive of urinary morbidity following permanent prostate brachytherapy (PPB) including cystoscopic findings and uroflowmetry
Proffered Papers
$28
received either brachytherapy alone (BXT), hormonebrachytherapy (HBXT) or combined external beam radiotherapy, brachytherapy and hormones (CBXT). Results: Several domains of the QLQ-C30 were observed to change but the changes only reached levels consistent with moderate severity for deterioration in general health , role function, social function, fatigue pain and insomnia at six weeks with recovery to levels considered 'a little' worse than baseline by 3 months. No statistically significant deterioration in global health or any specific domain of the QLQ-C30 were observed after 9 months and statistically significant improvements in emotional function, fatigue and insomnia occurred. QLQ-C30 Domain scores Baseline n= 189 6Wk n=I57 24Mts n=30
General Health 81.7 (16.5) 70.3 (18.5) '~
Role FHI1C, 93.1 (15.5) 81.0 (23.5) "+
En~otional Function 83.1 (18.4)
Social Function 90.4(16.9)
84.6(16.6)
76.4(25.1f +
76.7 ( i 9.4)
94.8 ( 11.0)
94.4 (8.8)*+
90.0(21.3)
Pain
Insomnia
14.9 (17.4) 27.3 (23.4)"
Fatigue
5.5 (11.8) 15.8 !20.1)
17.4(23.8)
5.93 (8. I )*
5.6 (9. I )
*=p<0.05 compared with baseline, %- clinically change
29.1(30.5) *+ 10.0(15.5)
significant
Significant increases in bother due to continence aids were not reported at any point of follow-up. Clinically significant increases in the urinary problems domain were reported, with moderate severity problems for up to 6 months and minor problems for up to 18 months. Conclusion: Toxicity peaks 6-weeks following brachytherapy and urinary s3qnptoms following brachytherapy can impact on general HRQol. However even when closely assessed using sensitive instruments HRQol is not significantly worse than baseline levels by 9months post implant. And some domains are improved following treatment. 63 Early and late rectal toxicity after Transperineal Interstitial Permanent Brachytherapy : a multivariate analysis of 600 patients treated by the Institut Curie/Hfipital Cochin/Hrpital Necker Paris group. L.Chauveinc I, T.Flam2, N.Thiounn ~, S.Solignac I, JC Rosenwald l, M. Timbert 1, J M Cosset l ~Institut Curie, Paris, France, 2Hdpital Cochin, Paris, France, 3H6pital Necker, Paris, France.
Purpose: To assess the early and late rectal morbidity experienced by the patients undergoing prostate Brachytherapy by 125I permanent implants, and to identify the relevant clinical and dosimetric parameters. Methods and Materials: From May, 1998 to June,2003, 600 patients were treated by the Institut Cufie/H6pital Cochin/H6pital Necker Paris group by free-seeds 125I (ISOSEED Bebig) transperineal interstitial permanent brachytherapy for selected localized prostate cancers. All patients benefited from a real-time ultrasound (US) -based dosimetry, then from a "reference" CT-based dosimetry performed at 2 months post-implant. Rectal morbidity was assessed according to RTOG scales at 2 months (Early toxicity) , then at 6 months and every 6 months thereafter (Late toxicity). Multivariate analysis took into account clinical factors (Age, T stage, PSA), Hormonal therapy and its duration, US-based dosimetrie criteria (prostate volume, D90,VI00,D95, V150 and rectal volume receiving more than 160 Gy =Vr160), CT-based criteria (Prostate volume, Dg0, V100, D95, V150, and rectal volume receiving more than 30, 50, 160 and 215 Gy), treatment's year and adjuvant therapies (steroids or non-steroid drugs). Various cut-offs were used for each linear criteria. Results: There was no ea~'ly toxicity (grade 0) in 85 % of our cases. For the other cases evaluated at 2 months, we registered a grade 1 in 14 %, a grade 2 in 1% and no grade 3. Late toxicity was registered as grade 0 in 87 % of our cases, grade 1 in 8 %, grade 2 in 4 %, and gade 3 in 1 % . For early toxicity, multivariate analysis only identified one independent factor; the Vrl60 (with a cut-off at 0.4 cc, p<0.0007).
