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EP-1131 INCIDENCE OF ACUTE URINARY TOXICITY IN PATIENTS TREATED WITH PELVIC EXTERNAL RADIOTHERAPY
S436
After 54 months, there was a statistically significant worsening of QoL with regards to 11 items among the 19 studied. However, the scores were clinically relevant (decrease > 10 points) only for physical functioning, role functioning, social functioning, fatigue, pain, dyspnea and constipation. No statistical differences were shown between 54 months and baseline for general health, bowel symptom, treatment related symptoms and sexual activity. Concerning urinary symptoms, there was a statistically significant deterioration but not clinically relevant (difference < 10 points). Conclusions: High-dose IMRT to the prostate with accurate positioning does not induce any clinically relevant deterioration in long-term urinary and gastrointestinal QoL. Deterioration in functioning items may also be related to age and comorbidities. To our knowledge, our study is the only prospective study regarding quality of life following prostate IMRT with a very long follow-up of 54 months. EP-1130 MR GUIDED CRYOABLATION OF RECURRENT PROSTATE CANCER AFTER RADIOTHERAPY; A FEASIBILITY STUDY J. Futterer1, J.G.R. Bomers1, M. Sedelaar2, E. van Lin3, F. de Lange1, D. Yakar1 1 Radboud University Nijmegen Medical Centre, Dept. of Radiology, Nijmegen, The Netherlands 2 Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, The Netherlands 3 Radboud University Nijmegen Medical Centre, Dept. of Radiotherapy, Nijmegen, The Netherlands Purpose/Objective: Cryosurgery of prostate cancer (PCa) under ultrasound (US) guidance has been performed for several years for primary treatment as well as salvage treatment purposes. However, high complication rates (incontinence 4.3 – 39.6%, erectile dysfunction 57 – 77.8%, rectal fistula rate 0 – 3.4% are a familiar disadvantage. Magnetic resonance (MR) imaging guided cryosurgery of the prostate may reduce these high complication rates. The purpose of this study is to evaluate therapy success, complications and technical feasibility and safety of MR-guided focal cryoablation of recurrent prostate cancer. Materials and Methods: Eight patients with local recurrence of PCa without evidence for distant metastases were treated under general anesthesia in a closed-bore 1.5T MR system (MAGNETOM Avanto, Siemens, Erlangen, Germany). An urethral-warmer was inserted in the urethra. A transperineal plate, attached to a flexible arm was placed against the perineum. Cryoneedles (IceSeed or IceRod, Galil Medical, Yokneam, Israel) were inserted with real-time MR imaging in at least two directions. A rectal warmer was inserted in the rectum. Both warmers were constantly flushed with warm water to protect the urethra and the rectum from freezing. Iceball growth and -shaping was performed by adjusting the freezing capacity of the individual cryoneedles under real-time MR imaging using T1-weighted VIBE imaging. Two freeze- and thaw cycles were performed. Follow-up consisted of PSA-level measurement every three months and a multiparametric prostate MR examination after 3, 6 and 12 months. Results: Eight patients with recurrent PCa were successfully treated with MR-guided focal cryoablation. In all patients the hyper intense ice ball rim was clearly visible and iceball growth and thus critical temperature zone were carefully monitored. Median number of cryoneedles used was 3 (range 2 – 4). In one patient the procedure was cancelled due to inability of insertion of the urethral warmer. In a second attempt, two months later the patient was successfully treated. Another patient had urine retention and was observed for 2 nights. All other patients went home one day after the procedure. No other complications were recorded. After three months, follow-up is known for the first four patients. In three of them, PSA level decreased severely and their multi-parametric MRI showed no presence of recurrent tumor. One patient had a local recurrence just above the previously treated area. He will be treated again with MR guided cryo. Conclusions: Transperineal focal MR-guided cryoablation of recurrent PCa after external beam radiation therapy was technically feasible and safe. No major complications were recorded. After 3 months PSA level decreased and follow-up MRI showed no cancer. One patient had a local recurrence. Initial results are promising and more patients have to be included.
