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Does Race Influence Quality of Life, Toxicity, or Early Relapse Following Proton Therapy in Men With Prostate Cancer?
S650
International Journal of Radiation Oncology Biology Physics
3148
dose was 14 Gy (range: 8-25) typically over 1 fraction (range: 1-10). At presentation, 10.1% were asymptomatic, 6.3% had neurological deficits, 72.2% had pain, and 11.4% had pain and neurological deficits. Following sSBRT, pain control was seen in 81% and 78.5% had radiographic control at last follow-up. Median time to pain relief was 0.7 months (range: 0-3.9). RPA Class, histology, presence of paraspinal disease, multilevel disease, presence of epidural disease, and neural foramina involvement did not predict for radiographic control or pain progression. None of the dosimetric factors predicted for radiographic control or pain progression as well. None of the patients in this series developed myelopathy. New vertebral body fracture developed in 8.9% of treatments. Conclusions: sSBRT for progression post cEBRT is effective and safe. Pain relief is quick following sSBRT. Our current standard dose is 16 Gy in 1 fraction. These results are consistent with our data for patients treated upfront for spine metastases. Previous cEBRT does not appear to compromise the effectiveness of sSBRT. Author Disclosure: S. Soeder: None. E.H. Balagamwala: None. J.H. Suh: G. Consultant; Abbott Oncology. C.A. Reddy: None. L. Angelov: F. Honoraria; BrainLab. T. Djemil: None. A. Magnelli: None. S.T. Chao: None.
Determinants of Quality of Life and Depression in Patients Undergoing External Beam Radiation R. Koul,1,2 E. Karreman,3,4 R. Tse,5 A. Dubey,1 and M. Behl1; 1Allan Blair Cancer Center, SCA, Regina, SK, Canada, 2SCA, Regina, SK, Canada, 3 RQHR, Regina, SK, Canada, 4Regina Quappelle Health Region, Regina, SK, Canada, 5University of Saskatchewan, Regina, SK, Canada Purpose/Objective(s): Assessment of quality of life (QOL) and depression in cancer research provides a good evaluation of the well-being of the patients. QOL diminishes very quickly when patients have cancer however, not much is known about external factors that influence their well-being. Therefore, the objective of this study is to measure the importance of some of these factors on QOL and depression while patients are on external radiation. Materials/Methods: A total of 148 participants (78 females, 63 males, 7 not reported) with cancer undergoing external beam radiation (Mean age Z 64.8 12.0) completed a survey pertaining to QOL and depression. QOL was measured using the Functional Assessment of Cancer Therapygeneral (FACT-G; version 3) and consisted of four subscales. Depression was measured using the Zung Self-Rating Depression Scale. Five predictor variables were included: week of radiation, history of cancer, and the current use of chemotherapy, hormones, and narcotics. Five (hierarchical) regressions were used to analyze the data. Results: Initial regressions showed that participants’ age was a significant predictor of the QOL subscale physical well-being and was included in subsequent analysis as a confounding variable. Sex was not found to be a significant predictor. All overall regression equations were significant (p < .05), except for QOL - Social/family well-being. F values ranged from 1.1 to 8.3. Whether participants received chemotherapy or narcotics were the most important predictors of QOL (negative relationships). Both predictors were significant for at least half of the QOL measures with all significant standardized betas indicating a large effect (>.25). Also, chemotherapy and narcotics were the only significant predictors of depression (positive relationship) and both effects were considered large. Whether participants have experienced cancer in the past and the week of radiation they were in both had a significant positive relationship with QOL - Emotional well-being. None of the other regressions with these two predictors was significant. Conclusions: This study examined and identified some external factors that showed to significantly impact the four measured aspects of QOL and depression. The results provide an in depth look at these important issues regarding the well-being of the patient. Author Disclosure: R. Koul: None. E. Karreman: None. R. Tse: None. A. Dubey: None. M. Behl: None.
