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EP-1305: Results of whole pelvic radiotherapy for locally advanced prostate cancer
S90
ESTRO 33, 2014 Mean age was 70.4 (range: 51-83). Concerning stage of prostate cancer, 88 patients were classified to T3 and 9 to T4. 63 patients were classified to N0, 34 to N1, Mean initial PSA was 70.7 (range: 5-580). Gleason score(GS) 5 was seen in 8 patients, GS 6 in 1, GS 7 in 40, GS 8 in 3, and GS 9 in 45. The dose of radiotherapy was 46 Gy to whole pelvis and 20 Gy to prostate (total 66 Gy) in 43 patients and in the remaining 54 patients, 46 Gy to whole pelvis and 26 Gy to prostate (total 72 Gy). IMRT was used in 33 patients. Hormonal therapy was performed in 96 patients and the duration was mean 22 months (range: 1-134 months). Median follow up was 63 months.
Conclusions: Orchiectomy with radiotherapy is a well-tolerated and effective treatment for stage I-II TS. Treatment caused concerns about fertility, changes in body image and negatively influenced sexual life. Furthermore a significant decrease in the quality of erections was reported. EP-1304 IGRT for prostate cancer with ultrasound-based system and surface imaging system: role of the two methods M. Krengli1, D. Beldì2, M. Di Genesio Pagliuca2, G. Apicella2, V. Amisano2, C. Pisani2, M. Guffi2, L. Mazzola2, G. Loi3, M. Brambilla3 1 University of Piemonte Orientale and University Hospital "Maggiore della Carità", Radiotherapy, Novara, Italy 2 University Hospital "Maggiore della Carità", Radiotherapy, Novara, Italy 3 University Hospital "Maggiore della Carità", Medical Physics, Novara, Italy Purpose/Objective: The aim of this study is to evaluate the interfraction reproducibility during fractionated radiotherapy (RT) for prostate cancer by using the ultrasound image guided radiotherapy (US-IGRT) Clarity® (Resonant Medical, Montreal, CA) and the surface imaging registration system AlignRT® (Vision RT, London, UK). Materials and Methods: We enrolled 40 patients (pts) with localized prostate carcinoma candidate to exclusive external beam RT. Median age was 72.8 years (range: 59-81). According to NCCN stratification, 4 pts (10%) were classified as low risk, 7 pts (17.5%) as intermediate risk, 22 pts (55%) as high risk and 7 pts (17.5%) as very high risk. Sixteen pts (40%) were treated with 3D conformal RT, 20 pts (50%) with intensitymodulated radiotherapy and 4 pts (10%) with arc therapy. Total dose administered to prostate gland was 76–78 Gy (2 Gy/fr). US images were acquired at the time of simulation to obtain a coregistered 3-mm slice CT/US dataset as reference, and daily before treatment delivery. This procedure lasted about 3-5 minutes. The reference 3D surface image was obtained by extraction of the surface image from simulation CT. Surface images were acquired daily at the beginning of each RT session by AlignRT. This procedure lasted about 30 seconds. The shifts of the two systems were analyzed measuring the vectors along the 3 axes x,y,z. Results: Mean shifts vectors were 5.7 mm (range: 2.2-13.8 mm) and 4.9 mm (range: 0.9-14.0 mm) for US-IGRT and for surface imaging respectively. Vectors resulted <3 mm in 32.5% of cases with US-IGRT and in 20% of cases with surface imaging. Vectors were >10 mm in 10% of cases with US-IGRT and in 7.5% of cases with surface imaging. The analysis revealed no correlation between the shifts detected from the two systems that were complementary in terms of information for IGRT. Conclusions: Both the ultrasound (Clarity) and the surface imaging (AlignRT) system are quick and easy to use and have good reliability. Our analysis suggests a complementary role of the two methods in the IGRT of patients affected by prostate cancer. A detailed analysis of data considering separately the 3 main axes x,y,z is ongoing. EP-1305 Results of whole pelvic radiotherapy for locally advanced prostate cancer K. Inaba1, K. Kobayashi1, S. Sekii1, M. Kitaguchi1, K. Takahashi1, N. Murakami1, M. Morota1, Y. Ito1, M. Sumi1, J. Itami1 1 National Cancer Center Hospital, Radiation Oncology, Tokyo, Japan
