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130 The indications for LHRH treatment in men with prostate cancer
CARO 2005
patients (>75 yr) have the same side effect profile as younger ones. 129 H o w Does B l a d d e r Filling A f f e c t D o s i m e t r y f o r Prostate Radiotherapy M. Liu, V. Moiseenko, S. Kristensen, G. Gelowitz British Columbia Cancer Agency, Fraser Valley Cancer Centre, Surrey, British Columbia To evaluate the effect of bladder filling on dosimetry in radiotherapy for prostate cancer. Twenty-one patients underwent CT simulation with full bladder by drinking 500-750 cc of water prior to simulation. They were asked to void within l h r , and a second CT was obtained. Prostate, bladder and rectum were contoured on both scans. Radiotherapy plans were generated with both the full and empty bladder CT using Box technique and dose prescription of 70 Gy/35 fx. Dose to the prostate (equivalent uniform dose-EUD), bladder and rectum (effective dose- Deff and normal tissue complication probability- NTCP) were compared between the plans. Dose to small bowels was examined. Median full bladder volume is 354.3 cc (range: 154.9 - 601.6 cc) and empty bladder volume is 118.2 cc (range: 48.8 - 351.6 cc). Median prostate EUD for the full bladder scans is 70 Gy (range: 69.7 - 70.5) vs 70 Gy (range: 69.7 - 70.6) for the empty bladder scans. The median rectal Deff for the full bladder scans is 55.6 Gy (range: 53.4 61.4) vs 56.8 Gy (range: 52.0 - 61.9) for the empty bladder scans; while the bladder Deff is 29.0 Gy (range: 22.0 - 51.8 Gy) for the full bladder scans vs 49.3Gy (range: 34.2 - 59.6Gy) for the empty bladder scans, NTCP values did not exceed 2% for both groups. There is wide range in bladder Deft in both groups. One patient had part of small bowel receiving >50 Gy with full bladder (7.5 cc), and 6 with empty bladder (2.5 cc- 30 cc). The filling of bladder has no significant impact on the prostate EUD, rectal Deft. Only minimal volume of small bowels received >50 Gy in both groups and is below dose tolerance. Bladder Deft is higher with empty bladder, however, with the currently available NTCP data, the predicted complication rates are not significantly different. 130 The I n d i c a t i o n s for LHRH T r e a t m e n t in Men w i t h Prostate Cancer P. BloodI, C. Paul2, G. Steinhofl ~, -1. Barnett 4, J. Spinelli 1, T. Pickles~ British Columbia Cancer Agency, University of British Columbia, Victoria, British Colurnbial; University of British Columbia, Vancouver, British Columbia2; Gary Steinhoff Clinical Research, Victoria, British Columbia3; British Columbia Cancer Agency, Victoria, British Columbia 4 Rationale: LHRH treatment is used increasingly in prostate cancer. The indications for LHRH treatment have not previously been determined in a population of men with prostate cancer. Objectives: To determine the indications for LHRH treatment in men with prostate cancer. Design: A structured chart review and a questionnaire sent to community urologists. M a t e r i a l s and Methods: A random sample was taken of 400 men diagnosed with prostate cancer from 1986-2000 from the Provincial Cancer Registry. A chart review was performed on the men seen at the Cancer Clinic to identify the indications for LHRH treatment. A letter was sent to the urologist's office to identify the indications for LHRH treatment for those men not seen at the Cancer Clinic. Urologists who did not reply to the letter were contacted by telephone. Results: 276 men in the study sample had been seen at the Cancer Clinic a n d 268 charts were available for review. 46 letters were sent to urologist's offices enquiring on 134 men. 28 replies were received on 60 men, of whom 40 had information on LHRH treatment. The indications for LHRH treatment in the 308 men for whom data was available from the chart review or urologist's office were: 9% (28) as sole
September 7-10
$39
treatment for localized prostate cancer; 25% (76) as adjuvant to radical radiation treatment; 6% (17) as adjuvant to radical prostatectomy; 15% (47) for locally recurrent prostate cancer after radical radiation treatment or radical prostatectomy; 11% (35) for metastatic prostate cancer; 1% (2) received LHRH treatment without an identifiable indication. 10% (31) received LHRH treatment for more than one indication; 44% (134) did not receive LHRH treatment. Conclusions: Sufficient data exist in medical records to determine the indications for LHRH treatment in men with prostate cancer. The commonest indication for LHRH treatment is adjuvant to radical radiation treatment. 