As for late toxicity, were identified as independent factors : a Vr160 superior to lcc (p<0.007) , and the prescription of steroids (p< 10-5 ) as adjuvant therapy. Conclusions : A relatively small volume of rectum receiving more than 160 Gy appears to be the main responsible for early and late rectal toxicity in our experience. Those results are consistent with previously reported data. Steroids appeared to be related with an increased rectal toxicity in our series. We have now systematically replaced them by non-steroid anti-inflammatory drugs when necessary. 64 Analysis of pretreatment factors predictive of urinary morbidity following permanent prostate brachytherapy (PPB) including cystoscopic findings and uroflowmetry B. DaviJ T. Wilson 2, L. MyndersC, S. Schatz e, D. Hilhnan s lMayo Clinic and Foundation - Radiation Oncology, Rochester, MN USA : Mayo Clinic andFoundation Urology, Rochester, M N - USA 3 Mayo Clinic and Foundation Cancer Center Statistics', Rochester, M N - USA
Purpose: To determine the incidence and predictors of urinary morbidity following permanent prostate brachytherapy (PPB). Methods: A total of 300 patients (pts) underwent PPB at our institution from 5/98-8/02 with pre-PPB work-up including cystoscopy, uroflowmetry (uf), and International Prostate Symptom Score (IPSS) (Range: 0-25; median: 6) with median follow-up of 19 months (mos). Cystoscopic obstruction was graded as none (44%), mild (40%), or moderate or greater (16%). Uf included measurement of post-void residual by transabdominal US with mean of 52cc (range: 0-525), peak flow 14.6cc (range: 4.2-45) and mean flow of 7.6cc (range: 2.5-24.7). Pts were taught clean intermittent catheterization (CIC) prior to PPB. 1PSS, modified Radiation Therapy Oncology Group (RTOG) urinary morbidity score, CIC use, and pad use were recorded at follow-up visits. Univariate (UVA) and multivariate (MVA) analysis were performed examining these endpoints at 3 and 12 mos after PPB. Results: Frequently reported post-PPB urinary symptoms are urgency (69%) and dysuria (48%); these symptoms persist at one yr in 30% and 14% of pts, respectively. While over 28% of pts report at least one episode of urge urinary incontinence, pad use at one yr is 2A%. Of 7 pts who had undergone pre-implant TURP, none report post-implant pad use. CIC was used for temporary urinary retention or significant obstructive symptoms in 9% of pts; 6% < 2 weeks, 1% < 60 days, and 2%> 60 days. One pt (0.3%) required TURP 18 mos post-PPB and had minimal incontinence thereafter. Pre-implant IPSS, cystoscopic and uf findings, prostate volume, and radiation dosimetry are found to predict morbidity on UVA, but no combination of factors was found to be significant on MVA possibly due to the low number of events. IPSS score was associated with increased risk of RTOG> 2 morbidity at 3 mos (p=0.02; odds ratio (osr) 1.6) and 12 mos (p=.015; osr=l.98) and pad use at 3 mos (p=0.014). Evidence of pre-PPB cystoscopic obstruction was associated with increased pad use at 12 mos (p=0.057). Low mean urofiow correlated with RTOG> 2 morbidity at 12 mos (p=.03). Conclusion: IPSS was found to be the most consistent predictor of urinary morbidity. A score < 20 is desirable in pt selection but pts with IPSS _< 10 remain the optimal candidates relating to urinary morbidity. Pre-PPB cystoscopy and uf demonstrate an association with some categories of urinary morbidity on UVA and continue to be performed on a routine basis to assist in pt selection. Although some urinary symptoms may persist beyond 1 yr, incidence of long-term urinary retention requiring TURP is very low.
