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Intraoperative Prostate Volume Change During Permanent Low-Dose-Rate I-125 Prostate Brachytherapy: Implications for Final Implant Dosimetry
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Abstracts / Brachytherapy 13 (2014) S15eS126
would hypothesize that HDR monotherapy may result in even better QOL scores.
PO71 Intraoperative Prostate Volume Change During Permanent LowDose-Rate I-125 Prostate Brachytherapy: Implications for Final Implant Dosimetry David E. Greene, MD, Sonja Dieterich, PhD, Richard K. Valicenti, MD, MA. Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA. Purpose: To evaluate the magnitude of real-time intra-operative change in prostatic volume during low-dose-rate I-125 prostate brachytherapy, to determine dosimetric implications to the target of this volume change, and to evaluate the associations between pre-procedural prostate volume, real-time intraoperative prostate volume change and day 30 prostate volume change. Materials and Methods: The prostate was retrospectively contoured on the pre-procedural and day 30 CT scans as well as on the intraoperative realtime pre- and postoperative transrectal ultrasound generated images of 37 patients treated with low-dose-rate I-125 permanent prostatic seed implant at UC Davis Medical Center. Real-time TRUS images were obtained just prior to initiation of the implant, and immediately following placement of the final seed. The average elapsed time between the preand postoperative TRUS image was 124 minutes. For TRUS images, SPOT-PRO was used to delineate pre- and post-procedural target volumes using serial 2.5 mm axial images. For CT images, Pinnacle was used to generate pre- and day 30 post-procedural target volumes using serial 3mm axial images. The resultant dosimetry based on these volumes was compared. Pre-procedural CT derived prostate volumes were evaluated as prognosticator of intraoperative volume change. Intraoperative volume change was evaluated as a prognosticator of Day 30 volume change. Results: The volume of the prostate increased by an average of 22% between the time of the initial and final real-time intraoperative TRUS image acquisitions. There was a wide range of volume change (846%). No significant correlation between pre-procedural CT or TRUS derived prostate volume and the magnitude of intraoperative TRUS derived volume change was noted. There was a non-significant correlation between the magnitude of intraoperative volume change and the magnitude of the CT derived day 30 prostate volume change. The absolute volume change was comparable between smaller and larger prostate glands, but the resultant change in dosimetry attributable to the volume change was more significant for smaller prostate glands. Conclusions: For patients with smaller prostate glands (!35cc) exhibiting higher than average volume change on post-implant intraoperative realtime TRUS, dose to the target (D90, V100) may be lower than desired. The impact of this dose reduction on clinical outcome is not known, but may merit consideration when tumor is known to involve those areas most prone to volume expansion. Neither CT derived pre-procedural nor initial real-time intra operative, TRUS-derived prostate volume are prognostic for post-procedural volume change. The magnitude of realtime intraoperative prostate volume change between initiation and completion of the implant may be associated with the day 30 prostate volume change. PO72 Definitive Multifraction High-Dose-Rate Monotherapy for Prostate Cancer Is Associated with Minimal Short-Term Toxicity and Improvement in Long-Term Urinary Function David R. Raleigh, MD, PhD1, Albert J. Chang, MD, PhD1, Katsuto Shinohara, MD2, I-Chow Hsu, MD1. 1Radiation Oncology, University of California San Francisco, San Francisco, CA; 2Urology, University of California San Francisco, San Francisco, CA. Purpose: High-dose-rate brachytherapy (HDR) alone is an effective treatment option for patients with low- to intermediate-risk prostate
cancer. The purpose of this study is to report acute and long-term toxicity, as well as quality of life outcomes for patients receiving HDR monotherapy at the University of California San Francisco (UCSF). Materials and Methods: Thirty-nine consecutive patients who underwent definitive multifraction HDR treatment between May of 2001 and January of 2012 at UCSF were retrospectively identified for this analysis. All implants were performed using 16 Flexi-guide catheters inserted under transrectal ultrasound guidance. CT-based inverse planning simulated annealing (IPSA) optimization was used to deliver a total dose of 9.5 Gy in 4 fractions (n516), 10.5 Gy in 3 fractions (n522), or 9.5 Gy in 2 fractions plus 6.5 Gy in 2 fractions (n51) to the prostate and proximal seminal vesicles. A Foley catheter was used to define the prostatic urethra. All but 2 patients were treated with a single implant. Symptoms were assessed by American Urological Association (AUA) scores and urinary quality of life (QOL) score prior to HDR, as well as during acute (within 90 days of HDR) and long-term followup. Results: The median age at the time of treatment was 64 years (range 5180). 69% of men met criteria for low-risk disease, and 28% were intermediate-risk by NCCN criteria. Twenty-eight percent of men had prostate volumes greater than 60 cc. With median followup of 2.42 years there was no grade 3 or greater toxicity. Seventy-three percent and 21% of men experienced acute grade 1-2 genitourinary or gastrointestinal toxicities, respectively. In the long term, 66% and 10% of men reported grade 1-2 genitourinary and gastrointestinal toxicities, respectively. Seven men underwent cystoscopy for hematuria or obstruction on long-term followup, with 4 incidents of radiation urethritis and 2 urethral strictures. Long-term gastrointestinal side effects were limited to 3 reports of grade 1-2 hematochezia or increased stool frequency. Median pre-treatment AUA score was 9.5 with QOL 1.5. For those with quantitative followup, 74% of men reported an acute increase in AUA score after treatment. In the long term, 56% of men were found to have unchanged or improved AUA relative to pre-treatment levels. 62% of men reported an acute increase in nocturia after HDR. With long-term followup, 75% reported the same or fewer episodes of nighttime urination relative to pretreatment levels. Conclusions: The side effect profile for definitive multifraction HDR monotherapy for prostate cancer is minimal. Although a large proportion of patients experience an acute worsening of their urinary function after treatment, these symptoms resolve or may even improve with long-term followup.
