- Email: [email protected]
Improved Irritative Voiding Symptoms 3 Years After Stereotactic Body Radiation Therapy for Prostate Cancer
S712
International Journal of Radiation Oncology Biology Physics
to the baseline during the next years. The physical functioning score did follow the same trend as the global health score. The dyspnea score increased during the first 6 months to a score of 6, then ameliorated after the 1st year (score -3). During the following years, the dyspnea score gradually increased to a score of 17 at 5 years. The coughing score increased to 4 at 3 weeks after the treatment and slowly decreased during the first 2 years to -11. After the first 2 years, the score increased to a score of 8 at 5 years. The actuarial 2- and 5-years overall survival was 62% and 31%, resp. The 5-years actuarial local control was 93%. Two patients had a local recurrence. The actuarial 2- and 5-years disease free survival was 69% and 52%, resp. No grade 4 or 5 treatment related toxicity occurred. Conclusions: During the 5 years after the treatment, the quality of life was maintained and emotional functioning improved significantly after stereotactic radiation therapy for stage I NSCLC. Dyspnea slowly increased 2 years after the treatment. The local tumor control was high and toxicity was low. Author Disclosure: J. Nuyttens: None. R. Ubels: None. N. Van der Voort van Zyp: None.
prescribe androgen deprivation treatment for the purpose of cytoreduction in patients with large prostate glands. Author Disclosure: A. Goenka: None. O. Cahlon: None. B.H. Chon: None. H. Tsai: None. E. Hug: None. C. Brown: None. C.E. Vargas: None. H.P. Fontanilla: None.
3274 The Impact of Prostate Size on Patient-Assessed Quality of Life Following Proton Beam Radiation Therapy A. Goenka,1 O. Cahlon,1 B.H. Chon,1 H. Tsai,1 E. Hug,1 C. Brown,2 C.E. Vargas,3 and H.P. Fontanilla1; 1Princeton Radiation Oncology, Princeton, NJ, 2ProCure, Somerset, NJ, 3Lynn Cancer Institute of Boca Raton Community Hospital, Boca Raton, FL Purpose/Objective(s): To assess the impact of prostate gland size on patient assessed genitourinary (GU) and gastrointestinal (GI) quality of life (QOL) following definitive treatment for prostate adenocarcinoma (PC) with proton beam therapy (PBT). Materials/Methods: As part of an ongoing prospective outcome tracking protocol REG001-09 sponsored by the Proton Collaborative Group (PCG), patients complete an Expanded Prostate Cancer Index Composite questionnaire (EPIC). We identified all patients at our center between 03/2012 and 09/2013 who had a completed EPIC pre-treatment and at follow-up. Patients were treated to a target dose of 79.2 CGE. Prostate size was based on pre-treatment MRI or CT, and categorized into three groups: <30 cc; 30-49cc; and 50cc. GU QOL was assessed with AUA symptom score and EPIC urinary domain score (UDS). GI QOL was assessed using the EPIC GI domain score (GDS). Results: 81 patients completed pre-treatment EPIC, of which 27 had a completed 3 month EPIC, 44 a 6 month EPIC, and 21 a 12 month EPIC. Twenty-two (27%) patients had a prostate size <30cc, 36 (44%) 30-49cc, and 23 (28%) 50cc (range 51cc-170cc). The average pre-treatment AUA score was 7.2 at baseline, 8.6 (+1.4) at three months, 8.8 (+1.6) at six months, and 7.4 (+0.2) at twelve months. Patients with larger prostates had a higher pre-treatment AUA score (<30 cc, AUA Z 5.8; 30-49 cc, AUA Z 6.4; 50cc, AUA Z 9.9; p Z 0.03), but did not have greater average changes in their AUA score at six months (<30 cc, +2.3; 30-49cc, +3.2; 50cc, +0.2; p Z 0.06). In total, 6 patients (14%) had an elevation in AUA 5 points at 6 months, none of which