74 Health related quality of life in prostate cancer patients: Combined high dose rate brachytherapy and external beam radiotherapy versus permanent seed implantation

event of local recurrence external beam irradiation decrease PSA in 40 - 70% of the patients. High dose external beam radiotherapy combined with radical surgery is associated with high risk of normal tissue injury. We used ultrasound guided HDR brachytherapy to reach a circumscribed high dose in the region of local recurrence. Materials and m e t h o d s : Qualification of all patients with histologically proven local recurrence was examined by using transrectal ultrasound (TRUS). Included were patients with a minimum distance of 5mm to rectal wall and no infiltration in bladder as well as TRUS visible target for brachytherapy. A TRUS guided pretreatment planning was performed (planning distance 5mm). Controlled by ultrasound 4 - 8 needles were implanted transperineally. Needles were arranged as a V-figure. The applicated dose was 15 Gy prescribed on the target shaping reference isodose. HDR brachytherapy was performed two times in two weeks. Brachytherapy was given incorporated into the 30 Gy external beam course using conventional fractionation and the box technique. External beam target was the small pelvis. Results: 15 patients ranged from 56 to 67 years were treated. Initial mean PSA was 6.3 (range 2.6 to 13.75). PSA decreased after treatment for all patients. After a mean follow-up of 12 months 80% had a steep decrease of PSA (mean 0.66, range 0.03 to 1.34). Three patients had a increase of PSA and a verified local progress. 4 patients had a continuous hormonal blockade before the decision for radiation therapy had been fallen. We did not observe any RTOG III or IV side effects during or after radiotherapy. Today 14 patients are continent and without urethral stricture. 1 patient needed a permanent urethral catheter even before treatment. Conclusions: Combined Tele- and HDR brachytherapy of local recurrence after radical prostatectomy is a feasible and effective method of treatment. Side effects and complications could be reduced compared to exclusive external beam radiotherapy. TRUS guidance and pretreatment planning allows a optimal control of region of interest and local dose escalation. For long term results must be waited. 74 HEALTH RELATED QUALITY OF LIFE IN PROSTATE CANCER PATIENTS: COMBINED HIGH DOSE RATE BRACHYTHERAPYAND EXTERNAL BEAM