Results: 5 year biochemical relapse free rate was 66%, 5 year clinical relapse free rate was 83% and 5 year overall survival was 91%. There were 6 radiotherapy related late adverse events which were over grade 2 (CTCAE version 4.0) in 5 patients. Urinary retention and fracture were seen in each 1 patient and rectal hemorrhage and hematuria were seen in each 2 patients. Radiotherapy related late adverse events were seen in 4 (6.25%) of 64 patients using conventional radiotherapy, while in 1 (3.03%) of 33 patients using IMRT. Concerning biochemical relapse free rate, GS under 8 and N0 had a tendency for good control (5 year biochemical relapse free rate: 75% vs 57%, p=0.008 and 71% vs 57%, p=0.09).Concerning clinical relapse free rate and overall survival, lymph node metastasis were worse prognostic factor (5 year clinical relapse free rate: 90% vs 69%, p=0.15 and 5 year overall survival: 94% vs 88%, p=0.06). Conclusions :Whole pelvic radiotherapy for locally advanced prostate cancer yields good results and could be a treatment option. GS over 9 and lymph node metastasis are worse prognostic factors. Radiation related adverse events were tolerable. EP-1306 Curative treatment of invasive bladder cancer in patients not candidates for cystectomy M. Gentil Jiménez1, I. Linares Galiana1, M. Martínez Carrillo1, C. Prieto Prieto1, J. Expósito Hernández1, R. Guerrero Tejada1, I. Tovar Martín1, R. Del Moral Ávila1, M. Zurita Herrera1, F. Pérez Carrascosa1 1 Hospital Universitario Virgen de las Nieves, Radiation Oncology, Granada, Spain Purpose/Objective: Bladder preservation with chemoradiation is a standard treatment used for patients with muscle invasive bladder cancer when the cystectomy is contraindicated. We analyze survival and acute toxicity of patients diagnosed of infiltrating bladder cancer treated in our center with radiotherapy +/concomitant chemotherapy. Materials and Methods: Between 2007 and 2013, 53 patients T2-4N0M0 not candidates for cystectomy were treated with radical intention in our department. Main reasons to refuse radical surgery: inoperable for medical conditions (19), urethral obstruction (13), patient refusal (11),age (6), postrenal failure (2) and other (1). Prior to treatment we evaluated the following prognostic factors: T stage (T2, T3, T4), tumoral multicentricity and obstructive hydronephrosis. We used platinum-based agents and a curative radiotherapy dose, with a mean of 66 Gy (60-70 Gy). We have revised these cases. Results: The age ranged from 52 to 83 years (mean 71,25). Stage II was the most frequently diagnosed: 80% (42). Patients treated with chemoradiation: 80 % (42). Complete response: 80% (42). The principal method used for the evaluation of the response after treatment were cystoscopy+ TAC: 94% (50). At five-year follow-up, overall survival was 68 % (36) and disease-free survival was 70 % (37). Sixty percent of patients had no severe toxicity (32). Most common type of acute toxicity was urinary grade 3 or 4 (16 patients). There was no case of mortality related toxicity. Conclusions: Our results show excellent tolerance, as well as high percentage of complete response and survival. Organ-preserving treatment is an effective and safe alternative to cystectomy in patients not candidates to surgery.
Purpose/Objective: This study was conducted to analyze the results of whole pelvic radiotherapy for locally advanced prostate cancer (T3/T4 or N1) and find the possible prognostic factors.
EP-1307 Hypofractionated stereotactic body radiation therapy in low-risk prostate cancer H.J. Kim1, W.C. Kim1 1 Inha University Hospital, Radiation Oncology, Inchon, Korea Republic of
Materials and Methods: We reviewed the records of 97 patients with locally advanced prostate cancer who were treated with whole pelvic radiotherapy between 1995 and 2010 in our institution. Patients profile, Stage, treatment and results were retrieved from medical records and analysis the data.
Purpose/Objective: Technological advanced Stereotactic body radiotherapy (SBRT) may allow precise targeting and delivery of radiation to the prostate without increasing treatment toxicity. We report our experience using cyberknife to patients with low-risk prostate cancer.
