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86 Patient involvement in the choice of radiation dose in prostate cancer
proffered Papers treatment'. Dose volume parameters remained significant in most MV models. Mean dose to the anal canal was the strongest predictor for 'incontinence needing pads' and 'proctitis needing steroids' (MV p=0.01-0.07). Anorectal volume > 40 Gy was the best predictor for 'stool frequency > 6/day' (MV p=0.04-0.09) and rectal volume > 70 Gy for intermittent bleeding (MV p=0.04-0.1). The combination of moderate-severe acute reactions and a mean dose to the anal canal above the median (> 37 Gy) led to a 4-year cumulative incidence of 60 % late _> G2 toxicity (24 % for the total group). Conclusions: Acute GI toxicity is significantly correlated with late toxicity even when relevant dose volume parameters are taken into account. This suggests a significant consequential component in the development of late anorectal toxicity. 85 A randomised trial of t h e impact of an educational support group for prostate cancer patients
_A. O'Donovan, E. O'Shea, M. O'Loughlin, M. Hogan, L. Mullaney, S. Dempsey, M. Moriarty, K. McKenzie Radiotherapy Dept, Saint Luke's Hospital, Dublin, Ireland. This research is sponsored by the Irish Cancer Society. Introduction: Research in to the psycho-educational support for prostate cancer patients is relatively sparse. Much of the research that has been conducted lacks quantitative measures and is frequently not randomised. The purpose of the prospective randomised controlled trial is to assess the effect / benefit of an educational support group on prostate cancer patients. Methodology: 100 newly diagnosed prostate cancer patients, receiving radical radiotherapy, with or without hormone treatment, will be randomised to either of two arms: A r m 1: an educational supportive group or A r m 2: a control group. Patients randomised to the educational support group arm will attend a weekly multidisciplinary educational support group meeting while receiving their radiotherapy treatment. The model used is that of the Brain Tumour Support Group which is on-going in Ireland (ref ESTRO 2002). The educational focus to this support group deals with specific topics of concern to prostate cancer patients i.e. prostate cancer, hormone treatment, sexuality, radiotherapy, fatigue and pastoral needs. This educational support group is facilitated by a multidisciplinary team of Radiation Therapists, Social Workers and a Prostate Specialist Nurse. Patients complete the EORTC quality of life questionnaire, FACT-P, Piper Fatigue scale and HADS questionnaires at predefined stages. Results: This study opened for patient recruitment in May 2004. To date (April 2005) 40 patients have been randomised. Preliminary results indicate that patients greatly benefit from attending the educational support group. These results will be available in September for presentation at the ESTRO conference. Conclusion: This educational support group will remain ongoing until this research is completed in March 2006. If it is shown that a prostate cancer educational support group confers a positive benefit on the quality of life of prostate cancer patients then it will be proposed that this educational support group should be continued at Saint Luke's Hospital. 86 Patient i n v o l v e m e n t in t h e choice of radiation dose in prostate cancer
J. van ToI-Geerdink 1, P. Stalmeier 2, H. Huizenga I, E. van
Lin 1, E. Schimmel 3, W. van Daal I, .1. Leer I 1Radboud University Nijmegen Medical Center, Radiation Oncology, Nijmegen, The Netherlands) 2Radboud University Nijmegen Medical Center, Medical Technology Assessment, Nijmegen, The Netherlands)
Monday, September 26
$49
3Arnhems Radiotherapeutic Institute, Arnhem, The Netherlands) I n t r o d u c t i o n : Over the years, technological developments have enabled radiation oncologists to reach more cure with the same risk of side effects or, alternatively, to reach the same cure with less side effects. Our research question is how patients would like to benefit from these developments; 1) Do they want to be involved in the treatment choice and 2) Do they opt for the increase in cure or for the decrease in the risk of side effects? Methods: In the past year, these questions were studied in 140 patients with prostate cancer (T1-3NoM0) treated with 3D conformal radiotherapy. In an interview, the effects of two alternative treatment options (70 Gy and 74 Gy) were explained, and the patients were asked whether they wanted to leave the decision to the physician or choose one of these two treatments, and if so, which treatment. The patient's choice was implemented and the interview was evaluated by means of a questionnaire. P r e l i m i n a r y results: Even in this older patient population, most of the patients (80%) accepted the option to choose the radiation dose. A majority of these patients (75%) chose the lower dose (70 Gy). Most patients (92%) considered it a good idea to be offered a choice. Conclusion: Once informed, most patients want to make their own choice of the radiation dose. The majority of the patients prefer the more conservative treatment out of these two active treatment options. In conclusion, patients with T13NoMo prostate cancer should be informed and involved in the choice of radiation dose. Secondly, since many patients find the risk of complications more important than cure, radiation oncologists may need to reconsider the general focus on cure. 87 I s DVH a tool to c o m p a r e I M R T of head and neck in several radiation t h e r a p y units ?
