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Short Term Urinary Morbidity Following Cesium-131 Ultrasound Guided Transperineal Prostate Seed Implantation
I. J. Radiation Oncology d Biology d Physics
S388
2412
Volume 78, Number 3, Supplement, 2010
Short Term Urinary Morbidity Following Cesium-131 Ultrasound Guided Transperineal Prostate Seed Implantation
V. Arterbery1, P. Chuba2, R. Sharma3, J. Caruthers1 Karmanos Crittenton Cancer Center, Rochester, MI, 2St. John Macomb- Webber Cancer Center, Warren, MI, 3West Michigan Cancer Center, Kalamazoo, MI
1
Purpose/Objective(s): To assess short term urinary morbidity experienced by patients undergoing Cesium 131 ultrasound guided permanent transperineal brachytherapy implant. Materials/Methods: Between December 2006 and January of 2010, 53 patients with clinically localized adenocarcinoma of the prostate were treated with permanent seed implant using a TRUS guided preplanned technique. 30% of patients received 4500 cGy using IMRT prior to brachytherapy. The implant dose for Cs 131 implant as monotherapy was 115 Gy, and with external beam was 85 Gy. The planned V150 was less than 45% of the prostate volume. Average source strength was 2.00 U (3.135mCi) and average number of sources was 82. Due to concerns about post implant edema with the short half life, most patients underwent CT post implant dosimetry at day 0 (45 patients). Post treatment PSA and rectal exams were obtained every 3 months for the first 24 months and then every 6 months thereafter. AUA and IPSS score were assessed at the time of consult and follow-up at 2, 4, 8 weeks and then 3, 6, and 12 months after seed implant. Urinary toxicity was classified using the RTOG toxicity scale. RTOG Toxicity, IPSS score, prostate volume, AUA score, percentage prostate volume receiving 150% (V150) of the prescribed dose were evaluated to correlate with toxicity. Results: Median follow-up was 22 months. Within the first two weeks, 40% of patients are reported grade 1 urinary toxicity, 45% had grade two and 3% had grade 3 toxicity. At one month 33% still reported grade 1 urinary toxicity and 12% and 1% complained of grade 2 and 3 urinary difficulties respectively. At 8 weeks 14% still had grade one toxicity while 11% and 2% still had grade 2 and 3 symptoms. IPSS scores peaked in 79% of patients within 8 weeks after implant. The (V150) of the prescribed dose did not predict urinary toxicity. Patients with initial AUA score less than or equal to 7, showed lower incidence of grade 2 urinary toxicity at 1 month. (p = .001) There was no increase in toxicity with the use of pre-implant XRT at 3 months. (p = .069) Small prostate volumes seem to affect toxicity with glands less than 40 cc reporting lower incidence of grade 2 and 3 urinary toxicity at 8 weeks. (p = .001) . No patient required long term catheterization due to urinary retention. Conclusions: Cesium 131 transperineal ultrasound guided prostate implant is associated with mild to moderate urinary morbidity. The majority of symptoms occur in first two months. Pre-implant urinary symptoms as well as prostate volume were shown to significantly predict for greater toxicity. The use of pre-implant radiation did not identify patients at risk increased symptoms. As Cesium 131 is used as a choice of isotope selection, the associated toxicities and the definition of pretreatment factors that may contribute to post implant toxicity need to be properly defined. Author Disclosure: V. Arterbery, None; P. Chuba, None; R. Sharma, None; J. Caruthers, None.
