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Complications and late toxicity following definitive permanent prostate brachytherapy
P r o c e e d i n g s of the 40th A n n u a l A S T R O M e e t i n g
309
2163 COMPLICATIONS AND LATE TOXICITY FOLLOWING DEFINITIVE PERMANENT PROSTATE BRACHYTHERAPY
David C. Beyer, M.D. Arizona Oncology Services Foundation for Cancer Research and Education
Purpose/Objective: With the growing popularity of prostate brachytherapy it is increasingly important to have careful documentation of the risk of chronic complications in a cohort of patients with long-term follow-up. Materials & Methods: From 1988 through 1996 734 patients were treated with permanent prostate brachytherapy for stage T1 or T2 adenocarcinoma of the prostate. Twenty-eight patients with less than 12 months follow-up were excluded from analysis. Symptoms and complications were prospectively collected and retrospectively graded according to RTOG complication scales, modified as necessary to address prostate specific issues. The significance and timing or prior transurethral resection of the prostate (TLrRP), hormonal intervention, and choice of isotope were analyzed and compared. All long-term complications are presented as Kaplan Meier actuarial risks. Results: The 706 evaluable patients had a median follow-up of 47 months. Ninety-three complications were identified in 81 patients. Urinary symptoms were most common. Acute post implant difficulties with frequency, urgency, hesitancy, and dysuria were common within the first few months and were not scored as complications unless persistent or severe enough to impact on quality of life. Forty-three patients experienced grade 2 or 3 "prostatitis" for a risk of 7%. No differences were seen between patients with a prior TURP and those without. Similarly no differences were identified based on cl;oiee of isotope (125Ior ~°3pd) or prior androgen ablation. Transient catheterization was required in 12 patients (generally within the first month) for a period of more than four weeks in two. Subsequent procedures (TURP, urethral dilatation) were required in 17 with a 2% risk of stricture. Some degree of incontinence was reported in 6% of patients. Proctitis developed in 3% after a median interval of twenty months versus seven months for prostatitis. Other sporadic complications including urinary tract infection, hematuria, anal incontinence, and nonspecific upper GI symptoms were recorded. Of 268 patients claiming normal potency prior to treatment 135 retain normal sexual function while 209 retain any erectile function. Conclusion: Follow-up in a substantial group of similarly treated patients confirms that prostate brachytherapy remains well tolerated. Urinary complications predominate, with bowel symptoms less common. Significant f,.aow-up is required as many of the complications develop two years after brachytherapy. The actuarial risk shows complications occur in fewer than 5% of patients.
2164 MINIMAL TOXICITY WITH 3-FAT RADIOTHERAPY OF PROSTATE CANCER Michael D Weil MD 1, E David Crawford MD 2, Wayne Dzingle RTT l, Patricia Cornish RTT l, Donald Parnell RTT 1, Francis Newman MS 1, L Michael Glode MD 3, Gary Miller MD, Ph D 4, Robert Donahue MD 2, Barby Pickett5, and Mack Roach III MD 5. 1Department of Radiation Oncology, 2Division of Urology, 3Divison of Medical Oncology, 4 Department of Radiation Oncology and Division of Urology, 5Department of Radiation Oncology, University of California, San Francisco Purpose/Objective: We have previously reported an optimization of external beam radiotherapy for treating the malignant prostate, 3-FAT. Based on 3 D conformal comparisons using dose-volume histograms, 3-FAT had the best profile of dose to the surrounding normal structures of any external beam technique. Materials & Methods: We report the toxicity of the first 100 patients with carcinoma of the prostate treated with 3-FAT. Patients were treated at 200 cGy per day to a minimum tumor dose of 7400 cGy, Dmax doses approached 8000 cGy. Results: We detected no gastrointestinal toxicity or decreased potency related to irradiation (Grade 0). One-third oftbe patients experienced minimal urinary frequency and dysuria (Grade l) as some point during treatment. There were no patients with urinary complaints following radiotherapy (Grade0). Less than l0 percent of the patients reported mild fatigue during treatment that resolved immediately following the irradiation. Many patients were on concurrent hormonal blockade and reported hot flashes and loose stools (the latter ended with cessation of Eulexin). Median follow-up is at 16 months, and presently all PSA levels are undetectable or declining except for l post-operative patient whose PSA was >10 at the start of radiotherapy. Conclusion: 3-FAT appears to have minimal side-effects, and therefore allows for treatment at higher daily doses and overall dose without complications thus far. Patients daily activities are essentially unchanged during the therapy.