ESTRO 33, 2014 Mean age was 70.4 (range: 51-83). Concerning stage of prostate cancer, 88 patients were classified to T3 and 9 to T4. 63 patients were classified to N0, 34 to N1, Mean initial PSA was 70.7 (range: 5-580). Gleason score(GS) 5 was seen in 8 patients, GS 6 in 1, GS 7 in 40, GS 8 in 3, and GS 9 in 45. The dose of radiotherapy was 46 Gy to whole pelvis and 20 Gy to prostate (total 66 Gy) in 43 patients and in the remaining 54 patients, 46 Gy to whole pelvis and 26 Gy to prostate (total 72 Gy). IMRT was used in 33 patients. Hormonal therapy was performed in 96 patients and the duration was mean 22 months (range: 1-134 months). Median follow up was 63 months.
Conclusions: Orchiectomy with radiotherapy is a well-tolerated and effective treatment for stage I-II TS. Treatment caused concerns about fertility, changes in body image and negatively influenced sexual life. Furthermore a significant decrease in the quality of erections was reported. EP-1304 IGRT for prostate cancer with ultrasound-based system and surface imaging system: role of the two methods M. Krengli1, D. Beldì2, M. Di Genesio Pagliuca2, G. Apicella2, V. Amisano2, C. Pisani2, M. Guffi2, L. Mazzola2, G. Loi3, M. Brambilla3 1 University of Piemonte Orientale and University Hospital "Maggiore della Carità", Radiotherapy, Novara, Italy 2 University Hospital "Maggiore della Carità", Radiotherapy, Novara, Italy 3 University Hospital "Maggiore della Carità", Medical Physics, Novara, Italy Purpose/Objective: The aim of this study is to evaluate the interfraction reproducibility during fractionated radiotherapy (RT) for prostate cancer by using the ultrasound image guided radiotherapy (US-IGRT) Clarity® (Resonant Medical, Montreal, CA) and the surface imaging registration system AlignRT® (Vision RT, London, UK). Materials and Methods: We enrolled 40 patients (pts) with localized prostate carcinoma candidate to exclusive external beam RT. Median age was 72.8 years (range: 59-81). According to NCCN stratification, 4 pts (10%) were classified as low risk, 7 pts (17.5%) as intermediate risk, 22 pts (55%) as high risk and 7 pts (17.5%) as very high risk. Sixteen pts (40%) were treated with 3D conformal RT, 20 pts (50%) with intensitymodulated radiotherapy and 4 pts (10%) with arc therapy. Total dose administered to prostate gland was 76–78 Gy (2 Gy/fr). US images were acquired at the time of simulation to obtain a coregistered 3-mm slice CT/US dataset as reference, and daily before treatment delivery. This procedure lasted about 3-5 minutes. The reference 3D surface image was obtained by extraction of the surface image from simulation CT. Surface images were acquired daily at the beginning of each RT session by AlignRT. This procedure lasted about 30 seconds. The shifts of the two systems were analyzed measuring the vectors along the 3 axes x,y,z. Results: Mean shifts vectors were 5.7 mm (range: 2.2-13.8 mm) and 4.9 mm (range: 0.9-14.0 mm) for US-IGRT and for surface imaging respectively. Vectors resulted <3 mm in 32.5% of cases with US-IGRT and in 20% of cases with surface imaging. Vectors were >10 mm in 10% of cases with US-IGRT and in 7.5% of cases with surface imaging. The analysis revealed no correlation between the shifts detected from the two systems that were complementary in terms of information for IGRT. Conclusions: Both the ultrasound (Clarity) and the surface imaging (AlignRT) system are quick and easy to use and have good reliability. Our analysis suggests a complementary role of the two methods in the IGRT of patients affected by prostate cancer. A detailed analysis of data considering separately the 3 main axes x,y,z is ongoing. EP-1305 Results of whole pelvic radiotherapy for locally advanced prostate cancer K. Inaba1, K. Kobayashi1, S. Sekii1, M. Kitaguchi1, K. Takahashi1, N. Murakami1, M. Morota1, Y. Ito1, M. Sumi1, J. Itami1 1 National Cancer Center Hospital, Radiation Oncology, Tokyo, Japan