RADIOTHERAPY VERSUS PERMANENT SEED IMPLANTATION Julie Kleczek, Timothy Campbell, M.D., Greg Devanna, M.S., James McGee, M.D. OSF St Francis Medical Center, Peoria, IL and University of Illinois College of Medicine at Peoria Purpose: Combined high dose rate brachytherapy and external beam radiotherapy (HDR/EBRT) has been used to treat high grade prostate cancers. Permanent Seed implantation (Seed) without external beam radiotherapy has been used to treat lower grade lesions. Because HDR/EBRT may improve cure rates in lower grade disease, we compared Health Related Quality of Life in HDR/EBRT versus Seed patients to assess safety and morbidity. M a t e r i a l s and m e t h o d s : Ninety-four consecutive patients (n=52 HDR/EBRT, n=42 Seed) were sent the UCLA Prostate Cancer Index (PCI). Patients were assured that the treating physician was blinded to individual survey responses. The PCI includes a general HRQOL using the RAND 36-1tem Health Survey (SF-36) and an organ-targeted HRQOL using the UCLA/RAND Prostate/Targeted Index (PTI). The SF-36 contains 8 scales: physical functioning (PF), limitations due to physical health (LP), limitations due to emotional problems (LE), energy/fatigue (EF), emotional well-being (EH), social functioning (SF), pain (P) and general health (GH). Test-retest correlation at 4 weeks is 0.60 and above for 7 of 8 scales (range 0.54-0.85). internal consistency reliability is 0.78 or above for all 8 scales (range 0.78-0.93). The PTI contains 6 scales: urinary function (UF), urinary bother (UB), bowel function (BF), bowel bother (BB), sexual function (SF) sexual bother (SB). Test-retest correlation (4 weeks) is 0.70 or greater for 5 of 6 scales (range 0.66-0.93). Internal consistency reliability for the multi-item function scales was UF 0.87, BF 0.65 and SF 0.93. All scales range from 0 to 100. HDR/EBRT patients were treated with 16.5 Gy HDR brachytherapy in 3 fractions over 24 hours followed by 45 Gy EBRT in 25 fractions to a limited pelvic field. All Seed implants were given a peripheral dose of 115 Gy with Pd-103. Results: Survey response was excellent with 85% return rate. The return rate was equivalent in the 2 groups. Mean age was 68.2 years, the HDR/EBRT group being older (69.6 vs. 66.3 yrs., p=0.05). Median follow-up was 14.5 months with longer follow-up in the HDR/EBRT patients (16.1 vs. 12.8 m., p=0.02). Mean PSA was 8.3 and mean Gleason score was 6.4 with the HDR/EBRT patients being greater for both (PSA 9.7 vs. 6.3, p=0.02; Gleason 6.8 vs. 5.7, p=0.00). No significant differences were found comparing general HRQOL for HDR/EBRT vs. Seeds (PF 84 vs. 75, p=0.18; LP71 vs. 50, p=0.06, LE 83 vs. 74, p=0.41; EF87 vs. 80, p=0.64; EH 82 vs. 83, p=0.90; SF79 vs. 68, p=0.07; P 7 0 vs. 65, p=0.30; GH 63 vs. 56, p=0.22). Most informative was that no differences were found when comparing urinary, bowel and sexual function and bother for HDR/EBRT vs. Seeds (UF 82 vs. 73, p=0.10, UB 74 vs. 66, p=0.29, BF 90 vs. 82, p=0.65, BB 74 vs. 77, p=0.62, SF 27 vs. 27, p=0.96, SB 35 vs. 46, p=0.30). No significant continuing side effects have been reported to treating physicians by HDR/EBRT patients. One patient reported significant diarrhea and anemia which resolved after he had a diagnosis and resection of a duodenal carcinoid tumor. Additionally, using a strict definition of no biochemical evidence of disease of achieving and maintaining a PSA of 1.0 or less, all HDR/EBRT patients are without disease at current follow-up. Conclusions: In experienced hands HRQOL is similar for HDR/EBRT patients compared to permanent seed implantation alone. HDR prostate brachytherapy is safe using HRQOL as a surrogate measure for true morbidity of therapy. It is also similar to HRQOL measurements using the PCI for EBRT alone or radical prostatectomy previously published by other investigators. Although further follow-up is required, HDR appears to be effective as a curative therapy. 75 PERMANENT PROSTATE IMPLANTS AND ACUTE URINARYOBSTRUCTION: A MULTIVARIATE ANALYSISON EDEMA AND DOSIMETRIC PARAMETERS

Andr6-Guy Martin, Jean Roy, Eric Vigneault, Richard Taschereau and Jean Pouliot Centre Hospitalier Universitaire de Qu6bec (Pavilion L'Hotel-Dieu), 11 C6te du Palais, Qu6bec, QC, Canada, GIR 2J6 Purpose: To characterize the post-implant edema in magnitude and duration following 125-I and 103-Pd prostate optimized implantation for early stage prostate cancer. Evaluate its impact on post-implant side effects and establish relationships with possible etiologic factors of edema. Materials and methods: A pre-implant trans-rectal ultrasound (TRUS) prostate volume characterization was followed by an ultrasound guided dosimetric optimized implantation. The prescribed dose was 160 Gy (AAPM-Task Group 43). One hundred and thirty eight patients received hormone therapy before implantation in a cohort of 180 patients. In the post implant time period, seed distribution was observed from orthogonal X-ray films taken at 0, 1 and 3 days for most patients (respectively 27, 45 and 73 patients). A sub-group of seven (7) patients bad sequential

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