2413
Effect of Androgen Deprivation Therapy on Hemoglobin, Testosterone and Erythropoietin Levels in Prostate Cancer Patients Receiving Radiotherapy
M. Golfam, R. Samant, L. Eapen, S. Malone The Ottawa Hospital Cancer Center, Ottawa, ON, Canada Purpose/Objective(s): The objective of this study was to evaluate the incidence, time of onset and extent of hemoglobin changes in patients with localized prostate cancer receiving either radiation alone or combined with androgen deprivation therapy (ADT). Materials/Methods: Patients with clinically localized prostate cancer receiving 3D-conformal radiation with or without ADT were enrolled. Patients were generally treated with radiation alone (Group l), radiation plus short-term (# 6 months) ADT (Group 2), or radiation plus long-term ($2 years) ADT (Group 3). A prospective evaluation of serum hemoglobin, testosterone and erythropoietin levels was carried out for these patients. The linear regression analysis model used to evaluate the data. Results: Thirty-five patients were evaluated with a median age of 69 years. The number of patients in Groups 1, 2 and 3 were 20, 6, and 9 respectively. The mean baseline hemoglobin for group 1,2 and 3 were 149, 143 and 153 in the order given. There was no significant decrease in hemoglobin, testosterone or erythropoietin levels among patients treated with radiotherapy alone. There was a significant drop in testosterone levels noted in the Groups 2 and 3 patients within one month (p value \0.001) and it reached a plateau at approximately six months. This was followed by a significant decrease in hemoglobin levels of 16 and 14 g/L among patients in Groups 2 and 3 respectively (p value\001) at three to six months. There was a small but statistically significant increase in erythropoietin levels noted after six months in the patients receiving ADT (p value\0.001). There was no immediate recovery in hemoglobin, testosterone or erythropoietin levels upon completion of ADT. Conclusions: Although conformal radiotherapy alone for localized prostate cancer has no effect on hemoglobin, testosterone or erythropoietin levels, ADT leads to a significant decrease in testosterone levels, which is followed by decrease in hemoglobin levels, and this is not due to a deficiency in erythropoietin. Author Disclosure: M. Golfam, None; R. Samant, an unrestricted educational grant from Ortho-Biotech to conduct this research., B. Research Grant; L. Eapen, None; S. Malone, None.
2414
Long-term Outcomes of the Combined Approach of Maximal Surgical Resection and Intraoperative Electron Radiotherapy for Recurrent or Locally Advanced Renal Malignancies
C. L. Hallemeier1, R. Choo1, L. L. Gunderson2, B. C. Leibovich1, M. G. Haddock1 1
Mayo Clinic, Rochester, MN, 2Mayo Clinic, Scottsdale, AZ
Purpose/Objective(s): For patients with a recurrent tumor after radical nephrectomy or a locally advanced primary renal malignancy, there are limited therapeutic options of proven efficacy. We report long-term outcomes of an aggressive locoregional therapy combining maximal surgical resection with intraoperative electron radiotherapy (IOERT) ± perioperative external beam radiotherapy (EBRT).
S388
2412
Volume 78, Number 3, Supplement, 2010
Short Term Urinary Morbidity Following Cesium-131 Ultrasound Guided Transperineal Prostate Seed Implantation
V. Arterbery1, P. Chuba2, R. Sharma3, J. Caruthers1 Karmanos Crittenton Cancer Center, Rochester, MI, 2St. John Macomb- Webber Cancer Center, Warren, MI, 3West Michigan Cancer Center, Kalamazoo, MI
1
Purpose/Objective(s): To assess short term urinary morbidity experienced by patients undergoing Cesium 131 ultrasound guided permanent transperineal brachytherapy implant. Materials/Methods: Between December 2006 and January of 2010, 53 patients with clinically localized adenocarcinoma of the prostate were treated with permanent seed implant using a TRUS guided preplanned technique. 30% of patients received 4500 cGy using IMRT prior to brachytherapy. The implant dose for Cs 131 implant as monotherapy was 115 Gy, and with external beam was 85 Gy. The planned V150 was less than 45% of the prostate volume. Average source strength was 2.00 U (3.135mCi) and average number of sources was 82. Due to concerns about post implant edema with the short half life, most patients underwent CT post implant dosimetry at day 0 (45 patients). Post treatment PSA and rectal exams were obtained every 3 months for the first 24 months and then every 6 months thereafter. AUA and IPSS score were assessed at the time of consult and follow-up at 2, 4, 8 weeks and then 3, 6, and 12 months after seed implant. Urinary toxicity was classified using the RTOG toxicity scale. RTOG Toxicity, IPSS score, prostate volume, AUA score, percentage prostate volume receiving 150% (V150) of the prescribed dose were evaluated to correlate with toxicity. Results: Median follow-up was 22 months. Within the first two weeks, 40% of patients are reported grade 1 urinary toxicity, 45% had grade two and 3% had grade 3 toxicity. At one month 33% still reported grade 1 urinary toxicity and 12% and 1% complained of grade 2 and 3 urinary difficulties respectively. At 8 weeks 14% still had grade one toxicity while 11% and 2% still had grade 2 and 3 symptoms. IPSS scores peaked in 79% of patients within 8 weeks after implant. The (V150) of the prescribed dose did not predict urinary toxicity. Patients with initial AUA score less than or equal to 7, showed lower incidence of grade 2 urinary toxicity at 1 month. (p = .001) There was no increase in toxicity with the use of pre-implant XRT at 3 months. (p = .069) Small prostate volumes seem to affect toxicity with glands less than 40 cc reporting lower incidence of grade 2 and 3 urinary toxicity at 8 weeks. (p = .001) . No patient required long term catheterization due to urinary retention. Conclusions: Cesium 131 transperineal ultrasound guided prostate implant is associated with mild to moderate urinary morbidity. The majority of symptoms occur in first two months. Pre-implant urinary symptoms as well as prostate volume were shown to significantly predict for greater toxicity. The use of pre-implant radiation did not identify patients at risk increased symptoms. As Cesium 131 is used as a choice of isotope selection, the associated toxicities and the definition of pretreatment factors that may contribute to post implant toxicity need to be properly defined. Author Disclosure: V. Arterbery, None; P. Chuba, None; R. Sharma, None; J. Caruthers, None.