had a prostate gland 50cc. EPIC UDS for the entire cohort was 87.4 at baseline, 84.2 (-3.2) at three months, 83.1 (-4.3) at six months, and 84.4 (-3.0) at twelve months. Patients with larger prostates had a lower pre-treatment UDS (<30 cc, 86.2; 30-49cc, 82.8; 50, 74.8; p<0.01). At six months, the average change in UDS was not different based on prostate size (<30 cc, -3.6; 30-49cc -3.1; 50, +3.8; p Z 0.76). EPIC GDS for the entire cohort was 93.1 at baseline, 91.4 (-1.7) at three months, 92.0 (-1.1) at six months, and 88.6 (-4.7) at twelve months. Pre-treatment GDS was not related to prostate size (<30 cc, 95.5; 30-49 cc, 92.7; 50, 91.7; p Z 0.36). Change in EPIC GDS at six months was not dependent on prostate size (<30 cc, -3.7; 30-49 cc, -1.1; 50 cc, -0.55; p Z 0.67). Conclusions: Our experience suggests that definitive PBT for PC to a dose of 79.2 CGE results in excellent patient reported urinary and gastrointestinal QOL, and is independent of baseline prostate gland size. This supports our current treatment algorithm with PBT in which we do not
3275 Improved Irritative Voiding Symptoms 3 Years After Stereotactic Body Radiation Therapy for Prostate Cancer Z.H. Rana,1 L.N. Chen,2 J.S. Kim,2 R. Moures,2 T. Yung,2 S. Lei,2 B.T. Collins,2 S. Suy,2 A. Dritschilo,2 and S.P. Collins2; 1Howard University College of Medicine, Washington, DC, 2Georgetown University Hospital, Washington, DC Purpose/Objective(s): Irritative voiding symptoms are common in elderly men and acutely following prostate radiation therapy. The impact of hypofractionated radiation therapy on irritative voiding symptoms has not been determined. This study sought to evaluate urgency, frequency and nocturia following SBRT for prostate cancer. Materials/Methods: Patients treated with SBRT monotherapy for localized prostate cancer from August, 2007 to July, 2011 at an academic hospital with a minimum of three years of follow-up were included in this study. Treatment was delivered using the CyberKnifeÒ with doses of 35 Gy-36.25 Gy in 5 fractions. Patient-reported urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) before treatment and at 1, 3, 6, 9, 12 and every 6 months thereafter. Results: 204 patients at a median age of 69 years received SBRT with a median follow-up of 3 years. Prior to treatment, 50% of patients reported moderate to severe lower urinary track symptoms and 17.7% felt that urinary frequency was a moderate to big problem. The mean prostate volume was 39 cc and 10% had prior procedures for benign prostatic hyperplasia (BPH). A mean baseline IPSS-irritative score of 4.8 significantly increased to 6.5 at 1 month (p < 0.0001), however returned to baseline at 3 months (p Z 0.73). The IPSS-irritative score returned to baseline in 92.6% within a median time of 3 months. Transient increases in irritative voiding symptoms were common at one year. The mean baseline IPSS-irritative score decreased to 4.4 at 24 months (p Z 0.034) and 3.7 at 36 months (p < 0.0001). Only 14.6% of patients felt that urinary frequency was a moderate to big problem at three years post-SBRT (p Z 0.2303). Conclusions: Treatment of prostate cancer with SBRT resulted in an acute increase in irritative urinary symptoms which peaked at 1 month posttreatment. Irritative voiding symptoms returned to baseline in the majority of patients by 3 months post-SBRT. Irritative voiding symptoms were actually improved from baseline at three years post-SBRT. Author Disclosure: Z.H. Rana: None. L.N. Chen: None. J.S. Kim: None. R. Moures: None. T. Yung: None. S. Lei: None. B.T. Collins: None. S. Suy: None. A. Dritschilo: None. S.P. Collins: G. Consultant; Accuray.