3149 Outcomes of Spine Stereotactic Body Radiation Therapy in Patients Previously Treated With Conventional Radiation S. Soeder, E.H. Balagamwala, J.H. Suh, C.A. Reddy, L. Angelov, T. Djemil, A. Magnelli, and S.T. Chao; Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Spine stereotactic body radiation therapy (sSBRT) is used to treat relapse following conventional radiation (cEBRT). This study seeks to determine the risk factors for local relapse both radiographically and in regards to pain. Materials/Methods: Patients who underwent sSBRT following cEBRT were included in an IRB-approved database. RPA Class, histology, presence of paraspinal disease, multilevel disease (more than 1 spinal level involved), presence of epidural disease, neural foramina involvement, and dosimetric factors (volume, prescription dose, % coverage by the prescription dose, maximum dose, minimum dose) were retrospectively collected. These factors were correlated to radiographic control and pain progression as determined by the Brief Pain Inventory. Results: A total of 79 procedures were performed in 65 patients. Median age was 60 years (range: 27-90). Median follow-up was 8.5 months (range: 0-57.7) and median overall survival was 10.5 months. Median prescription
3150 Does Race Influence Quality of Life, Toxicity, or Early Relapse Following Proton Therapy in Men With Prostate Cancer? C.M. Bryant,1 B. Hoppe,1 R.C. Nichols,1 R. Henderson,1 W.M. Mendenhall,1 C. Morris,1 C. Williams,2 Z. Su,1 Z. Li,1 and N.P. Mendenhall1; 1University of Florida Proton Therapy Institute, Jacksonville, FL, 2University of Florida, Jacksonville, FL Purpose/Objective(s): This retrospective matched-paired analysis explores disparities in pretreatment prognostic factors, short-term biochemical relapse-free survival, common toxicities, and quality of life between African American and white patients following proton therapy. Materials/Methods: A total of 1,536 men with clinically localized prostate cancer were treated between 2006 and 2009 with definitive proton therapy to a median dose of 78 Gy +/- androgen deprivation. A cohort of 92 men who self-reported their race as African American were matched to a cohort of 92 white men based on NCCN risk category and age. The 2 groups were compared in regards to comorbidities, demographics, and treatment regimen. They were also compared based on genitourinary and gastrointestinal toxicity according to the CTCAE scale and Expanded Prostate Index Composite questionnaire (EPIC) quality of life data. Early biochemical relapse-free survival was also reported for the 2 groups. Results: Median follow-up was 2.1 years. On matched-pair analysis, African Americans had a higher rate of PSA 10 (32% vs. 19%) compared to white patients. African Americans consequently had higher rates of androgen deprivation therapy than whites. African Americans had higher rates of diabetes mellitus (27% vs. 10%, pZ0.0079) compared to whites. Compared to whites, African Americans had a higher absolute risk of grade 3 genitourinary toxicity (5.4% vs. 0%, pZ0.03), which included urinary obstruction, hematuria, and radiation cystitis. Grade 2 gastrointestinal toxicity occurred less often among African American patients than white patients (23% vs. 29%), but the difference was not statistically significant (pZ0.45). Only 2% of African Americans required cautery for rectal bleeding compared to 4.3% of whites. No difference in EPIC-26 sexual summary score, urinary incontinence score, urinary obstruction score, or bowel summary score was detected between the 2 groups. Biochemical relapse-free survival was 98% for African Americans and 96% for the matched white patients at 2 years (pZ0.9062). Conclusions: After 2 years, there were no disparities in patient-reported quality of life or physician-reported CTCAE gastrointestinal toxicity. African Americans were more likely to develop grade 3 genitourinary toxicity than whites, but longer follow-up is needed. No difference in biochemical relapse with 2-year follow up was detected in the matched-cohort analysis. Author Disclosure: C.M. Bryant: None. B. Hoppe: None. R.C. Nichols: None. R. Henderson: None. W.M. Mendenhall: None. C. Morris: None. C. Williams: None. Z. Su: None. Z. Li: None. N.P. Mendenhall: None.