ESTRO 31
EP-1131 INCIDENCE OF ACUTE URINARY TOXICITY IN PATIENTS TREATED WITH PELVIC EXTERNAL RADIOTHERAPY J. Park1, Y. Kim1, J.H. Kim1, E.K. Choi1, J. Park1, S. Lee1, S.D. Ahn1 1 Asan Medical Center Univ of Ulsan, Radiation Oncology Department, Seoul, Korea Republic of Purpose/Objective: We performed prospective study to evaluate the incidence of lower urinary tract symptoms (LUTS) associated with pelvic radiation therapy (RT) using validated instruments and to analyze dose-volume relationship with LUTS. Materials and Methods: This study enrolled patients with pelvic malignancy who received pelvic RT with curative intent. LUTS was weekly evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Common Terminology Criteria for Adverse Events (CTCAE). We analyzed CT based dosimetry for bladder to find correlation between dose-volume histogram (DVH) and the incidence of LUTS. Results: A total of 92 patients were included in present study. Among 92 patients, 27 patients (29%) showed CTCAE grade 2 or higher toxicity. For these patients, a total sum of score was 9 (inter-quartile range, 7-13) in IPSS and 4 (inter-quartile range, 3-7) in OABSS. Irrespective of CTCAE grade, IPSS showed significantly higher proportion of patient with moderate to severe symptom than OABSS (p = 0.028 in grade 2≥, p = 0.003 in grade 0-1). The patients with CTCAE grade 2 or higher showed significantly higher prevalence of moderate to severe symptom in IPSS (70% vs. 46%, p = 0.034), but not in OABSS (41% vs. 22%, p = 0.059). In receiver operating characteristic curve (AUC) analysis, the largest AUC was observed in V20 in both of bladder wall and bladder as a solid organ. Conclusions: The current trial showed that acute genitourinary toxicities during RT for non-genitourinary tract are considerable and should be actively managed. IPSS and OABSS could be more reliable than the physician-reported instruments and IPSS could be more sensitive than other instruments to discriminate moderate to severe LUTS among the patient receiving RT. Dose-volume relationships, especially in bladder wall V20 and bladder as a solid organ V20, were significant predicting factors for moderate to severe acute genitourinary toxicities. EP-1132 SALVAGE STEREOTACTIC BODY RADIOTHERAPY FOR PATIENTS WITH LIMITED PROSTATE CANCER METASTASES G. De Meerleer1, P. Berkovic1, L. Delrue2, B. Lambert3, N. Lumen4, V. Fonteyne1, G. Villeirs5, P. Ost1 1 Universitair Ziekenhuis Gent, Radiation oncology, Gent, Belgium 2 Universitair Ziekenhuis, Radiology, Gent, Belgium 3 Universitair Ziekenhuis Gent, Nuclear Medicine, Gent, Belgium 4 Universitair Ziekenhuis Gent, Urology, Gent, Belgium 5 Universitair Ziekenhuis Gent, Radiology, Gent, Belgium Purpose/Objective: The management of patients with asymptomatic limited metastatic prostate cancer (PCa) remains controversial. To investigate whether repeated Stereotactic body radiotherapy (SBRT) of oligometastatic disease is able to defer the initiation of androgen deprivation therapy (ADT). Materials and Methods: Patients diagnosed with up to 3 metastases (bone and/or lymph nodes) on positron emitting tomography, following biochemical recurrence after curative treatment and exclusion of local recurrence, were analyzed. Patients underwent a salvage hypofractionated linac based SBRT combined with a single injection of a short acting luteinizing hormone releasing hormone (LHRH). Androgen deprivation therapy-free survival (ADT-FS), defined as the time interval between the first day of SBRT and the initiation of ADT, was estimated by the Kaplan-Meier method. Univariate (Logrank) analysis was used examining tumour-related variables. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic or in case of a PSA rise above 50ng/ml in the absence of metastases. Toxicity was scored using the Common Terminology Criteria for Adverse Events. Results: We included 24 patients with a median follow-up of 24 months. Ten patients started with ADT resulting in a median ADT-FS of 38 months. On univariate analysis, a high Gleason score at initial diagnosis was a significant predictor for an earlier start of ADT (p= 0.048). 11 and 3 patients respectively required a second and third salvage treatment for metachronous oligometastases. No grade 3 toxicity was observed.
