- Email: [email protected]
Effects of Exercise on Bone Loss and Functional Capacity During Prostate Cancer Treatment
Proceedings of the 49th Annual ASTRO Meeting (p = 0.0045). Disease specific survival at 4 years was 98.5% vs. 82.5%. Post NAHD PSA nadir remained an independent statistically significant predictor of biochemical failure when examined using multivariate regression analysis (Figs. 1 and 2). Conclusions: Patients who have a PSA .1 ng/ml at the beginning of external beam radiotherapy following at least 2 months of neo-adjuvant LHRHa therapy, have a significantly higher rate of biochemical failure, and a lower survival rate compared to those who have PSA #1 ng/ml. Patients who fail to achieve adequate suppression should be considered as a higher risk group and considered for dose escalation or the use of novel treatments.
Author Disclosure: D.M. Mitchell, None; J. McAleese, None; R.M. Park, None; D.P. Stewart, None; S. Stranex, None; R. Eakin, None; R.F. Houston, None; J.M. O’Sullivan, None.
2214
Effects of Exercise on Bone Loss and Functional Capacity During Prostate Cancer Treatment
P. Chiplis, V. Mock, J. Wenzel, K. Stewart, K. Griffith, T. DeWeese Johns Hopkins University, Baltimore, MD Background: Men with localized prostate cancer (PC) frequently receive months of hormone ablation (HA+) therapy plus radiation therapy (RT). These patients experience significant bone loss; those receiving HA+ therapy experience even greater bone loss of 4–13% yearly which can affect functional status and symptoms. Despite strong evidence demonstrating exercise benefits during treatment for breast cancer, there has been little investigation of exercise to reduce losses in bone mineral density (BMD) and functional status among PC patients. Purpose/Objective(s): This RCCT was conducted to determine the effects of a nurse-led, home-based walking program in maintaining physical function and managing cancer- and treatment-related symptoms during RT for PC. Materials/Methods: Eighty men with AJCC Stage I-III PC scheduled for RT were randomized to usual care (UC) or exercise (EX) during treatment; of these, more than half (n = 37) received HA+ therapy. The EX intervention was a brisk, incremental 20–30
S321
I. J. Radiation Oncology d Biology d Physics
S322
Volume 69, Number 3, Supplement, 2007
minute walk, 5–6 times/week. Data were collected prior to and at the end of RT and included measures of physical function (treadmill tests), BMD (DEXA scans), HRQOL, physical activity, and symptom distress. Results: Sample age range was 41–80 (mean = 66) years; 27% were ethnic minorities. The majority were partnered, college-educated and had stage II cancer. Overall, general symptom distress was low; bowel problems were the most prevalent symptom. Of patients randomized to EX, 87% were able to adhere to the program, walking an average of 32 minutes/session 5 days/week. Peak VO2 increased in the EX group and decreased in the UC group (F = 3.84) (p = .05), consistent with increased measures of physical activity in EX and decreases in UC. A 2–3 month EX intervention during RT appeared to reduce/reverse the rate of bone loss associated with HA+ therapy as demonstrated by an increase in BMD (0.48%) in the HA+ EX group, and a decrease (2.26%) in the HA+ UC group (p = 0.047). These differences are clinically significant given normal yearly BMD losses of 0.05–1.0% for males, beginning in middle age. Further, T-scores comparing changes in bone mineral density over 2 months approached significance among those who completed a post-test DEXA scan (p = 0.067; n = 34) [Table 1]. Conclusions: A low-cost, moderate-intensity, nurse-led EX program improves functional capacity and may reduce or actually reverse bone loss associated with HA+ therapy during RT for PC. Findings will guide implementation of EX interventions for PC patients during RT. Further investigation should also be conducted on the effects of HA+ therapy on BMD, bone loss, and functional capacity among PC patients, particularly those receiving HA+ therapy, using larger samples over a longer period.
