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282 poster Chronic fatigue after permanent interstitial I-125-brachytherapy, temporary interstitial Ir-192-brachytherapy and external beam radiotherapy for prostate cancer
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approximately 15 - 21 months following brachytherapy. For biochemically disease-free patients, the median PSA increase above nadir was 0.1 ng/mL, and the median number of consecutive rises in PSA was 1. Using the ASTRO and Houston definitions, only 2.3% and 0.6% of patients would have been inadvertently scored as failures.
Conclusions: In brachytherapy patients receiving 3 - 6 months of neoadjuvant androgen deprivation therapy, the median PSA increase above nadir was 0.1 ng/mL. The ASTRO and Houston definitions of biochemical failure inadvertently scored only 2.3% and 0.6% of patients as failures. Although both definitions remain reasonable choices in the follow-up of hormonatly manipulated brachytherapy patients, the Houston definition appears to most accurately reflect ultimate biochemical outcome. 282 poster
Chronic fatigue after permanent interstitial 1-125brachytherapy, temporary interstitial Ir-192-braehytherapy and external beam radiotherapy for prostate cancer
M. Pinkawa ~, K. Fischedick ~, B. Asadpou/, B. Krenkel ~, R. Holy ~, Y. Kaplan ~, H. Borchers 2, G. Jakse 2, M.J. Eble ~ I University Hospital Aachen, Radiotherapy, Aachen, Germany 2University Hospital Aachen, Urology, Aachen, Germany Purpose: Evaluation of the incidence and duration of chronic fatigue after different radiotherapeutic treatment methods for prostate cancer and the association with urinary, bowel and sexual symptoms. Materials and methods: A validated questionnaire (Expanded Prostate Cancer Index) has been answered by 214 patients 13 (median, 2-36) months after primary treatment for prostate cancer (T1-3NOM0) - 92 after 1-125-implantation, 50 after HDRbrachytherapy with Ir-192 (18Gy + median 50.4Gy external beam radiotherapy - EBRT), 72 after sole EBRT (median 70.2Gy). The grade of feeling depressed and lack of energy as well the associated bothersome hess served as indicators for the fatigue syndrome. Baseline values existed from 52 patients who answered a questionnaire before the beginning of treatment. Results: Lack of energy and feeling depressed was a moderate or big problem for 22% and 11% of patients (15% and 13% before treatment, not significant (ns)). The portion of patients who did not receive an antiandrogen treatment and reported lack of energy to be a moderate/big problem was larger up to one year after the treatment than later (32% vs. 11%, p<0.01). This could not be observed for patients receiving an antiandrogen treatment (30% vs. 55%, ns). It was similar for patients of different ages (22% <70 years vs. 23%>70 years) but smaller after 1-125-implantation compared to the other treatment methods (14% vs. 27%, p=0.03). Prostate volume was a significant risk factor (no problem from feeling depressed in 85% vs. 68% - p=0.04 - no problem from lack of energy in 72% vs. 59% - ns - for prostate volumes <35cc vs. _>35cc). Patients with a moderate/big problem from lack of energy or feeling depressed had significantly lower urinary, bowel and sexual function and bothersome ness scores (p<0.01 for all but sexual function- p=0.02 with lack of energy and p=0.08 with depression). Conclusion: Chronic fatigue has an impact particularly during the first year after a radiotherapeutic treatment, especially after sole EBRT or EBRT combined with HDR-brachytherapy. A long antiandrogen treatment leads to a higher rate of fatigue. Prostate volume is a significant risk factor, contrary to patient age. A striking association exists with urinary, bowel and sexual problems.