3276 Patient-Reported QOL Outcomes From a Prospective Phase 2 Trial of Short Course Radiation Therapy Followed by FOLFOX Chemotherapy as Preoperative Treatment for Rectal Cancer S.S. Khwaja, S. Markovina, S. Hunt, B. Tan, R.J. Myerson, P.J. Parkih, and J.R. Olsen; Washington University in St. Louis, St. Louis, MO Purpose/Objective(s): A prospective phase II trial of short course radiation therapy (SCRT) followed by four cycles of mFOLFOX6 prior to extirpative surgery was recently completed at our institution. Favorable rates of downstaging (DS), local control (LC), and disease free survival (DFS) were previously reported. Here we present the patient-reported quality of life (QOL) outcomes. Materials/Methods: 80 patients with cT3/T4, any N, any M rectal adenocarcinoma planned for resection were enrolled between 2009 and 2012. Preoperative treatment included SCRT (25 Gy to involved mesorectum, 20 Gy to elective nodes in 5 fractions), followed by 4 cycles of mFOLFOX6 prior to resection. QOL data was obtained prospectively using the FACT-C questionnaire (Version 4) prior to RT, prior to surgery,
International Journal of Radiation Oncology Biology Physics
to the baseline during the next years. The physical functioning score did follow the same trend as the global health score. The dyspnea score increased during the first 6 months to a score of 6, then ameliorated after the 1st year (score -3). During the following years, the dyspnea score gradually increased to a score of 17 at 5 years. The coughing score increased to 4 at 3 weeks after the treatment and slowly decreased during the first 2 years to -11. After the first 2 years, the score increased to a score of 8 at 5 years. The actuarial 2- and 5-years overall survival was 62% and 31%, resp. The 5-years actuarial local control was 93%. Two patients had a local recurrence. The actuarial 2- and 5-years disease free survival was 69% and 52%, resp. No grade 4 or 5 treatment related toxicity occurred. Conclusions: During the 5 years after the treatment, the quality of life was maintained and emotional functioning improved significantly after stereotactic radiation therapy for stage I NSCLC. Dyspnea slowly increased 2 years after the treatment. The local tumor control was high and toxicity was low. Author Disclosure: J. Nuyttens: None. R. Ubels: None. N. Van der Voort van Zyp: None.
prescribe androgen deprivation treatment for the purpose of cytoreduction in patients with large prostate glands. Author Disclosure: A. Goenka: None. O. Cahlon: None. B.H. Chon: None. H. Tsai: None. E. Hug: None. C. Brown: None. C.E. Vargas: None. H.P. Fontanilla: None.
3274 The Impact of Prostate Size on Patient-Assessed Quality of Life Following Proton Beam Radiation Therapy A. Goenka,1 O. Cahlon,1 B.H. Chon,1 H. Tsai,1 E. Hug,1 C. Brown,2 C.E. Vargas,3 and H.P. Fontanilla1; 1Princeton Radiation Oncology, Princeton, NJ, 2ProCure, Somerset, NJ, 3Lynn Cancer Institute of Boca Raton Community Hospital, Boca Raton, FL Purpose/Objective(s): To assess the impact of prostate gland size on patient assessed genitourinary (GU) and gastrointestinal (GI) quality of life (QOL) following definitive treatment for prostate adenocarcinoma (PC) with proton beam therapy (PBT). Materials/Methods: As part of an ongoing prospective outcome tracking protocol REG001-09 sponsored by the Proton Collaborative Group (PCG), patients complete an Expanded Prostate Cancer Index Composite questionnaire (EPIC). We identified all patients at our center between 03/2012 and 09/2013 who had a completed EPIC pre-treatment and at follow-up. Patients were treated to a target dose of 79.2 CGE. Prostate size was based on pre-treatment MRI or CT, and categorized into three groups: <30 cc; 30-49cc; and 50cc. GU QOL was assessed with AUA symptom score and EPIC urinary domain score (UDS). GI QOL was assessed using the EPIC GI domain score (GDS). Results: 81 patients completed pre-treatment EPIC, of which 27 had a completed 3 month EPIC, 44 a 6 month EPIC, and 21 a 12 month EPIC. Twenty-two (27%) patients had a prostate size <30cc, 36 (44%) 30-49cc, and 23 (28%) 50cc (range 51cc-170cc). The average pre-treatment AUA score was 7.2 at baseline, 8.6 (+1.4) at three months, 8.8 (+1.6) at six months, and 7.4 (+0.2) at twelve months. Patients with larger prostates had a higher pre-treatment AUA score (<30 cc, AUA Z 5.8; 30-49 cc, AUA Z 6.4; 50cc, AUA Z 9.9; p Z 0.03), but did not have greater average changes in their AUA score at six months (<30 cc, +2.3; 30-49cc, +3.2; 50cc, +0.2; p Z 0.06). In total, 6 patients (14%) had an elevation in AUA 5 points at 6 months, none of which had a prostate gland 50cc. EPIC UDS for the entire cohort was 87.4 