Author Disclosure: P. Chiplis, None; V. Mock, None; J. Wenzel, None; K. Stewart, None; K. Griffith, None; T. DeWeese, None.
2215
Seed Marker-Based IGRT for Prostate Cancer: Excellent Preliminary Toxicity Outcomes
T. J. Scarbrough1,2, J. Y. Ting1,2, L. Feja1,3, N. M. Golden1, C. A. Levitt1 1 3
MIMA Cancer Center, Melbourne, FL, 2Oregon Health & Science University, Dept. of Radiation Medicine, Portland, OR, Florida Institute of Technology, Melbourne, FL
Purpose/Objective(s): In 2004, we completed extensive seed marker-based image guided radiation therapy (IGRT) measurements to correct for the setup/targeting error inherent in external beam radiotherapy of the prostate (Scarbrough et al., IJROBP 2006;65:378–87). Our calculations indicated that seed marker-based IGRT could substantially shrink the necessary PTV margins (in the 3 mm range) versus what we or others had used previously. Validation of the calculations via post-repositioning analyses followed (Ting et al., Hematol Oncol Clin North Am, 2006;20:63–86). This is a preliminary report of our toxicity outcomes using IMRT and IGRT for prostate cancer. Materials/Methods: Only pts followed a minimum of 6 months post-treatment were included in this retrospective analysis; a continuous cohort of 231 pts meet this criteria and have a median followup of 1.4 years. The seed marker insertion and setup method is previously described (Scarbrough et al., IJROBP 2006;65:378–87). All pts received a minimum prostate dose of 81 Gy/45 fx. For pts receiving pelvic nodal plus seminal vesicle (21/231 pts) or seminal vesicle (151/231) elective irradiation, the combined CTV (elective structures plus prostate) was expanded 1.0 cm circumferentially/0.5 cm posteriorly to create PTV1. PTV1 received 45 Gy/ 25 fx. The prostate was expanded 4 mm circumferentially to create PTV2 which received 27 Gy/15 fx. The prostate was expanded 4 mm circumferentially/0 mm posteriorly to create PTV3 which received 9 Gy/5 fx. In low-risk pts, the prostate was expanded circumferentially by 4 mm to create PTV1 which received 72 Gy/40 fx, and by 4 mm/0 mm posteriorly to create PTV2 which received 9 Gy/5 fx. This yielded an ‘‘average rectal margin’’ of 3–4 mm for all plans. PTVs were normalized so $95% of the volume received 100% of the Rx dose (keeping the prostate minimum dose always 81 Gy); this yielded a mean dose maximum of 85.7 Gy for all pts. Most pts’ (75%) prostates were contoured using thin-slice (2.5 mm) MRI with marker-to-marker/MRI-to-CT fusion. All pts were treated using sliding-window IMRT (600 MU/min dose rate), 6MV energy, 7–11 discrete beams, and kV X-ray seed marker-based IGRT; 132/231 pts received anti-androgen therapy of 4–8 months duration. Toxicities were assessed in followup according to CTCAE v.3.0 for rectal morbidity and International Prostate Symptom Score (IPSS) for GU morbidity. Pts (220/ 231) also completed sexual satisfaction questionnaires in followup. Results: At a median followup of 1.4 years, 226/231 (97.8%) pts have grade 0 rectal toxicity, 3/231 have grade 1 (1.3%), and 2/231 have grade 2 (0.9%); there are no grade 3 or greater toxicities of any sort in any pts. Pre-treatment IPSS is 7/35 and post-treatment IPSS is 8/35. Of 220 pts completing sexual satisfaction questionnaires post-treatment, 105/220 were potent pre-treatment; 76/105 (72.3%) maintain sexual activity post-treatment. As the data matures, we will report oncologic outcomes at a later date. Conclusions: The precision of high-dose, tight margin IMRT–made possible via the accuracy offered by seed marker-based IGRT–results in excellent and very low treatment morbidity. If these outcomes hold over time and can be reproduced by others, IMRT+IGRT for prostate cancer will yield some of the lowest toxicity rates of any of the definitive local treatments for this disease. Author Disclosure: T.J. Scarbrough, Varian Medical Systems, D. Speakers Bureau/Honoraria; J.Y. Ting, Varian Medical Systems, D. Speakers Bureau/Honoraria; L. Feja, None; N.M. Golden, None; C.A. Levitt, None.
