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1018 poster HIGH-DOSE-RATE (HDR) BRACHYTHERAPY WITH EXTERNAL BEAM RADIOTHERAPY FOR LOCALIZED HIGH RISK PROSTATE CANCER: 5-YEAR RESULTS IN 141 PATIENTS
S 382
P ROSTATE CANCER
Treatment characteristics and follow-up data were retrospectively analyzed. 3 of these patients received EBRT to regional lymph nodes, the others only seminal vesicals. Results: Genitourinary toxicity was graded according to the the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer radiation morbidity scoring system. The incidence of slight Grade 2 acute GU side effects was about 50%. The incidence of slight Grade 2 acute GI side effects was 2% and no higher grade acute rectal side effects was observed. It was hard to clearly summarise PSA value dynamics during the period after this CM therapy because of short follow-up and slow, PSA dynamics after tis type of treatment. It seems there is no point to check PSA earlier than 3 moths after implantation and PSA could reach nadir after 12 18 moths or later Conclusions: The longer follow-up is needed to get reliable data on PSA dynamics and late GU and GI toxicities. The investigation showed that the major advantage of this type of CM radiotherapy could be less acute urinary and especially rectal toxicity with dose escalation up to 76 izoGy. The longer follow-up is needed to get reliable data on PSA dynamics and late urinary and rectal toxicities.
androgen-senisitive group and 4/8 in androgen-resistant group), the time to relapse range from 0,5 to 8,7 years (median 1,25). Seven patients revealed distant metastases (4/25 and 3/8, respectively) - all with diagnosed biochemical relapses earlier. Median time to occur metastases was 2,8 years (androgen-sensitive 7,6, androgen-resistant 1,8). One patient recurred locally (androgen-sensitive subgroup), with time to recurrence 65,9 months. The 7-year bRFS was 58%, RFS 89% , MFS 77% and OS 60%. Conclusions: In rigorously selected patients, especially androgen-sensitive, radical radiotherapy for high PSA can achieve satisfactory prostate cancer control. 1020 poster HOW BIOLOGICALLY EFFECTIVE DOSE (BED) LEVEL IMPACT LONG-TERM OUTCOMES IN INTERMEDIATE-RISK PROSTATE CANCER PATIENTS TREATED WITH HIGH-DOSERATE BRACHYTHERAPY H. Ye1 , A. Martinez1 , D. Krauss1 , L. Kestin1 , M. Ghilezan1 , G. Gustafson1 1 W ILLIAM B EAUMONT H OSPITAL, Radiation Oncology, Royal Oak, USA
1018 poster HIGH-DOSE-RATE (HDR) BRACHYTHERAPY WITH EXTERNAL BEAM RADIOTHERAPY FOR LOCALIZED HIGH RISK PROSTATE CANCER: 5-YEAR RESULTS IN 141 PATIENTS K. Masahito1 , K. Miki1 , M. Aoki2 1 J IKEI U NIVERSITY S CHOOL OF M EDICINE, Department of Urology, Minato-ku, Japan 2 J IKEI U NIVERSITY S CHOOL OF M EDICINE, Department of Radiation Oncology, Minato-ku, Japan Purpose: To present outcome and morbidity of high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) for localized high risk prostate cancer. Materials: Between May 2005 and April 2009, 131 patients underwent Ir-192 HDR brachytherapy with EBRT and passed after HDR bachytherapy more than one year. The median follow-up was 26 months (range 2-52 months). All patients were high risk and localized prostate cancer. Median PSA was 25.3ng/ml (range 4.1-201ng/ml). Median Gleason Score was 8 (range 6-10). Initial 77 patients, the total prescribed dose was 11Gy in 2 fractions of HDR and 45Gy in 15 fractions of EBRT. Recent 64 patients, 18Gy in 2 fractions of HDR and 40Gy in 16 fractions of EBRT. All patients were treated over six months neo-adjuvant hormonal therapy and over twenty-four months adjuvant hormonal therapy. Results: Only one patient had died of lung small cell carcinoma. Five patients had revealed biochemical (BC) failure by Phoenix definition. BC free rate was 80.5%. Of the 131 patients, only one patient displayed Grade 3 late GI toxicity. There were no other acute nor late severe toxicity. Conclusions: HDR brachytherapy for localized high risk prostate cancer resulted in good outcomes and had comparatively minor toxicity. Based on this result, we are planning the clinical prospective randomized study for HDR in Japanese high risk prostate cancer. 