131 Fatigue and its I m p a c t on Q u a l i t y o f Life ( Q O L ) in Prostate Cancer Patients Undergoing Radical R a d i o t h e r a p y (EBRT) P. Truong, E. Berthelet, _1. Lee, C. Gaul, J. Lira, H. Pal, P. Blood, C. Ludgate British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia and University of Victoria, Victoria, British Columbia Objective: To evaluate the prevalence and severity of fatigue and its impact on QOL during and after radical EBRT for prostate cancer. Methods: 30 patients undergoing at least 6 weeks of EBRT were prospectively accrued. The Brief Fatigue Inventory (BFI), a validated instrument with 9 questions, each using 0-10 scales to rate fatigue severity and interference with six QOL domains, was administered at baseline (week 1), during ERBT (week 34), at EBRT completion (week 6-7), and at 6 weeks post-EBRT. Results: Patient and tumor characteristics were: median age 69y (range 57-84 y), 52% T2, 36% T3, Gleason score 7 (range 6-10), median PSA 9 (range 2.5-103). Median EBRT dose was 76 Gy (range 60-78 Gy), median # fractions were 37 (range 30-39). 93% received hormone therapy: duration <6 months in 17% and > 6 months in 76%. At baseline, 66% of patients reported fatigue: 43% mild, 13% moderate, and 10% severe. The proportion of patients reporting moderate-severe fatigue increased from 23% at baseline to 34% at week 3-4, and 47% at week 6-7. Compared to baseline (mean score 18.9), fatigue increased significantly at week 3-4 (mean score 21.7, p=0.03) and further at week 6-7 (mean score 29.7, p=0.001). Fatigue interference with general activity, mood, and social relations exhibited similar time trends. Fatigue significantly interfered with walking ability only at the end of EBRT. At 6-wk follow-up post-EBRT, fatigue declined (mean score 21.8) but moderate-severe fatigue was still reported by 27% of patients. On linear regression analysis, age, Gleason score, PSA, T-stage, hormone therapy duration, and EBRT dose and fractions were not significantly associated with mean fatigue scores. Conclusion: Patients undergoing EBRT experienced increased fatigue adversely affecting QOL independent of hormone therapy duration. Walking ability was not affected until the end of EBRT. A walking program during EBRT to combat fatigue may be feasible and is being investigated. 132 T r e a t m e n t of Elderly Patients w i t h Muscle I n v a s i v e Carcinoma of the Bladder with Short-course R a d i o t h e r a p y and C o n c u r r e n t P l a t i n u m C h e m o t h e r a p y . A R e t r o s p e c t i v e R e v i e w o f 2 6 Patients S. Welch, R. Ash, E. Winquist London Regional Cancer Centre, University of Western Ontario, London, Ontario I n t r o d u c t i o n : Curative treatment for bladder cancer is often not possible in elderly, unfit patients and, thus, palliative treatment is recommended. The optimal treatment for locally advanced bladder cancer has not been defined. Methods: A chart review was undertaken in February 2005 to retrospectively identify patients treated with
patients (>75 yr) have the same side effect profile as younger ones. 129 H o w Does B l a d d e r Filling A f f e c t D o s i m e t r y f o r Prostate Radiotherapy M. Liu, V. Moiseenko, S. Kristensen, G. Gelowitz British Columbia Cancer Agency, Fraser Valley Cancer Centre, Surrey, British Columbia To evaluate the effect of bladder filling on dosimetry in radiotherapy for prostate cancer. Twenty-one patients underwent CT simulation with full bladder by drinking 500-750 cc of water prior to simulation. They were asked to void within l h r , and a second CT was obtained. Prostate, bladder and rectum were contoured on both scans. Radiotherapy plans were generated with both the full and empty bladder CT using Box technique and dose prescription of 70 Gy/35 fx. Dose to the prostate (equivalent uniform dose-EUD), bladder and rectum (effective dose- Deff and normal tissue complication probability- NTCP) were compared between the plans. Dose to small bowels was examined. Median full bladder volume is 354.3 cc (range: 154.9 - 601.6 cc) and empty bladder volume is 118.2 cc (range: 48.8 - 351.6 cc). Median prostate EUD for the full bladder scans is 70 Gy (range: 69.7 - 70.5) vs 70 Gy (range: 69.7 - 70.6) for the empty bladder scans. The median rectal Deff for the full bladder scans is 55.6 Gy (range: 53.4 61.4) vs 56.8 Gy (range: 52.0 - 61.9) for the empty bladder scans; while the bladder Deff is 29.0 Gy (range: 22.0 - 51.8 Gy) for the full bladder scans vs 49.3Gy (range: 34.2 - 59.6Gy) for the empty bladder scans, NTCP values did not exceed 2% for both groups. There is wide range in bladder Deft in both groups. One patient had part of small bowel receiving >50 Gy with full bladder (7.5 cc), and 6 with empty bladder (2.5 cc- 30 cc). The filling of bladder has no significant impact on the prostate EUD, rectal Deft. Only minimal volume of small bowels received >50 Gy in both groups and is below dose tolerance. Bladder Deft is higher with empty bladder, however, with the currently available NTCP data, the predicted complication rates are not significantly different. 