S. M a r c i ~ C. Pichenot2, S. Zefkilia, J. Plassat 4, 3. Caron 4, L. Vieillevigne5, D. Lefkopoulos 2 1Antoine Lacassagne Centre, Nice, France 2Gustave Roussy Institute, Villejuif, France 3Curie Institute, Paris, France 4Bergoni~ Institute, Bordeaux, France SClaudius Regaud Institute, Toulouse, France Purpose: For the choice of the best treatment plan, dosevolume histograms (DVHs) are necessaries. We have compared the DVHs of organs at risk and target volume given by 5 radiation therapy units working in the same french group of medical-economic evaluation of the head and neck IMRT. Materials and methods: Doses to 95 % and 5 % of PTV and CTV volumes, mean doses and volumes of CI-V, PTV, parotids have been compared for respectively 26 (10 nasopharynx, 7 oropharynx, 6 tonsils and 3 others), 9 (4 tonsils, 1 nasopharynx, 4 others), 10 (4 nasopharynx, 5 tongues, 1 tonsil), 7 ( 4 oropharynx and 3 nasopharynx), 2 oropharynx patients of Antoine Lacassagne Centre (Nice), Gustave Roussy Institute (Villejuif), Curie Institute (Paris), Bergoni~ Institute (Bordeaux) and Claudius Regaud Institute (Toulouse). Results: If mean volume of parotids are the same (19.3 ~1.1 cc) for 4 units, there is a large difference for mean volumes of CTV (respectively 260, 98, 54 and 53 cc) receiving 66 to 70 Gy and PIV (respectively 708, 458, 203, 311, 410 cc) receiving 50 Gy. A best sparing of parotids has been obtained with the smaller target volume with a mean dose to ipsilateral parotid of 50 Gy for the 2 first therapy units and 30 for the 3 others. For contralateral parotid, mean doses are between 20 and 31 Gy. Considering nasopharynx or oropharynx alone, the same differences were observed. Conclusion: In head and neck, the definition of the target volume is not uniforme. The HDVs have not permitted to
_A. O'Donovan, E. O'Shea, M. O'Loughlin, M. Hogan, L. Mullaney, S. Dempsey, M. Moriarty, K. McKenzie Radiotherapy Dept, Saint Luke's Hospital, Dublin, Ireland. This research is sponsored by the Irish Cancer Society. Introduction: Research in to the psycho-educational support for prostate cancer patients is relatively sparse. Much of the research that has been conducted lacks quantitative measures and is frequently not randomised. The purpose of the prospective randomised controlled trial is to assess the effect / benefit of an educational support group on prostate cancer patients. Methodology: 100 newly diagnosed prostate cancer patients, receiving radical radiotherapy, with or without hormone treatment, will be randomised to either of two arms: A r m 1: an educational supportive group or A r m 2: a control group. Patients randomised to the educational support group arm will attend a weekly multidisciplinary educational support group meeting while receiving their radiotherapy treatment. The model used is that of the Brain Tumour Support Group which is on-going in Ireland (ref ESTRO 2002). The educational focus to this support group deals with specific topics of concern to prostate cancer patients i.e. prostate cancer, hormone treatment, sexuality, radiotherapy, fatigue and pastoral needs. This educational support group is facilitated by a multidisciplinary team of Radiation Therapists, Social Workers and a Prostate Specialist Nurse. Patients complete the EORTC quality of life questionnaire, FACT-P, Piper Fatigue scale and HADS questionnaires at predefined stages. Results: This study opened for patient recruitment in May 2004. To date (April 2005) 40 patients have been randomised. Preliminary results indicate that patients greatly benefit from attending the educational support group. These results will be available in September for presentation at the ESTRO conference. Conclusion: This educational support group will remain ongoing until this research is completed in March 2006. If it is shown that a prostate cancer educational support group confers a positive benefit on the quality of life of prostate cancer patients then it will be proposed that this educational support group should be continued at Saint Luke's Hospital. 86 Patient i n v o l v e m e n t in t h e choice of radiation dose in prostate cancer