1019 poster HIGH-RISK PROSTATE CANCER PATIENTS WITH INITIAL PSA100 NG/ML TREATED WITH EXTERNAL-BEAM RADIOTHERAPY. B. Smolska-Ciszewska1 , G. Plewicki1 , M. Giglok1 , K. Behrendt1 , M. Gawkowska-Suwinska1 , E. Nowicka1 , T. Dworzecki1 , U. Dworzecka1 , A. Zajusz1 1 M ARIA S KŁODOWSKA -C URIE M EMORIAL C ANCER C ENTER AND I NSTITUTE OF O NCOLOGY, G LIWICE B RANCH, II Radiotherapy Clinic, Gliwice, Poland Purpose: To assess the outcome of patients with initial PSA of 100 ng/ml or higher undergoing radical radiotherapy for prostate cancer. Materials: Thirty three patients with a median age of 65 years (range: 5374) underwent external beam radiotherapy (EBRT) in our department. The initial PSA range from 100 to 930 ng/ml (median 136). The stage distribution was: T1c - 5 patients (15,2%), T2a 1 (3%), T2b - 11 (33,3%), T2c 8 (24,3%), T3a 7 (21,2%), T3b 1 (3%). Five patients had node metastases (N1). The Gleason score range from 3 to 8 (median 7). The results of imaging tests (bone scan, abdominopelvic ultrasound, CT or MRI, chest X-ray) were all interpreted as being normal. Hormonal therapy prior to radiotherapy was applied in all patients with median duration time of 6,5 months (range: 3-38,8). Twenty five patients were androgen-sensitive at the beginning of radiotherapy, 8 - androgen-resistant. All patients underwent EBRT. Adjuvant androgen deprivation was used in 26 cases (78,8%), the duration time of adjuvant therapy range from 4,5 to 53 months (median 22,4). The efficacy of the treatment was evaluated by biochemical relapse free survival (bRFS), metastases-free survival (MFS) recurrence-free survival (RFS) and overall survival (OS). Kaplan-Meier method was used to plot survival curves. Results: All patients were followed continuously during a median of 4 years (range 1-12 years). Biochemical relapses occurred in 11 cases (7/25 in
Purpose: We are reporting the 10-years prostate cancer related events and survival outcomes for intermediate-risk prostate cancer patients treated with HDR brachytherapy. Materials: From 1991 to 2010, 1047 men were treated with dose escalated HDR brachytherapy boost and HDR monotherapy for prostate cancer. Seven hundred seventy one men had either one or more intermediate-risk features (prostate-specific antigen [PSA] level 1020 ng/mL, Gleason score 7, or Stage T2b). Biologically effective dose (BED) values were calculated by using α/f 1.5. Patients were stratified according to BED. BED ranged from 184 to 278. Low dose level was considered as BED ≤ 227 Gy1.5 and high dose level was BED >227 Gy1.5. Biochemical failure was analyzed by the Phoenix (nadir+2 ng/ml) definition, clinical failure (CF) was defined as any locoregional recurrence (LRR) or distant metastasis (DM). Univariate analyses were used to determine whether any patient characteristics and treatment related factors was predictive for prostate cancer related events and survival. A two-sided p value of <0.05 was considered significant. Results: The median follow-up time was 7.2 years (0.4-18.96 years). At 10years, CF was 19.2% and 3.3% for low-dose and high-dose level (p<0.001), DM was 11% vs. 2.1% (p=0.002), OS was 70.5% and 81.0% (p=0.025), respectively. On univariate analysis, increasing CF was associated with increasing PSA (p=0.025), higher stage (p=0.004), lower BED level (p=0.001), and number of