International Journal of Radiation Oncology Biology Physics
3148
dose was 14 Gy (range: 8-25) typically over 1 fraction (range: 1-10). At presentation, 10.1% were asymptomatic, 6.3% had neurological deficits, 72.2% had pain, and 11.4% had pain and neurological deficits. Following sSBRT, pain control was seen in 81% and 78.5% had radiographic control at last follow-up. Median time to pain relief was 0.7 months (range: 0-3.9). RPA Class, histology, presence of paraspinal disease, multilevel disease, presence of epidural disease, and neural foramina involvement did not predict for radiographic control or pain progression. None of the dosimetric factors predicted for radiographic control or pain progression as well. None of the patients in this series developed myelopathy. New vertebral body fracture developed in 8.9% of treatments. Conclusions: sSBRT for progression post cEBRT is effective and safe. Pain relief is quick following sSBRT. Our current standard dose is 16 Gy in 1 fraction. These results are consistent with our data for patients treated upfront for spine metastases. Previous cEBRT does not appear to compromise the effectiveness of sSBRT. Author Disclosure: S. Soeder: None. E.H. Balagamwala: None. J.H. Suh: G. Consultant; Abbott Oncology. C.A. Reddy: None. L. Angelov: F. Honoraria; BrainLab. T. Djemil: None. A. Magnelli: None. S.T. Chao: None.
Determinants of Quality of Life and Depression in Patients Undergoing External Beam Radiation R. Koul,1,2 E. Karreman,3,4 R. Tse,5 A. Dubey,1 and M. Behl1; 1Allan Blair Cancer Center, SCA, Regina, SK, Canada, 2SCA, Regina, SK, Canada, 3 RQHR, Regina, SK, Canada, 4Regina Quappelle Health Region, Regina, SK, Canada, 5University of Saskatchewan, Regina, SK, Canada Purpose/Objective(s): Assessment of quality of life (QOL) and depression in cancer research provides a good evaluation of the well-being of the patients. QOL diminishes very quickly when patients have cancer however, not much is known about external factors that influence their well-being. Therefore, the objective of this study is to measure the importance of some of these factors on QOL and depression while patients are on external radiation. Materials/Methods: A total of 148 participants (78 females, 63 males, 7 not reported) with cancer undergoing external beam radiation (Mean age Z 64.8 12.0) completed a survey pertaining to QOL and depression. QOL was measured using the Functional Assessment of Cancer Therapygeneral (FACT-G; version 3) and consisted of four subscales. Depression was measured using the Zung Self-Rating Depression Scale. Five predictor variables were included: week of radiation, history of cancer, and the current use of chemotherapy, hormones, and narcotics. Five (hierarchical) regressions were used to analyze the data. Results: Initial regressions showed that participants’ age was a significant predictor of the QOL subscale physical well-being and was included in subsequent analysis as a confounding variable. Sex was not found to be a significant predictor. All overall regression equations were significant (p < .05), except for QOL - Social/family well-being. F values ranged from 1.1 to 8.3. Whether participants received chemotherapy or narcotics were the most important predictors of QOL (negative relationships). Both predictors were significant for at least half of the QOL measures with all significant standardized betas indicating a large effect (>.25). Also, chemotherapy and narcotics were the only significant predictors of depression (positive relationship) and both effects were considered large. Whether participants have experienced cancer in the past and the week of radiation they were in both had a significant positive relationship with QOL - Emotional well-being. None of the other regressions with these two predictors was significant. Conclusions: This study examined and identified some external factors that showed to significantly impact the four measured aspects of QOL and depression. The results provide an in depth look at these important issues regarding the well-being of the patient. Author Disclosure: R. Koul: None. E. Karreman: None. R. Tse: None. A. Dubey: None. M. Behl: None.