J. van ToI-Geerdink 1, P. Stalmeier 2, H. Huizenga I, E. van
Lin 1, E. Schimmel 3, W. van Daal I, .1. Leer I 1Radboud University Nijmegen Medical Center, Radiation Oncology, Nijmegen, The Netherlands) 2Radboud University Nijmegen Medical Center, Medical Technology Assessment, Nijmegen, The Netherlands)
Monday, September 26
$49
3Arnhems Radiotherapeutic Institute, Arnhem, The Netherlands) I n t r o d u c t i o n : Over the years, technological developments have enabled radiation oncologists to reach more cure with the same risk of side effects or, alternatively, to reach the same cure with less side effects. Our research question is how patients would like to benefit from these developments; 1) Do they want to be involved in the treatment choice and 2) Do they opt for the increase in cure or for the decrease in the risk of side effects? Methods: In the past year, these questions were studied in 140 patients with prostate cancer (T1-3NoM0) treated with 3D conformal radiotherapy. In an interview, the effects of two alternative treatment options (70 Gy and 74 Gy) were explained, and the patients were asked whether they wanted to leave the decision to the physician or choose one of these two treatments, and if so, which treatment. The patient's choice was implemented and the interview was evaluated by means of a questionnaire. P r e l i m i n a r y results: Even in this older patient population, most of the patients (80%) accepted the option to choose the radiation dose. A majority of these patients (75%) chose the lower dose (70 Gy). Most patients (92%) considered it a good idea to be offered a choice. Conclusion: Once informed, most patients want to make their own choice of the radiation dose. The majority of the patients prefer the more conservative treatment out of these two active treatment options. In conclusion, patients with T13NoMo prostate cancer should be informed and involved in the choice of radiation dose. Secondly, since many patients find the risk of complications more important than cure, radiation oncologists may need to reconsider the general focus on cure. 87 I s DVH a tool to c o m p a r e I M R T of head and neck in several radiation t h e r a p y units ?
S. M a r c i ~ C. Pichenot2, S. Zefkilia, J. Plassat 4, 3. Caron 4, L. Vieillevigne5, D. Lefkopoulos 2 1Antoine Lacassagne Centre, Nice, France 2Gustave Roussy Institute, Villejuif, France 3Curie Institute, Paris, France 4Bergoni~ Institute, Bordeaux, France SClaudius Regaud Institute, Toulouse, France Purpose: For the choice of the best treatment plan, dosevolume histograms (DVHs) are necessaries. We have compared the DVHs of organs at risk and target volume given by 5 radiation therapy units working in the same french group of medical-economic evaluation of the head and neck IMRT. Materials and methods: Doses to 95 % and 5 % of PTV and CTV volumes, mean doses and volumes of CI-V, PTV, parotids have been compared for respectively 26 (10 nasopharynx, 7 oropharynx, 6 tonsils and 3 others), 9 (4 tonsils, 1 nasopharynx, 4 others), 10 (4 nasopharynx, 5 tongues, 1 tonsil), 7 ( 4 oropharynx and 3 nasopharynx), 2 oropharynx patients of Antoine Lacassagne Centre (Nice), Gustave Roussy Institute (Villejuif), Curie Institute (Paris), Bergoni~ Institute (Bordeaux) and Claudius Regaud Institute (Toulouse). Results: If mean volume of parotids are the same (19.3 ~1.1 cc) for 4 units, there is a large difference for mean volumes of CTV (respectively 260, 98, 54 and 53 cc) receiving 66 to 70 Gy and PIV (respectively 708, 458, 203, 311, 410 cc) receiving 50 Gy. A best sparing of parotids has been obtained with the smaller target volume with a mean dose to ipsilateral parotid of 50 Gy for the 2 first therapy units and 30 for the 3 others. For contralateral parotid, mean doses are between 20 and 31 Gy. Considering nasopharynx or oropharynx alone, the same differences were observed. Conclusion: In head and neck, the definition of the target volume is not uniforme. The HDVs have not permitted to