risk factors (p<0.001); BC was associated with Gleason score (p=0.042) and number of risk factors (p=0.012); DM was associated with stage, BED level and number of risk factors with p-value 0.049, 0.005, and 0.001 respectively. BED was the only factor significantly impact on OS with the p-value 0.026. On multivariate analysis, BED and number of risk factors were found to be associated with CF, DM and OS. Conclusions: Radiation dose is an important predictor for CF, DM and OS in intermediate-risk prostate cancer patients. However, high BED has not found to significantly impact on BC. 1021 poster HYPOFRACTIONATED IMAGE GUIDED IMRT FOR PROSTATE CANCER:PHILIPPINE’S FIRST CLINICAL EXPERIENCE G. Banuelos1 , C. Aguilar1 , M. Cruz1 , M. Olvina1 , T. Sarmiento1 , E. Tangco1 , N. Arriola1 , C. De Villeres1 1 S T F RANCES C ABRINI M EDICAL C ENTER AND C ANCER I NSTITUTE, Department of Radiation Oncology, Sto Tomas, Philippines Purpose: Dose escalation with Intensity Modulated Radiation Therapy (IMRT) and Hypofractionation in the treatment of Prostate Cancer has shown improvement in local control and has minimized the acute and late toxicities of normal tissues. The advent of Image Guided Radiation Therapy (IGRT) allowed greater accuracy and precision in daily treatment and higher doses per fraction to be delivered safely. The first IGRT machine for the Philippines was started in 2008. In 2009, we started the Hypofractionated IG-IMRT treatment for Prostate Cancer. This is a report on our clinical experience regarding this modality. Materials: Elekta synergy E1594 system which integrates an X-ray volumetric imager (XVI) and Cone Beam Ct-scan, was used to treat the first 4 cases of Prostate cancer with Hypofractionated IMRT using 6 MV photons. All patients have Gleasons Score between 6-8. Between 5-9 non-coplanar beams were generated via forward planning using Precise treatment planning system. Image guided on-line registration using Cone Beam Computed Tomography (CBCT) was done daily before treatment. A total dose of 64Gy in 20 fractions was given in 4 weeks. Acute toxicity for the GIT and GUT regions were monitored at the end of each week. Results: The mean dose received by the CTV was 65.24 Gy. The critical structures received the following mean doses: rectum 37.49 Gy; bladder 31.93 Gy; small bowels 12.40 Gy. Acute upper GIT reactions was Grade 1 with nausea. Acute lower GIT reactions was Grade 1, 2 with diarrhea and mild abdominal pain. Acute GUT reactions was Grade 1, 2 with frequency
P ROSTATE CANCER
Treatment characteristics and follow-up data were retrospectively analyzed. 3 of these patients received EBRT to regional lymph nodes, the others only seminal vesicals. Results: Genitourinary toxicity was graded according to the the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer radiation morbidity scoring system. The incidence of slight Grade 2 acute GU side effects was about 50%. The incidence of slight Grade 2 acute GI side effects was 2% and no higher grade acute rectal side effects was observed. It was hard to clearly summarise PSA value dynamics during the period after this CM therapy because of short follow-up and slow, PSA dynamics after tis type of treatment. It seems there is no point to check PSA earlier than 3 moths after implantation and PSA could reach nadir after 12 18 moths or later Conclusions: The longer follow-up is needed to get reliable data on PSA dynamics and late GU and GI toxicities. The investigation showed that the major advantage of this type of CM radiotherapy could be less acute urinary and especially rectal toxicity with dose escalation up to 76 izoGy. The longer follow-up is needed to get reliable data on PSA dynamics and late urinary and rectal toxicities.