Results: 5 year biochemical relapse free rate was 66%, 5 year clinical relapse free rate was 83% and 5 year overall survival was 91%. There were 6 radiotherapy related late adverse events which were over grade 2 (CTCAE version 4.0) in 5 patients. Urinary retention and fracture were seen in each 1 patient and rectal hemorrhage and hematuria were seen in each 2 patients. Radiotherapy related late adverse events were seen in 4 (6.25%) of 64 patients using conventional radiotherapy, while in 1 (3.03%) of 33 patients using IMRT. Concerning biochemical relapse free rate, GS under 8 and N0 had a tendency for good control (5 year biochemical relapse free rate: 75% vs 57%, p=0.008 and 71% vs 57%, p=0.09).Concerning clinical relapse free rate and overall survival, lymph node metastasis were worse prognostic factor (5 year clinical relapse free rate: 90% vs 69%, p=0.15 and 5 year overall survival: 94% vs 88%, p=0.06). Conclusions :Whole pelvic radiotherapy for locally advanced prostate cancer yields good results and could be a treatment option. GS over 9 and lymph node metastasis are worse prognostic factors. Radiation related adverse events were tolerable. EP-1306 Curative treatment of invasive bladder cancer in patients not candidates for cystectomy M. Gentil Jiménez1, I. Linares Galiana1, M. Martínez Carrillo1, C. Prieto Prieto1, J. Expósito Hernández1, R. Guerrero Tejada1, I. Tovar Martín1, R. Del Moral Ávila1, M. Zurita Herrera1, F. Pérez Carrascosa1 1 Hospital Universitario Virgen de las Nieves, Radiation Oncology, Granada, Spain Purpose/Objective: Bladder preservation with chemoradiation is a standard treatment used for patients with muscle invasive bladder cancer when the cystectomy is contraindicated. We analyze survival and acute toxicity of patients diagnosed of infiltrating bladder cancer treated in our center with radiotherapy +/concomitant chemotherapy. Materials and Methods: Between 2007 and 2013, 53 patients T2-4N0M0 not candidates for cystectomy were treated with radical intention in our department. Main reasons to refuse radical surgery: inoperable for medical conditions (19), urethral obstruction (13), patient refusal (11),age (6), postrenal failure (2) and other (1). Prior to treatment we evaluated the following prognostic factors: T stage (T2, T3, T4), tumoral multicentricity and obstructive hydronephrosis. We used platinum-based agents and a curative radiotherapy dose, with a mean of 66 Gy (60-70 Gy). We have revised these cases. Results: The age ranged from 52 to 83 years (mean 71,25). Stage II was the most frequently diagnosed: 80% (42). Patients treated with chemoradiation: 80 % (42). Complete response: 80% (42). The principal method used for the evaluation of the response after treatment were cystoscopy+ TAC: 94% (50). At five-year follow-up, overall survival was 68 % (36) and disease-free survival was 70 % (37). Sixty percent of patients had no severe toxicity (32). Most common type of acute toxicity was urinary grade 3 or 4 (16 patients). There was no case of mortality related toxicity. Conclusions: Our results show excellent tolerance, as well as high percentage of complete response and survival. Organ-preserving treatment is an effective and safe alternative to cystectomy in patients not candidates to surgery.
Purpose/Objective: This study was conducted to analyze the results of whole pelvic radiotherapy for locally advanced prostate cancer (T3/T4 or N1) and find the possible prognostic factors.
EP-1307 Hypofractionated stereotactic body radiation therapy in low-risk prostate cancer H.J. Kim1, W.C. Kim1 1 Inha University Hospital, Radiation Oncology, Inchon, Korea Republic of
Materials and Methods: We reviewed the records of 97 patients with locally advanced prostate cancer who were treated with whole pelvic radiotherapy between 1995 and 2010 in our institution. Patients profile, Stage, treatment and results were retrieved from medical records and analysis the data.
Purpose/Objective: Technological advanced Stereotactic body radiotherapy (SBRT) may allow precise targeting and delivery of radiation to the prostate without increasing treatment toxicity. We report our experience using cyberknife to patients with low-risk prostate cancer.