After 54 months, there was a statistically significant worsening of QoL with regards to 11 items among the 19 studied. However, the scores were clinically relevant (decrease > 10 points) only for physical functioning, role functioning, social functioning, fatigue, pain, dyspnea and constipation. No statistical differences were shown between 54 months and baseline for general health, bowel symptom, treatment related symptoms and sexual activity. Concerning urinary symptoms, there was a statistically significant deterioration but not clinically relevant (difference < 10 points). Conclusions: High-dose IMRT to the prostate with accurate positioning does not induce any clinically relevant deterioration in long-term urinary and gastrointestinal QoL. Deterioration in functioning items may also be related to age and comorbidities. To our knowledge, our study is the only prospective study regarding quality of life following prostate IMRT with a very long follow-up of 54 months. EP-1130 MR GUIDED CRYOABLATION OF RECURRENT PROSTATE CANCER AFTER RADIOTHERAPY; A FEASIBILITY STUDY J. Futterer1, J.G.R. Bomers1, M. Sedelaar2, E. van Lin3, F. de Lange1, D. Yakar1 1 Radboud University Nijmegen Medical Centre, Dept. of Radiology, Nijmegen, The Netherlands 2 Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, The Netherlands 3 Radboud University Nijmegen Medical Centre, Dept. of Radiotherapy, Nijmegen, The Netherlands Purpose/Objective: Cryosurgery of prostate cancer (PCa) under ultrasound (US) guidance has been performed for several years for primary treatment as well as salvage treatment purposes. However, high complication rates (incontinence 4.3 – 39.6%, erectile dysfunction 57 – 77.8%, rectal fistula rate 0 – 3.4% are a familiar disadvantage. Magnetic resonance (MR) imaging guided cryosurgery of the prostate may reduce these high complication rates. The purpose of this study is to evaluate therapy success, complications and technical feasibility and safety of MR-guided focal cryoablation of recurrent prostate cancer. Materials and Methods: Eight patients with local recurrence of PCa without evidence for distant metastases were treated under general anesthesia in a closed-bore 1.5T MR system (MAGNETOM Avanto, Siemens, Erlangen, Germany). An urethral-warmer was inserted in the urethra. A transperineal plate, attached to a flexible arm was placed against the perineum. Cryoneedles (IceSeed or IceRod, Galil Medical, Yokneam, Israel) were inserted with real-time MR imaging in at least two directions. A rectal warmer was inserted in the rectum. Both warmers were constantly flushed with warm water to protect the urethra and the rectum from freezing. Iceball growth and -shaping was performed by adjusting the freezing capacity of the individual cryoneedles under real-time MR imaging using T1-weighted VIBE imaging. Two freeze- and thaw cycles were performed. Follow-up consisted of PSA-level measurement every three months and a multiparametric prostate MR examination after 3, 6 and 12 months. Results: Eight patients with recurrent PCa were successfully treated with MR-guided focal cryoablation. In all patients the hyper intense ice ball rim was clearly visible and iceball growth and thus critical temperature zone were carefully monitored. Median number of cryoneedles used was 3 (range 2 – 4). In one patient the procedure was cancelled due to inability of insertion of the urethral warmer. In a second attempt, two months later the patient was successfully treated. Another patient had urine retention and was observed for 2 nights. All other patients went home one day after the procedure. No other complications were recorded. After three months, follow-up is known for the first four patients. In three of them, PSA level decreased severely and their multi-parametric MRI showed no presence of recurrent tumor. One patient had a local recurrence just above the previously treated area. He will be treated again with MR guided cryo. Conclusions: Transperineal focal MR-guided cryoablation of recurrent PCa after external beam radiation therapy was technically feasible and safe. No major complications were recorded. After 3 months PSA level decreased and follow-up MRI showed no cancer. One patient had a local recurrence. Initial results are promising and more patients have to be included.