androgen-senisitive group and 4/8 in androgen-resistant group), the time to relapse range from 0,5 to 8,7 years (median 1,25). Seven patients revealed distant metastases (4/25 and 3/8, respectively) - all with diagnosed biochemical relapses earlier. Median time to occur metastases was 2,8 years (androgen-sensitive 7,6, androgen-resistant 1,8). One patient recurred locally (androgen-sensitive subgroup), with time to recurrence 65,9 months. The 7-year bRFS was 58%, RFS 89% , MFS 77% and OS 60%. Conclusions: In rigorously selected patients, especially androgen-sensitive, radical radiotherapy for high PSA can achieve satisfactory prostate cancer control. 1020 poster HOW BIOLOGICALLY EFFECTIVE DOSE (BED) LEVEL IMPACT LONG-TERM OUTCOMES IN INTERMEDIATE-RISK PROSTATE CANCER PATIENTS TREATED WITH HIGH-DOSERATE BRACHYTHERAPY H. Ye1 , A. Martinez1 , D. Krauss1 , L. Kestin1 , M. Ghilezan1 , G. Gustafson1 1 W ILLIAM B EAUMONT H OSPITAL, Radiation Oncology, Royal Oak, USA
1018 poster HIGH-DOSE-RATE (HDR) BRACHYTHERAPY WITH EXTERNAL BEAM RADIOTHERAPY FOR LOCALIZED HIGH RISK PROSTATE CANCER: 5-YEAR RESULTS IN 141 PATIENTS K. Masahito1 , K. Miki1 , M. Aoki2 1 J IKEI U NIVERSITY S CHOOL OF M EDICINE, Department of Urology, Minato-ku, Japan 2 J IKEI U NIVERSITY S CHOOL OF M EDICINE, Department of Radiation Oncology, Minato-ku, Japan Purpose: To present outcome and morbidity of high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) for localized high risk prostate cancer. Materials: Between May 2005 and April 2009, 131 patients underwent Ir-192 HDR brachytherapy with EBRT and passed after HDR bachytherapy more than one year. The median follow-up was 26 months (range 2-52 months). All patients were high risk and localized prostate cancer. Median PSA was 25.3ng/ml (range 4.1-201ng/ml). Median Gleason Score was 8 (range 6-10). Initial 77 patients, the total prescribed dose was 11Gy in 2 fractions of HDR and 45Gy in 15 fractions of EBRT. Recent 64 patients, 18Gy in 2 fractions of HDR and 40Gy in 16 fractions of EBRT. All patients were treated over six months neo-adjuvant hormonal therapy and over twenty-four months adjuvant hormonal therapy. Results: Only one patient had died of lung small cell carcinoma. Five patients had revealed biochemical (BC) failure by Phoenix definition. BC free rate was 80.5%. Of the 131 patients, only one patient displayed Grade 3 late GI toxicity. There were no other acute nor late severe toxicity. Conclusions: HDR brachytherapy for localized high risk prostate cancer resulted in good outcomes and had comparatively minor toxicity. Based on this result, we are planning the clinical prospective randomized study for HDR in Japanese high risk prostate cancer. 1019 poster HIGH-RISK PROSTATE CANCER PATIENTS WITH INITIAL PSA100 NG/ML TREATED WITH EXTERNAL-BEAM RADIOTHERAPY. B. Smolska-Ciszewska1 , G. Plewicki1 , M. Giglok1 , K. Behrendt1 , M. Gawkowska-Suwinska1 , E. Nowicka1 , T. Dworzecki1 , U. Dworzecka1 , A. Zajusz1 1 M ARIA S KŁODOWSKA -C URIE M EMORIAL C ANCER C ENTER AND I NSTITUTE OF O NCOLOGY, G LIWICE B RANCH, II Radiotherapy Clinic, Gliwice, Poland Purpose: To assess the outcome of patients with initial PSA of 100 ng/ml or higher undergoing radical radiotherapy for prostate cancer. Materials: Thirty three patients with a median age of 65 years (range: 5374) underwent external beam radiotherapy (EBRT) in our department. The initial PSA range from 100 to 930 ng/ml (median 136). The stage distribution was: T1c - 5 patients (15,2%), T2a 1 (3%), T2b - 11 (33,3%), T2c 8 (24,3%), T3a 7 (21,2%), T3b 1 (3%). Five patients had node metastases (N1). The Gleason score range from 3 to 8 (median 7). The results of imaging tests (bone scan, abdominopelvic ultrasound, CT or MRI, chest X-ray) were all interpreted as being normal. Hormonal therapy prior to radiotherapy was applied in all patients with median duration time of 6,5 months (range: 3-38,8). Twenty five patients were androgen-sensitive at the beginning of radiotherapy, 8 - androgen-resistant. All patients underwent EBRT. Adjuvant androgen deprivation was used in 26 cases (78,8%), the duration time of adjuvant therapy range from 4,5 to 53 months (median 22,4). The efficacy of the treatment was evaluated by biochemical relapse free survival (bRFS), metastases-free survival (MFS) recurrence-free survival (RFS) and overall survival (OS). Kaplan-Meier method was used to plot survival curves. Results: All patients were followed continuously during a median of 4 years (range 1-12 years). Biochemical relapses occurred in 11 cases (7/25 in