3149 Outcomes of Spine Stereotactic Body Radiation Therapy in Patients Previously Treated With Conventional Radiation S. Soeder, E.H. Balagamwala, J.H. Suh, C.A. Reddy, L. Angelov, T. Djemil, A. Magnelli, and S.T. Chao; Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Spine stereotactic body radiation therapy (sSBRT) is used to treat relapse following conventional radiation (cEBRT). This study seeks to determine the risk factors for local relapse both radiographically and in regards to pain. Materials/Methods: Patients who underwent sSBRT following cEBRT were included in an IRB-approved database. RPA Class, histology, presence of paraspinal disease, multilevel disease (more than 1 spinal level involved), presence of epidural disease, neural foramina involvement, and dosimetric factors (volume, prescription dose, % coverage by the prescription dose, maximum dose, minimum dose) were retrospectively collected. These factors were correlated to radiographic control and pain progression as determined by the Brief Pain Inventory. Results: A total of 79 procedures were performed in 65 patients. Median age was 60 years (range: 27-90). Median follow-up was 8.5 months (range: 0-57.7) and median overall survival was 10.5 months. Median prescription
3150 Does Race Influence Quality of Life, Toxicity, or Early Relapse Following Proton Therapy in Men With Prostate Cancer? C.M. Bryant,1 B. Hoppe,1 R.C. Nichols,1 R. Henderson,1 W.M. Mendenhall,1 C. Morris,1 C. Williams,2 Z. Su,1 Z. Li,1 and N.P. Mendenhall1; 1University of Florida Proton Therapy Institute, Jacksonville, FL, 2University of Florida, Jacksonville, FL Purpose/Objective(s): This retrospective matched-paired analysis explores disparities in pretreatment prognostic factors, short-term biochemical relapse-free survival, common toxicities, and quality of life between African American and white patients following proton therapy. Materials/Methods: A total of 1,536 men with clinically localized prostate cancer were treated between 2006 and 2009 with definitive proton therapy to a median dose of 78 Gy +/- androgen deprivation. A cohort of 92 men who self-reported their race as African American were matched to a cohort of 92 white men based on NCCN risk category and age. The 2 groups were compared in regards to comorbidities, demographics, and treatment regimen. They were also compared based on genitourinary and gastrointestinal toxicity according to the CTCAE scale and Expanded Prostate Index Composite questionnaire (EPIC) quality of life data. Early biochemical relapse-free survival was also reported for the 2 groups. Results: Median follow-up was 2.1 years. On matched-pair analysis, African Americans had a higher rate of PSA 10 (32% vs. 19%) compared to white patients. African Americans consequently had higher rates of androgen deprivation therapy than whites. African Americans had higher rates of diabetes mellitus (27% vs. 10%, pZ0.0079) compared to whites. Compared to whites, African Americans had a higher absolute risk of grade 3 genitourinary toxicity (5.4% vs. 0%, pZ0.03), which included urinary obstruction, hematuria, and radiation cystitis. Grade 2 gastrointestinal toxicity occurred less often among African American patients than white patients (23% vs. 29%), but the difference was not statistically significant (pZ0.45). Only 2% of African Americans required cautery for rectal bleeding compared to 4.3% of whites. No difference in EPIC-26 sexual summary score, urinary incontinence score, urinary obstruction score, or bowel summary score was detected between the 2 groups. Biochemical relapse-free survival was 98% for African Americans and 96% for the matched white patients at 2 years (pZ0.9062). Conclusions: After 2 years, there were no disparities in patient-reported quality of life or physician-reported CTCAE gastrointestinal toxicity. African Americans were more likely to develop grade 3 genitourinary toxicity than whites, but longer follow-up is needed. No difference in biochemical relapse with 2-year follow up was detected in the matched-cohort analysis. Author Disclosure: C.M. Bryant: None. B. Hoppe: None. R.C. Nichols: None. R. Henderson: None. W.M. Mendenhall: None. C. Morris: None. C. Williams: None. Z. Su: None. Z. Li: None. N.P. Mendenhall: None.