ESTRO 31
EP-1131 INCIDENCE OF ACUTE URINARY TOXICITY IN PATIENTS TREATED WITH PELVIC EXTERNAL RADIOTHERAPY J. Park1, Y. Kim1, J.H. Kim1, E.K. Choi1, J. Park1, S. Lee1, S.D. Ahn1 1 Asan Medical Center Univ of Ulsan, Radiation Oncology Department, Seoul, Korea Republic of Purpose/Objective: We performed prospective study to evaluate the incidence of lower urinary tract symptoms (LUTS) associated with pelvic radiation therapy (RT) using validated instruments and to analyze dose-volume relationship with LUTS. Materials and Methods: This study enrolled patients with pelvic malignancy who received pelvic RT with curative intent. LUTS was weekly evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Common Terminology Criteria for Adverse Events (CTCAE). We analyzed CT based dosimetry for bladder to find correlation between dose-volume histogram (DVH) and the incidence of LUTS. Results: A total of 92 patients were included in present study. Among 92 patients, 27 patients (29%) showed CTCAE grade 2 or higher toxicity. For these patients, a total sum of score was 9 (inter-quartile range, 7-13) in IPSS and 4 (inter-quartile range, 3-7) in OABSS. Irrespective of CTCAE grade, IPSS showed significantly higher proportion of patient with moderate to severe symptom than OABSS (p = 0.028 in grade 2≥, p = 0.003 in grade 0-1). The patients with CTCAE grade 2 or higher showed significantly higher prevalence of moderate to severe symptom in IPSS (70% vs. 46%, p = 0.034), but not in OABSS (41% vs. 22%, p = 0.059). In receiver operating characteristic curve (AUC) analysis, the largest AUC was observed in V20 in both of bladder wall and bladder as a solid organ. Conclusions: The current trial showed that acute genitourinary toxicities during RT for non-genitourinary tract are considerable and should be actively managed. IPSS and OABSS could be more reliable than the physician-reported instruments and IPSS could be more sensitive than other instruments to discriminate moderate to severe LUTS among the patient receiving RT. Dose-volume relationships, especially in bladder wall V20 and bladder as a solid organ V20, were significant predicting factors for moderate to severe acute genitourinary toxicities. EP-1132 SALVAGE STEREOTACTIC BODY RADIOTHERAPY FOR PATIENTS WITH LIMITED PROSTATE CANCER METASTASES G. De Meerleer1, P. Berkovic1, L. Delrue2, B. Lambert3, N. Lumen4, V. Fonteyne1, G. Villeirs5, P. Ost1 1 Universitair Ziekenhuis Gent, Radiation oncology, Gent, Belgium 2 Universitair Ziekenhuis, Radiology, Gent, Belgium 3 Universitair Ziekenhuis Gent, Nuclear Medicine, Gent, Belgium 4 Universitair Ziekenhuis Gent, Urology, Gent, Belgium 5 Universitair Ziekenhuis Gent, Radiology, Gent, Belgium Purpose/Objective: The management of patients with asymptomatic limited metastatic prostate cancer (PCa) remains controversial. To investigate whether repeated Stereotactic body radiotherapy (SBRT) of oligometastatic disease is able to defer the initiation of androgen deprivation therapy (ADT). Materials and Methods: Patients diagnosed with up to 3 metastases (bone and/or lymph nodes) on positron emitting tomography, following biochemical recurrence after curative treatment and exclusion of local recurrence, were analyzed. Patients underwent a salvage hypofractionated linac based SBRT combined with a single injection of a short acting luteinizing hormone releasing hormone (LHRH). Androgen deprivation therapy-free survival (ADT-FS), defined as the time interval between the first day of SBRT and the initiation of ADT, was estimated by the Kaplan-Meier method. Univariate (Logrank) analysis was used examining tumour-related variables. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic or in case of a PSA rise above 50ng/ml in the absence of metastases. Toxicity was scored using the Common Terminology Criteria for Adverse Events. Results: We included 24 patients with a median follow-up of 24 months. Ten patients started with ADT resulting in a median ADT-FS of 38 months. On univariate analysis, a high Gleason score at initial diagnosis was a significant predictor for an earlier start of ADT (p= 0.048). 11 and 3 patients respectively required a second and third salvage treatment for metachronous oligometastases. No grade 3 toxicity was observed.