$28
received either brachytherapy alone (BXT), hormonebrachytherapy (HBXT) or combined external beam radiotherapy, brachytherapy and hormones (CBXT). Results: Several domains of the QLQ-C30 were observed to change but the changes only reached levels consistent with moderate severity for deterioration in general health , role function, social function, fatigue pain and insomnia at six weeks with recovery to levels considered 'a little' worse than baseline by 3 months. No statistically significant deterioration in global health or any specific domain of the QLQ-C30 were observed after 9 months and statistically significant improvements in emotional function, fatigue and insomnia occurred. QLQ-C30 Domain scores Baseline n= 189 6Wk n=I57 24Mts n=30
General Health 81.7 (16.5) 70.3 (18.5) '~
Role FHI1C, 93.1 (15.5) 81.0 (23.5) "+
En~otional Function 83.1 (18.4)
Social Function 90.4(16.9)
84.6(16.6)
76.4(25.1f +
76.7 ( i 9.4)
94.8 ( 11.0)
94.4 (8.8)*+
90.0(21.3)
Pain
Insomnia
14.9 (17.4) 27.3 (23.4)"
Fatigue
5.5 (11.8) 15.8 !20.1)
17.4(23.8)
5.93 (8. I )*
5.6 (9. I )
*=p<0.05 compared with baseline, %- clinically change
29.1(30.5) *+ 10.0(15.5)
significant
Significant increases in bother due to continence aids were not reported at any point of follow-up. Clinically significant increases in the urinary problems domain were reported, with moderate severity problems for up to 6 months and minor problems for up to 18 months. Conclusion: Toxicity peaks 6-weeks following brachytherapy and urinary s3qnptoms following brachytherapy can impact on general HRQol. However even when closely assessed using sensitive instruments HRQol is not significantly worse than baseline levels by 9months post implant. And some domains are improved following treatment. 63 Early and late rectal toxicity after Transperineal Interstitial Permanent Brachytherapy : a multivariate analysis of 600 patients treated by the Institut Curie/Hfipital Cochin/Hrpital Necker Paris group. L.Chauveinc I, T.Flam2, N.Thiounn ~, S.Solignac I, JC Rosenwald l, M. Timbert 1, J M Cosset l ~Institut Curie, Paris, France, 2Hdpital Cochin, Paris, France, 3H6pital Necker, Paris, France.
Purpose: To assess the early and late rectal morbidity experienced by the patients undergoing prostate Brachytherapy by 125I permanent implants, and to identify the relevant clinical and dosimetric parameters. Methods and Materials: From May, 1998 to June,2003, 600 patients were treated by the Institut Cufie/H6pital Cochin/H6pital Necker Paris group by free-seeds 125I (ISOSEED Bebig) transperineal interstitial permanent brachytherapy for selected localized prostate cancers. All patients benefited from a real-time ultrasound (US) -based dosimetry, then from a "reference" CT-based dosimetry performed at 2 months post-implant. Rectal morbidity was assessed according to RTOG scales at 2 months (Early toxicity) , then at 6 months and every 6 months thereafter (Late toxicity). Multivariate analysis took into account clinical factors (Age, T stage, PSA), Hormonal therapy and its duration, US-based dosimetrie criteria (prostate volume, D90,VI00,D95, V150 and rectal volume receiving more than 160 Gy =Vr160), CT-based criteria (Prostate volume, Dg0, V100, D95, V150, and rectal volume receiving more than 30, 50, 160 and 215 Gy), treatment's year and adjuvant therapies (steroids or non-steroid drugs). Various cut-offs were used for each linear criteria. Results: There was no ea~'ly toxicity (grade 0) in 85 % of our cases. For the other cases evaluated at 2 months, we registered a grade 1 in 14 %, a grade 2 in 1% and no grade 3. Late toxicity was registered as grade 0 in 87 % of our cases, grade 1 in 8 %, grade 2 in 4 %, and gade 3 in 1 % . For early toxicity, multivariate analysis only identified one independent factor; the Vrl60 (with a cut-off at 0.4 cc, p<0.0007).