at baseline, 84.2 (-3.2) at three months, 83.1 (-4.3) at six months, and 84.4 (-3.0) at twelve months. Patients with larger prostates had a lower pre-treatment UDS (<30 cc, 86.2; 30-49cc, 82.8; 50, 74.8; p<0.01). At six months, the average change in UDS was not different based on prostate size (<30 cc, -3.6; 30-49cc -3.1; 50, +3.8; p Z 0.76). EPIC GDS for the entire cohort was 93.1 at baseline, 91.4 (-1.7) at three months, 92.0 (-1.1) at six months, and 88.6 (-4.7) at twelve months. Pre-treatment GDS was not related to prostate size (<30 cc, 95.5; 30-49 cc, 92.7; 50, 91.7; p Z 0.36). Change in EPIC GDS at six months was not dependent on prostate size (<30 cc, -3.7; 30-49 cc, -1.1; 50 cc, -0.55; p Z 0.67). Conclusions: Our experience suggests that definitive PBT for PC to a dose of 79.2 CGE results in excellent patient reported urinary and gastrointestinal QOL, and is independent of baseline prostate gland size. This supports our current treatment algorithm with PBT in which we do not
3275 Improved Irritative Voiding Symptoms 3 Years After Stereotactic Body Radiation Therapy for Prostate Cancer Z.H. Rana,1 L.N. Chen,2 J.S. Kim,2 R. Moures,2 T. Yung,2 S. Lei,2 B.T. Collins,2 S. Suy,2 A. Dritschilo,2 and S.P. Collins2; 1Howard University College of Medicine, Washington, DC, 2Georgetown University Hospital, Washington, DC Purpose/Objective(s): Irritative voiding symptoms are common in elderly men and acutely following prostate radiation therapy. The impact of hypofractionated radiation therapy on irritative voiding symptoms has not been determined. This study sought to evaluate urgency, frequency and nocturia following SBRT for prostate cancer. Materials/Methods: Patients treated with SBRT monotherapy for localized prostate cancer from August, 2007 to July, 2011 at an academic hospital with a minimum of three years of follow-up were included in this study. Treatment was delivered using the CyberKnifeÒ with doses of 35 Gy-36.25 Gy in 5 fractions. Patient-reported urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) before treatment and at 1, 3, 6, 9, 12 and every 6 months thereafter. Results: 204 patients at a median age of 69 years received SBRT with a median follow-up of 3 years. Prior to treatment, 50% of patients reported moderate to severe lower urinary track symptoms and 17.7% felt that urinary frequency was a moderate to big problem. The mean prostate volume was 39 cc and 10% had prior procedures for benign prostatic hyperplasia (BPH). A mean baseline IPSS-irritative score of 4.8 significantly increased to 6.5 at 1 month (p < 0.0001), however returned to baseline at 3 months (p Z 0.73). The IPSS-irritative score returned to baseline in 92.6% within a median time of 3 months. Transient increases in irritative voiding symptoms were common at one year. The mean baseline IPSS-irritative score decreased to 4.4 at 24 months (p Z 0.034) and 3.7 at 36 months (p < 0.0001). Only 14.6% of patients felt that urinary frequency was a moderate to big problem at three years post-SBRT (p Z 0.2303). Conclusions: Treatment of prostate cancer with SBRT resulted in an acute increase in irritative urinary symptoms which peaked at 1 month posttreatment. Irritative voiding symptoms returned to baseline in the majority of patients by 3 months post-SBRT. Irritative voiding symptoms were actually improved from baseline at three years post-SBRT. Author Disclosure: Z.H. Rana: None. L.N. Chen: None. J.S. Kim: None. R. Moures: None. T. Yung: None. S. Lei: None. B.T. Collins: None. S. Suy: None. A. Dritschilo: None. S.P. Collins: G. Consultant; Accuray.
3276 Patient-Reported QOL Outcomes From a Prospective Phase 2 Trial of Short Course Radiation Therapy Followed by FOLFOX Chemotherapy as Preoperative Treatment for Rectal Cancer S.S. Khwaja, S. Markovina, S. Hunt, B. Tan, R.J. Myerson, P.J. Parkih, and J.R. Olsen; Washington University in St. Louis, St. Louis, MO Purpose/Objective(s): A prospective phase II trial of short course radiation therapy (SCRT) followed by four cycles of mFOLFOX6 prior to extirpative surgery was recently completed at our institution. Favorable rates of downstaging (DS), local control (LC), and disease free survival (DFS) were previously reported. Here we present the patient-reported quality of life (QOL) outcomes. Materials/Methods: 80 patients with cT3/T4, any N, any M rectal adenocarcinoma planned for resection were enrolled between 2009 and 2012. Preoperative treatment included SCRT (25 Gy to involved mesorectum, 20 Gy to elective nodes in 5 fractions), followed by 4 cycles of mFOLFOX6 prior to resection. QOL data was obtained prospectively using the FACT-C questionnaire (Version 4) prior to RT, prior to surgery,