2413
Effect of Androgen Deprivation Therapy on Hemoglobin, Testosterone and Erythropoietin Levels in Prostate Cancer Patients Receiving Radiotherapy
M. Golfam, R. Samant, L. Eapen, S. Malone The Ottawa Hospital Cancer Center, Ottawa, ON, Canada Purpose/Objective(s): The objective of this study was to evaluate the incidence, time of onset and extent of hemoglobin changes in patients with localized prostate cancer receiving either radiation alone or combined with androgen deprivation therapy (ADT). Materials/Methods: Patients with clinically localized prostate cancer receiving 3D-conformal radiation with or without ADT were enrolled. Patients were generally treated with radiation alone (Group l), radiation plus short-term (# 6 months) ADT (Group 2), or radiation plus long-term ($2 years) ADT (Group 3). A prospective evaluation of serum hemoglobin, testosterone and erythropoietin levels was carried out for these patients. The linear regression analysis model used to evaluate the data. Results: Thirty-five patients were evaluated with a median age of 69 years. The number of patients in Groups 1, 2 and 3 were 20, 6, and 9 respectively. The mean baseline hemoglobin for group 1,2 and 3 were 149, 143 and 153 in the order given. There was no significant decrease in hemoglobin, testosterone or erythropoietin levels among patients treated with radiotherapy alone. There was a significant drop in testosterone levels noted in the Groups 2 and 3 patients within one month (p value \0.001) and it reached a plateau at approximately six months. This was followed by a significant decrease in hemoglobin levels of 16 and 14 g/L among patients in Groups 2 and 3 respectively (p value\001) at three to six months. There was a small but statistically significant increase in erythropoietin levels noted after six months in the patients receiving ADT (p value\0.001). There was no immediate recovery in hemoglobin, testosterone or erythropoietin levels upon completion of ADT. Conclusions: Although conformal radiotherapy alone for localized prostate cancer has no effect on hemoglobin, testosterone or erythropoietin levels, ADT leads to a significant decrease in testosterone levels, which is followed by decrease in hemoglobin levels, and this is not due to a deficiency in erythropoietin. Author Disclosure: M. Golfam, None; R. Samant, an unrestricted educational grant from Ortho-Biotech to conduct this research., B. Research Grant; L. Eapen, None; S. Malone, None.
2414
Long-term Outcomes of the Combined Approach of Maximal Surgical Resection and Intraoperative Electron Radiotherapy for Recurrent or Locally Advanced Renal Malignancies
C. L. Hallemeier1, R. Choo1, L. L. Gunderson2, B. C. Leibovich1, M. G. Haddock1 1
Mayo Clinic, Rochester, MN, 2Mayo Clinic, Scottsdale, AZ
Purpose/Objective(s): For patients with a recurrent tumor after radical nephrectomy or a locally advanced primary renal malignancy, there are limited therapeutic options of proven efficacy. We report long-term outcomes of an aggressive locoregional therapy combining maximal surgical resection with intraoperative electron radiotherapy (IOERT) ± perioperative external beam radiotherapy (EBRT).