As for late toxicity, were identified as independent factors : a Vr160 superior to lcc (p<0.007) , and the prescription of steroids (p< 10-5 ) as adjuvant therapy. Conclusions : A relatively small volume of rectum receiving more than 160 Gy appears to be the main responsible for early and late rectal toxicity in our experience. Those results are consistent with previously reported data. Steroids appeared to be related with an increased rectal toxicity in our series. We have now systematically replaced them by non-steroid anti-inflammatory drugs when necessary. 64 Analysis of pretreatment factors predictive of urinary morbidity following permanent prostate brachytherapy (PPB) including cystoscopic findings and uroflowmetry B. DaviJ T. Wilson 2, L. MyndersC, S. Schatz e, D. Hilhnan s lMayo Clinic and Foundation - Radiation Oncology, Rochester, MN USA : Mayo Clinic andFoundation Urology, Rochester, M N - USA 3 Mayo Clinic and Foundation Cancer Center Statistics', Rochester, M N - USA
Purpose: To determine the incidence and predictors of urinary morbidity following permanent prostate brachytherapy (PPB). Methods: A total of 300 patients (pts) underwent PPB at our institution from 5/98-8/02 with pre-PPB work-up including cystoscopy, uroflowmetry (uf), and International Prostate Symptom Score (IPSS) (Range: 0-25; median: 6) with median follow-up of 19 months (mos). Cystoscopic obstruction was graded as none (44%), mild (40%), or moderate or greater (16%). Uf included measurement of post-void residual by transabdominal US with mean of 52cc (range: 0-525), peak flow 14.6cc (range: 4.2-45) and mean flow of 7.6cc (range: 2.5-24.7). Pts were taught clean intermittent catheterization (CIC) prior to PPB. 1PSS, modified Radiation Therapy Oncology Group (RTOG) urinary morbidity score, CIC use, and pad use were recorded at follow-up visits. Univariate (UVA) and multivariate (MVA) analysis were performed examining these endpoints at 3 and 12 mos after PPB. Results: Frequently reported post-PPB urinary symptoms are urgency (69%) and dysuria (48%); these symptoms persist at one yr in 30% and 14% of pts, respectively. While over 28% of pts report at least one episode of urge urinary incontinence, pad use at one yr is 2A%. Of 7 pts who had undergone pre-implant TURP, none report post-implant pad use. CIC was used for temporary urinary retention or significant obstructive symptoms in 9% of pts; 6% < 2 weeks, 1% < 60 days, and 2%> 60 days. One pt (0.3%) required TURP 18 mos post-PPB and had minimal incontinence thereafter. Pre-implant IPSS, cystoscopic and uf findings, prostate volume, and radiation dosimetry are found to predict morbidity on UVA, but no combination of factors was found to be significant on MVA possibly due to the low number of events. IPSS score was associated with increased risk of RTOG> 2 morbidity at 3 mos (p=0.02; odds ratio (osr) 1.6) and 12 mos (p=.015; osr=l.98) and pad use at 3 mos (p=0.014). Evidence of pre-PPB cystoscopic obstruction was associated with increased pad use at 12 mos (p=0.057). Low mean urofiow correlated with RTOG> 2 morbidity at 12 mos (p=.03). Conclusion: IPSS was found to be the most consistent predictor of urinary morbidity. A score < 20 is desirable in pt selection but pts with IPSS _< 10 remain the optimal candidates relating to urinary morbidity. Pre-PPB cystoscopy and uf demonstrate an association with some categories of urinary morbidity on UVA and continue to be performed on a routine basis to assist in pt selection. Although some urinary symptoms may persist beyond 1 yr, incidence of long-term urinary retention requiring TURP is very low.