Author Disclosure: D.M. Mitchell, None; J. McAleese, None; R.M. Park, None; D.P. Stewart, None; S. Stranex, None; R. Eakin, None; R.F. Houston, None; J.M. O’Sullivan, None.
2214
Effects of Exercise on Bone Loss and Functional Capacity During Prostate Cancer Treatment
P. Chiplis, V. Mock, J. Wenzel, K. Stewart, K. Griffith, T. DeWeese Johns Hopkins University, Baltimore, MD Background: Men with localized prostate cancer (PC) frequently receive months of hormone ablation (HA+) therapy plus radiation therapy (RT). These patients experience significant bone loss; those receiving HA+ therapy experience even greater bone loss of 4–13% yearly which can affect functional status and symptoms. Despite strong evidence demonstrating exercise benefits during treatment for breast cancer, there has been little investigation of exercise to reduce losses in bone mineral density (BMD) and functional status among PC patients. Purpose/Objective(s): This RCCT was conducted to determine the effects of a nurse-led, home-based walking program in maintaining physical function and managing cancer- and treatment-related symptoms during RT for PC. Materials/Methods: Eighty men with AJCC Stage I-III PC scheduled for RT were randomized to usual care (UC) or exercise (EX) during treatment; of these, more than half (n = 37) received HA+ therapy. The EX intervention was a brisk, incremental 20–30
S321
I. J. Radiation Oncology d Biology d Physics
S322
Volume 69, Number 3, Supplement, 2007
minute walk, 5–6 times/week. Data were collected prior to and at the end of RT and included measures of physical function (treadmill tests), BMD (DEXA scans), HRQOL, physical activity, and symptom distress. Results: Sample age range was 41–80 (mean = 66) years; 27% were ethnic minorities. The majority were partnered, college-educated and had stage II cancer. Overall, general symptom distress was low; bowel problems were the most prevalent symptom. Of patients randomized to EX, 87% were able to adhere to the program, walking an average of 32 minutes/session 5 days/week. Peak VO2 increased in the EX group and decreased in the UC group (F = 3.84) (p = .05), consistent with increased measures of physical activity in EX and decreases in UC. A 2–3 month EX intervention during RT appeared to reduce/reverse the rate of bone loss associated with HA+ therapy as demonstrated by an increase in BMD (0.48%) in the HA+ EX group, and a decrease (2.26%) in the HA+ UC group (p = 0.047). These differences are clinically significant given normal yearly BMD losses of 0.05–1.0% for males, beginning in middle age. Further, T-scores comparing changes in bone mineral density over 2 months approached significance among those who completed a post-test DEXA scan (p = 0.067; n = 34) [Table 1]. Conclusions: A low-cost, moderate-intensity, nurse-led EX program improves functional capacity and may reduce or actually reverse bone loss associated with HA+ therapy during RT for PC. Findings will guide implementation of EX interventions for PC patients during RT. Further investigation should also be conducted on the effects of HA+ therapy on BMD, bone loss, and functional capacity among PC patients, particularly those receiving HA+ therapy, using larger samples over a longer period.
Author Disclosure: P. Chiplis, None; V. Mock, None; J. Wenzel, None; K. Stewart, None; K. Griffith, None; T. DeWeese, None.