130 The I n d i c a t i o n s for LHRH T r e a t m e n t in Men w i t h Prostate Cancer P. BloodI, C. Paul2, G. Steinhofl ~, -1. Barnett 4, J. Spinelli 1, T. Pickles~ British Columbia Cancer Agency, University of British Columbia, Victoria, British Colurnbial; University of British Columbia, Vancouver, British Columbia2; Gary Steinhoff Clinical Research, Victoria, British Columbia3; British Columbia Cancer Agency, Victoria, British Columbia 4 Rationale: LHRH treatment is used increasingly in prostate cancer. The indications for LHRH treatment have not previously been determined in a population of men with prostate cancer. Objectives: To determine the indications for LHRH treatment in men with prostate cancer. Design: A structured chart review and a questionnaire sent to community urologists. M a t e r i a l s and Methods: A random sample was taken of 400 men diagnosed with prostate cancer from 1986-2000 from the Provincial Cancer Registry. A chart review was performed on the men seen at the Cancer Clinic to identify the indications for LHRH treatment. A letter was sent to the urologist's office to identify the indications for LHRH treatment for those men not seen at the Cancer Clinic. Urologists who did not reply to the letter were contacted by telephone. Results: 276 men in the study sample had been seen at the Cancer Clinic a n d 268 charts were available for review. 46 letters were sent to urologist's offices enquiring on 134 men. 28 replies were received on 60 men, of whom 40 had information on LHRH treatment. The indications for LHRH treatment in the 308 men for whom data was available from the chart review or urologist's office were: 9% (28) as sole
September 7-10
$39
treatment for localized prostate cancer; 25% (76) as adjuvant to radical radiation treatment; 6% (17) as adjuvant to radical prostatectomy; 15% (47) for locally recurrent prostate cancer after radical radiation treatment or radical prostatectomy; 11% (35) for metastatic prostate cancer; 1% (2) received LHRH treatment without an identifiable indication. 10% (31) received LHRH treatment for more than one indication; 44% (134) did not receive LHRH treatment. Conclusions: Sufficient data exist in medical records to determine the indications for LHRH treatment in men with prostate cancer. The commonest indication for LHRH treatment is adjuvant to radical radiation treatment. 131 Fatigue and its I m p a c t on Q u a l i t y o f Life ( Q O L ) in Prostate Cancer Patients Undergoing Radical R a d i o t h e r a p y (EBRT) P. Truong, E. Berthelet, _1. Lee, C. Gaul, J. Lira, H. Pal, P. Blood, C. Ludgate British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia and University of Victoria, Victoria, British Columbia Objective: To evaluate the prevalence and severity of fatigue and its impact on QOL during and after radical EBRT for prostate cancer. Methods: 30 patients undergoing at least 6 weeks of EBRT were prospectively accrued. The Brief Fatigue Inventory (BFI), a validated instrument with 9 questions, each using 0-10 scales to rate fatigue severity and interference with six QOL domains, was administered at baseline (week 1), during ERBT (week 34), at EBRT completion (week 6-7), and at 6 weeks post-EBRT. Results: Patient and tumor characteristics were: median age 69y (range 57-84 y), 52% T2, 36% T3, Gleason score 7 (range 6-10), median PSA 9 (range 2.5-103). Median EBRT dose was 76 Gy (range 60-78 Gy), median # fractions were 37 (range 30-39). 93% received hormone therapy: duration <6 months in 17% and > 6 months in 76%. At baseline, 66% of patients reported fatigue: 43% mild, 13% moderate, and 10% severe. The proportion of patients reporting moderate-severe fatigue increased from 23% at baseline to 34% at week 3-4, and 47% at week 6-7. Compared to baseline (mean score 18.9), fatigue increased significantly at week 3-4 (mean score 21.7, p=0.03) and further at week 6-7 (mean score 29.7, p=0.001). Fatigue interference with general activity, mood, and social relations exhibited similar time trends. Fatigue significantly interfered with walking ability only at the end of EBRT. At 6-wk follow-up post-EBRT, fatigue declined (mean score 21.8) but moderate-severe fatigue was still reported by 27% of patients. On linear regression analysis, age, Gleason score, PSA, T-stage, hormone therapy duration, and EBRT dose and fractions were not significantly associated with mean fatigue scores. Conclusion: Patients undergoing EBRT experienced increased fatigue adversely affecting QOL independent of hormone therapy duration. Walking ability was not affected until the end of EBRT. A walking program during EBRT to combat fatigue may be feasible and is being investigated. 132 T r e a t m e n t of Elderly Patients w i t h Muscle I n v a s i v e Carcinoma of the Bladder with Short-course R a d i o t h e r a p y and C o n c u r r e n t P l a t i n u m C h e m o t h e r a p y . A R e t r o s p e c t i v e R e v i e w o f 2 6 Patients S. Welch, R. Ash, E. Winquist London Regional Cancer Centre, University of Western Ontario, London, Ontario I n t r o d u c t i o n : Curative treatment for bladder cancer is often not possible in elderly, unfit patients and, thus, palliative treatment is recommended. The optimal treatment for locally advanced bladder cancer has not been defined. Methods: A chart review was undertaken in February 2005 to retrospectively identify patients treated with