Posters
283 poster
Dose-volume-time-impact on t o x i c i t y in interstitial temporary HDR-Ir-192-brachytherapy (BT) for prostate cancer
M. Pinkawa 1, K. Fischedick 1, H. Treusache/, G. Demiref , R. Mager ~, H. Borchers2, G. Jakse2, M.J. Eble ~ ~University Hospital Aachen, Radiotherapy, Aachen, Germany 2University Hospital Aachen, Urology, Aachen, Germany Purpose: Evaluation of factors influencing toxicity in HDR-BT for prostate cancer. Materials and methods: A validated questionnaire (Expanded Prostate Cancer Index) has been answered by 50 patients 20 (median, 4-34) months after primary treatment (two BT-fractions up to 18Gy + median 50.4Gy external beam radiotherapy) for prostate cancer (T1-3NOM0). The influence of dose, volume and time on toxicity has been evaluated. Results: Patients with a dose exceeding 15Gy in at least one HDR-fraction had significantly worse urinary (70_+30 vs. 89_+15, p<0.01; at least daily pain with urination in 35% vs. 12%) and sexual function scores (11_+17 vs. 24+_21, p=0.04; poor or no ability to have an erection in 65% vs. 36%). A dose >6Gy at the rectal mucosa predisposed for worse bowel function scores (81+_20 vs. 88-+16; at least rare rectal bleeding in 37% vs. 11%, p=0.04). Patients with a volume increase of >10% between the BT fractions reached worse sexual function scores (10_+13 vs. 25+_23, p=0.03; no sexual intercourse in 85% vs. 56%). A prostate length of >-4,8cm in at least one fraction deteriorated urinary (73+~28 vs. 93_+12, p=0.01; at least daily pain with urination in 30% vs. 6%, p=0.05) and bowel function scores (81+_21 vs. 91_+11, p=0.07; loose bowel movements in 63% vs. 29%, p=0.03). A prostate width of >4,8cm in at least one fraction had only an influence on bowel function scores (81+_20 vs. 94_+8, p=O.02; at least rare rectal bleeding in 33% vs. 7%, p=0.06). A PTV>335cm 3 in the external beam treatment predisposed for a deterioration of urinary and bowel scores but significantly only the sexual function (12-+31 vs. 31+_27, p<0.01; poor or no ability to have an erection in 62% vs. 27%, p=0.03). No differences could be found after different doses of external beam radiotherapy. With an increasing posttreatment period urinary (>20 months 87_+18 vs. 75+_28, p=0.09; at least daily pain with urination in 41% vs. 0%, p<0.01) and sexual function scores improved (>20 months 27+_23 vs. 11 _+16, p=0.02; no sexual intercourse in 86% vs. 50%, p=0.01). Conclusion: Using HDR-BT in the treatment of prostate cancer a maximal dose of 15Gy to the urethra and 6Gy to the rectal mucosa should not be exceeded to minimize toxicity. Large borderlines between the treatment volume and organs at risk rise the probability of adverse effects. An improvement of urinary and sexual symptoms can be expected after an increasing posttreatment period. 285 poster A MRI based treatment concept for interstitial HDR prostate treatments - Part I: clinical feasibility
S. Wachter, C. Kirisits, S. Lang, D. Georg Medical University of Vienna, Radiotherapy and Radiobiology Vienna, Vienna, Austria Purpose: With aid of modern sectional imaging techniques (e.g. MRI) it is possible to differentiate zonal anatomy of the prostatic gland. In this prospective study we aimed to apply a concept on volume and dose parameters for different subportions of the prostate and to test them for feasibility, reproducibility and clinical relevance. Methods and material: In 14 patients a TRUS-guided interstitial HDR-brachytherapy boost using 2-3 fractions (7-8 Gy
approximately 15 - 21 months following brachytherapy. For biochemically disease-free patients, the median PSA increase above nadir was 0.1 ng/mL, and the median number of consecutive rises in PSA was 1. Using the ASTRO and Houston definitions, only 2.3% and 0.6% of patients would have been inadvertently scored as failures.
Conclusions: In brachytherapy patients receiving 3 - 6 months of neoadjuvant androgen deprivation therapy, the median PSA increase above nadir was 0.1 ng/mL. The ASTRO and Houston definitions of biochemical failure inadvertently scored only 2.3% and 0.6% of patients as failures. Although both definitions remain reasonable choices in the follow-up of hormonatly manipulated brachytherapy patients, the Houston definition appears to most accurately reflect ultimate biochemical outcome. 282 poster
Chronic fatigue after permanent interstitial 1-125brachytherapy, temporary interstitial Ir-192-braehytherapy and external beam radiotherapy for prostate cancer
M. Pinkawa ~, K. Fischedick ~, B. Asadpou/, B. Krenkel ~, R. Holy ~, Y. Kaplan ~, H. Borchers 2, G. Jakse 2, M.J. Eble ~ I University Hospital Aachen, Radiotherapy, Aachen, Germany 2University Hospital Aachen, Urology, Aachen, Germany Purpose: Evaluation of the incidence and duration of chronic fatigue after different radiotherapeutic treatment methods for prostate cancer and the association with urinary, bowel and sexual symptoms. Materials and methods: A validated questionnaire (Expanded Prostate Cancer Index) has been answered by 214 patients 13 (median, 2-36) months after primary treatment for prostate cancer (T1-3NOM0) - 92 after 1-125-implantation, 50 after HDRbrachytherapy with Ir-192 (18Gy + median 50.4Gy external beam radiotherapy - EBRT), 72 after sole EBRT (median 70.2Gy). The grade of feeling depressed and lack of energy as well the associated bothersome hess served as indicators for the fatigue syndrome. Baseline values existed from 52 patients who answered a questionnaire before the beginning of treatment. Results: Lack of energy and feeling depressed was a moderate or big problem for 22% and 11% of patients (15% and 13% before treatment, not significant (ns)). The portion of patients who did not receive an antiandrogen treatment and reported lack of energy to be a moderate/big problem was larger up to one year after the treatment than later (32% vs. 11%, p<0.01). This could not be observed for patients receiving an antiandrogen treatment (30% vs. 55%, ns). It was similar for patients of different ages (22% <70 years vs. 23%>70 years) but smaller after 1-125-implantation compared to the other treatment methods (14% vs. 27%, p=0.03). Prostate volume was a significant risk factor (no problem from feeling depressed in 85% vs. 68% - p=0.04 - no problem from lack of energy in 72% vs. 59% - ns - for prostate volumes <35cc vs. _>35cc). Patients with a moderate/big problem from lack of energy or feeling depressed had significantly lower urinary, bowel and sexual function and bothersome ness scores (p<0.01 for all but sexual function- p=0.02 with lack of energy and p=0.08 with depression). Conclusion: Chronic fatigue has an impact particularly during the first year after a radiotherapeutic treatment, especially after sole EBRT or EBRT combined with HDR-brachytherapy. A long antiandrogen treatment leads to a higher rate of fatigue. Prostate volume is a significant risk factor, contrary to patient age. A striking association exists with urinary, bowel and sexual problems.