2215
Seed Marker-Based IGRT for Prostate Cancer: Excellent Preliminary Toxicity Outcomes
T. J. Scarbrough1,2, J. Y. Ting1,2, L. Feja1,3, N. M. Golden1, C. A. Levitt1 1 3
MIMA Cancer Center, Melbourne, FL, 2Oregon Health & Science University, Dept. of Radiation Medicine, Portland, OR, Florida Institute of Technology, Melbourne, FL
Purpose/Objective(s): In 2004, we completed extensive seed marker-based image guided radiation therapy (IGRT) measurements to correct for the setup/targeting error inherent in external beam radiotherapy of the prostate (Scarbrough et al., IJROBP 2006;65:378–87). Our calculations indicated that seed marker-based IGRT could substantially shrink the necessary PTV margins (in the 3 mm range) versus what we or others had used previously. Validation of the calculations via post-repositioning analyses followed (Ting et al., Hematol Oncol Clin North Am, 2006;20:63–86). This is a preliminary report of our toxicity outcomes using IMRT and IGRT for prostate cancer. Materials/Methods: Only pts followed a minimum of 6 months post-treatment were included in this retrospective analysis; a continuous cohort of 231 pts meet this criteria and have a median followup of 1.4 years. The seed marker insertion and setup method is previously described (Scarbrough et al., IJROBP 2006;65:378–87). All pts received a minimum prostate dose of 81 Gy/45 fx. For pts receiving pelvic nodal plus seminal vesicle (21/231 pts) or seminal vesicle (151/231) elective irradiation, the combined CTV (elective structures plus prostate) was expanded 1.0 cm circumferentially/0.5 cm posteriorly to create PTV1. PTV1 received 45 Gy/ 25 fx. The prostate was expanded 4 mm circumferentially to create PTV2 which received 27 Gy/15 fx. The prostate was expanded 4 mm circumferentially/0 mm posteriorly to create PTV3 which received 9 Gy/5 fx. In low-risk pts, the prostate was expanded circumferentially by 4 mm to create PTV1 which received 72 Gy/40 fx, and by 4 mm/0 mm posteriorly to create PTV2 which received 9 Gy/5 fx. This yielded an ‘‘average rectal margin’’ of 3–4 mm for all plans. PTVs were normalized so $95% of the volume received 100% of the Rx dose (keeping the prostate minimum dose always 81 Gy); this yielded a mean dose maximum of 85.7 Gy for all pts. Most pts’ (75%) prostates were contoured using thin-slice (2.5 mm) MRI with marker-to-marker/MRI-to-CT fusion. All pts were treated using sliding-window IMRT (600 MU/min dose rate), 6MV energy, 7–11 discrete beams, and kV X-ray seed marker-based IGRT; 132/231 pts received anti-androgen therapy of 4–8 months duration. Toxicities were assessed in followup according to CTCAE v.3.0 for rectal morbidity and International Prostate Symptom Score (IPSS) for GU morbidity. Pts (220/ 231) also completed sexual satisfaction questionnaires in followup. Results: At a median followup of 1.4 years, 226/231 (97.8%) pts have grade 0 rectal toxicity, 3/231 have grade 1 (1.3%), and 2/231 have grade 2 (0.9%); there are no grade 3 or greater toxicities of any sort in any pts. Pre-treatment IPSS is 7/35 and post-treatment IPSS is 8/35. Of 220 pts completing sexual satisfaction questionnaires post-treatment, 105/220 were potent pre-treatment; 76/105 (72.3%) maintain sexual activity post-treatment. As the data matures, we will report oncologic outcomes at a later date. Conclusions: The precision of high-dose, tight margin IMRT–made possible via the accuracy offered by seed marker-based IGRT–results in excellent and very low treatment morbidity. If these outcomes hold over time and can be reproduced by others, IMRT+IGRT for prostate cancer will yield some of the lowest toxicity rates of any of the definitive local treatments for this disease. Author Disclosure: T.J. Scarbrough, Varian Medical Systems, D. Speakers Bureau/Honoraria; J.Y. Ting, Varian Medical Systems, D. Speakers Bureau/Honoraria; L. Feja, None; N.M. Golden, None; C.A. Levitt, None.