Purpose: We are reporting the 10-years prostate cancer related events and survival outcomes for intermediate-risk prostate cancer patients treated with HDR brachytherapy. Materials: From 1991 to 2010, 1047 men were treated with dose escalated HDR brachytherapy boost and HDR monotherapy for prostate cancer. Seven hundred seventy one men had either one or more intermediate-risk features (prostate-specific antigen [PSA] level 1020 ng/mL, Gleason score 7, or Stage T2b). Biologically effective dose (BED) values were calculated by using α/f 1.5. Patients were stratified according to BED. BED ranged from 184 to 278. Low dose level was considered as BED ≤ 227 Gy1.5 and high dose level was BED >227 Gy1.5. Biochemical failure was analyzed by the Phoenix (nadir+2 ng/ml) definition, clinical failure (CF) was defined as any locoregional recurrence (LRR) or distant metastasis (DM). Univariate analyses were used to determine whether any patient characteristics and treatment related factors was predictive for prostate cancer related events and survival. A two-sided p value of <0.05 was considered significant. Results: The median follow-up time was 7.2 years (0.4-18.96 years). At 10years, CF was 19.2% and 3.3% for low-dose and high-dose level (p<0.001), DM was 11% vs. 2.1% (p=0.002), OS was 70.5% and 81.0% (p=0.025), respectively. On univariate analysis, increasing CF was associated with increasing PSA (p=0.025), higher stage (p=0.004), lower BED level (p=0.001), and number of risk factors (p<0.001); BC was associated with Gleason score (p=0.042) and number of risk factors (p=0.012); DM was associated with stage, BED level and number of risk factors with p-value 0.049, 0.005, and 0.001 respectively. BED was the only factor significantly impact on OS with the p-value 0.026. On multivariate analysis, BED and number of risk factors were found to be associated with CF, DM and OS. Conclusions: Radiation dose is an important predictor for CF, DM and OS in intermediate-risk prostate cancer patients. However, high BED has not found to significantly impact on BC. 1021 poster HYPOFRACTIONATED IMAGE GUIDED IMRT FOR PROSTATE CANCER:PHILIPPINE’S FIRST CLINICAL EXPERIENCE G. Banuelos1 , C. Aguilar1 , M. Cruz1 , M. Olvina1 , T. Sarmiento1 , E. Tangco1 , N. Arriola1 , C. De Villeres1 1 S T F RANCES C ABRINI M EDICAL C ENTER AND C ANCER I NSTITUTE, Department of Radiation Oncology, Sto Tomas, Philippines Purpose: Dose escalation with Intensity Modulated Radiation Therapy (IMRT) and Hypofractionation in the treatment of Prostate Cancer has shown improvement in local control and has minimized the acute and late toxicities of normal tissues. The advent of Image Guided Radiation Therapy (IGRT) allowed greater accuracy and precision in daily treatment and higher doses per fraction to be delivered safely. The first IGRT machine for the Philippines was started in 2008. In 2009, we started the Hypofractionated IG-IMRT treatment for Prostate Cancer. This is a report on our clinical experience regarding this modality. Materials: Elekta synergy E1594 system which integrates an X-ray volumetric imager (XVI) and Cone Beam Ct-scan, was used to treat the first 4 cases of Prostate cancer with Hypofractionated IMRT using 6 MV photons. All patients have Gleasons Score between 6-8. Between 5-9 non-coplanar beams were generated via forward planning using Precise treatment planning system. Image guided on-line registration using Cone Beam Computed Tomography (CBCT) was done daily before treatment. A total dose of 64Gy in 20 fractions was given in 4 weeks. Acute toxicity for the GIT and GUT regions were monitored at the end of each week. Results: The mean dose received by the CTV was 65.24 Gy. The critical structures received the following mean doses: rectum 37.49 Gy; bladder 31.93 Gy; small bowels 12.40 Gy. Acute upper GIT reactions was Grade 1 with nausea. Acute lower GIT reactions was Grade 1, 2 with diarrhea and mild abdominal pain. Acute GUT reactions was Grade 1, 2 with frequency