309
2163 COMPLICATIONS AND LATE TOXICITY FOLLOWING DEFINITIVE PERMANENT PROSTATE BRACHYTHERAPY
David C. Beyer, M.D. Arizona Oncology Services Foundation for Cancer Research and Education
Purpose/Objective: With the growing popularity of prostate brachytherapy it is increasingly important to have careful documentation of the risk of chronic complications in a cohort of patients with long-term follow-up. Materials & Methods: From 1988 through 1996 734 patients were treated with permanent prostate brachytherapy for stage T1 or T2 adenocarcinoma of the prostate. Twenty-eight patients with less than 12 months follow-up were excluded from analysis. Symptoms and complications were prospectively collected and retrospectively graded according to RTOG complication scales, modified as necessary to address prostate specific issues. The significance and timing or prior transurethral resection of the prostate (TLrRP), hormonal intervention, and choice of isotope were analyzed and compared. All long-term complications are presented as Kaplan Meier actuarial risks. Results: The 706 evaluable patients had a median follow-up of 47 months. Ninety-three complications were identified in 81 patients. Urinary symptoms were most common. Acute post implant difficulties with frequency, urgency, hesitancy, and dysuria were common within the first few months and were not scored as complications unless persistent or severe enough to impact on quality of life. Forty-three patients experienced grade 2 or 3 "prostatitis" for a risk of 7%. No differences were seen between patients with a prior TURP and those without. Similarly no differences were identified based on cl;oiee of isotope (125Ior ~°3pd) or prior androgen ablation. Transient catheterization was required in 12 patients (generally within the first month) for a period of more than four weeks in two. Subsequent procedures (TURP, urethral dilatation) were required in 17 with a 2% risk of stricture. Some degree of incontinence was reported in 6% of patients. Proctitis developed in 3% after a median interval of twenty months versus seven months for prostatitis. Other sporadic complications including urinary tract infection, hematuria, anal incontinence, and nonspecific upper GI symptoms were recorded. Of 268 patients claiming normal potency prior to treatment 135 retain normal sexual function while 209 retain any erectile function. Conclusion: Follow-up in a substantial group of similarly treated patients confirms that prostate brachytherapy remains well tolerated. Urinary complications predominate, with bowel symptoms less common. Significant f,.aow-up is required as many of the complications develop two years after brachytherapy. The actuarial risk shows complications occur in fewer than 5% of patients.
2164 MINIMAL TOXICITY WITH 3-FAT RADIOTHERAPY OF PROSTATE CANCER Michael D Weil MD 1, E David Crawford MD 2, Wayne Dzingle RTT l, Patricia Cornish RTT l, Donald Parnell RTT 1, Francis Newman MS 1, L Michael Glode MD 3, Gary Miller MD, Ph D 4, Robert Donahue MD 2, Barby Pickett5, and Mack Roach III MD 5. 1Department of Radiation Oncology, 2Division of Urology, 3Divison of Medical Oncology, 4 Department of Radiation Oncology and Division of Urology, 5Department of Radiation Oncology, University of California, San Francisco Purpose/Objective: We have previously reported an optimization of external beam radiotherapy for treating the malignant prostate, 3-FAT. Based on 3 D conformal comparisons using dose-volume histograms, 3-FAT had the best profile of dose to the surrounding normal structures of any external beam technique. Materials & Methods: We report the toxicity of the first 100 patients with carcinoma of the prostate treated with 3-FAT. Patients were treated at 200 cGy per day to a minimum tumor dose of 7400 cGy, Dmax doses approached 8000 cGy. Results: We detected no gastrointestinal toxicity or decreased potency related to irradiation (Grade 0). One-third oftbe patients experienced minimal urinary frequency and dysuria (Grade l) as some point during treatment. There were no patients with urinary complaints following radiotherapy (Grade0). Less than l0 percent of the patients reported mild fatigue during treatment that resolved immediately following the irradiation. Many patients were on concurrent hormonal blockade and reported hot flashes and loose stools (the latter ended with cessation of Eulexin). Median follow-up is at 16 months, and presently all PSA levels are undetectable or declining except for l post-operative patient whose PSA was >10 at the start of radiotherapy. Conclusion: 3-FAT appears to have minimal side-effects, and therefore allows for treatment at higher daily doses and overall dose without complications thus far. Patients daily activities are essentially unchanged during the therapy.