Posters
283 poster
Dose-volume-time-impact on t o x i c i t y in interstitial temporary HDR-Ir-192-brachytherapy (BT) for prostate cancer
M. Pinkawa 1, K. Fischedick 1, H. Treusache/, G. Demiref , R. Mager ~, H. Borchers2, G. Jakse2, M.J. Eble ~ ~University Hospital Aachen, Radiotherapy, Aachen, Germany 2University Hospital Aachen, Urology, Aachen, Germany Purpose: Evaluation of factors influencing toxicity in HDR-BT for prostate cancer. Materials and methods: A validated questionnaire (Expanded Prostate Cancer Index) has been answered by 50 patients 20 (median, 4-34) months after primary treatment (two BT-fractions up to 18Gy + median 50.4Gy external beam radiotherapy) for prostate cancer (T1-3NOM0). The influence of dose, volume and time on toxicity has been evaluated. Results: Patients with a dose exceeding 15Gy in at least one HDR-fraction had significantly worse urinary (70_+30 vs. 89_+15, p<0.01; at least daily pain with urination in 35% vs. 12%) and sexual function scores (11_+17 vs. 24+_21, p=0.04; poor or no ability to have an erection in 65% vs. 36%). A dose >6Gy at the rectal mucosa predisposed for worse bowel function scores (81+_20 vs. 88-+16; at least rare rectal bleeding in 37% vs. 11%, p=0.04). Patients with a volume increase of >10% between the BT fractions reached worse sexual function scores (10_+13 vs. 25+_23, p=0.03; no sexual intercourse in 85% vs. 56%). A prostate length of >-4,8cm in at least one fraction deteriorated urinary (73+~28 vs. 93_+12, p=0.01; at least daily pain with urination in 30% vs. 6%, p=0.05) and bowel function scores (81+_21 vs. 91_+11, p=0.07; loose bowel movements in 63% vs. 29%, p=0.03). A prostate width of >4,8cm in at least one fraction had only an influence on bowel function scores (81+_20 vs. 94_+8, p=O.02; at least rare rectal bleeding in 33% vs. 7%, p=0.06). A PTV>335cm 3 in the external beam treatment predisposed for a deterioration of urinary and bowel scores but significantly only the sexual function (12-+31 vs. 31+_27, p<0.01; poor or no ability to have an erection in 62% vs. 27%, p=0.03). No differences could be found after different doses of external beam radiotherapy. With an increasing posttreatment period urinary (>20 months 87_+18 vs. 75+_28, p=0.09; at least daily pain with urination in 41% vs. 0%, p<0.01) and sexual function scores improved (>20 months 27+_23 vs. 11 _+16, p=0.02; no sexual intercourse in 86% vs. 50%, p=0.01). Conclusion: Using HDR-BT in the treatment of prostate cancer a maximal dose of 15Gy to the urethra and 6Gy to the rectal mucosa should not be exceeded to minimize toxicity. Large borderlines between the treatment volume and organs at risk rise the probability of adverse effects. An improvement of urinary and sexual symptoms can be expected after an increasing posttreatment period. 285 poster A MRI based treatment concept for interstitial HDR prostate treatments - Part I: clinical feasibility
S. Wachter, C. Kirisits, S. Lang, D. Georg Medical University of Vienna, Radiotherapy and Radiobiology Vienna, Vienna, Austria Purpose: With aid of modern sectional imaging techniques (e.g. MRI) it is possible to differentiate zonal anatomy of the prostatic gland. In this prospective study we aimed to apply a concept on volume and dose parameters for different subportions of the prostate and to test them for feasibility, reproducibility and clinical relevance. Methods and material: In 14 patients a TRUS-guided interstitial HDR-brachytherapy boost using 2-3 fractions (7-8 Gy