PO73 Prostate Cancer Dose Escalation via Simultaneous Integrated Brachytherapy Boost Delivered via Radioactive I125 vs. Pd103 Seeds Followed by External Beam Radiation Therapy Waleed F. Mourad, MD1,2, Barry S. Rosenstein, PhD3, Rania A. Shourbaji, MPH1, Robert Ambrose, MS1, James Dolan, MS1, James Dolan, MS1, Joseph Santoro, PhD1, Rudolph Woode, MS1, Mauricio Gamez, MD1, John J. Lukens, MD1, Louis B. Harrison, MD1, Daniel Shasha, MD1. 1Radiation Oncology, Beth Israel Medical Center, New York, NY; 2Radiation Oncology, Albert Einstein College of Medicine, New York, NY; 3Radiation Oncology, Mount Sinai School of Medicine, New York, NY. Purpose: To report the dosimetric impact of simultaneous integrated brachytherapy boost (SIBB) delivered via I125 and Pd103 seeds followed by external beam radiation therapy (EBRT) on prostate cancer and normal tissue tolerance. Materials and Methods: This is a single institution retrospective study. From January 2000-2010; 125 and 50 patients with high-risk prostate cancer underwent SIBB via I125 and Pd103, respectively, followed by EBRT. Seeds were implanted on day 0 (D0) 3 weeks prior to EBRT. On day 21 (D21) and day (D58) post-implant the EBRT started and completed respectively. A dose of 50.4, at daily 1.8 Gy x 28, was delivered. The posterior bladder wall and anterior rectal wall were in the range of seeds (#1 cm) and included in the PTV during EBRT were defined as bladder and rectum at risk. The linear-quadratic model was used to determine the biological equivalent dose (BED) for EBRT
Abstracts / Brachytherapy 13 (2014) S15eS126
would hypothesize that HDR monotherapy may result in even better QOL scores.
PO71 Intraoperative Prostate Volume Change During Permanent LowDose-Rate I-125 Prostate Brachytherapy: Implications for Final Implant Dosimetry David E. Greene, MD, Sonja Dieterich, PhD, Richard K. Valicenti, MD, MA. Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA. Purpose: To evaluate the magnitude of real-time intra-operative change in prostatic volume during low-dose-rate I-125 prostate brachytherapy, to determine dosimetric implications to the target of this volume change, and to evaluate the associations between pre-procedural prostate volume, real-time intraoperative prostate volume change and day 30 prostate volume change. Materials and Methods: The prostate was retrospectively contoured on the pre-procedural and day 30 CT scans as well as on the intraoperative realtime pre- and postoperative transrectal ultrasound generated images of 37 patients treated with low-dose-rate I-125 permanent prostatic seed implant at UC Davis Medical Center. Real-time TRUS images were obtained just prior to initiation of the implant, and immediately following placement of the final seed. The average elapsed time between the preand postoperative TRUS image was 124 minutes. For TRUS images, SPOT-PRO was used to delineate pre- and post-procedural target volumes using serial 2.5 mm axial images. For CT images, Pinnacle was used to generate pre- and day 30 post-procedural target volumes using serial 3mm axial images. The resultant dosimetry based on these volumes was compared. Pre-procedural CT derived prostate volumes were evaluated as prognosticator of intraoperative volume change. Intraoperative volume change was evaluated as a prognosticator of Day 30 volume change. Results: The volume of the prostate increased by an average of 22% between the time of the initial and final real-time intraoperative TRUS image acquisitions. There was a wide range of volume change (846%). No significant correlation between pre-procedural CT or TRUS derived prostate volume and the magnitude of intraoperative TRUS derived volume change was noted. There was a non-significant correlation between the magnitude of intraoperative volume change and the magnitude of the CT derived day 30 prostate volume change. The absolute volume change was comparable between smaller and larger prostate glands, but the resultant change in dosimetry attributable to the volume change was more significant for smaller prostate glands. Conclusions: For patients with smaller prostate glands (!35cc) exhibiting higher than average volume change on post-implant intraoperative realtime TRUS, dose to the target (D90, V100) may be lower than desired. The impact of this dose reduction on clinical outcome is not known, but may merit consideration when tumor is known to involve those areas most prone to volume expansion. Neither CT derived pre-procedural nor initial real-time intra operative, TRUS-derived prostate volume are prognostic for post-procedural volume change. The magnitude of realtime intraoperative prostate volume change between initiation and completion of the implant may be associated with the day 30 prostate volume change. PO72 Definitive Multifraction High-Dose-Rate Monotherapy for Prostate Cancer Is Associated with Minimal Short-Term Toxicity and Improvement in Long-Term Urinary Function David R. Raleigh, MD, PhD1, Albert J. Chang, MD, PhD1, Katsuto Shinohara, MD2, I-Chow Hsu, MD1. 1Radiation Oncology, University of California San Francisco, San Francisco, CA; 2Urology, University of California San Francisco, San Francisco, CA. Purpose: High-dose-rate brachytherapy (HDR) alone is an effective treatment option for patients with low- to intermediate-risk prostate
cancer. The purpose of this study is to report acute and long-term toxicity, as well as quality of life outcomes for patients receiving HDR monotherapy at the University of California San Francisco (UCSF). Materials and Methods: Thirty-nine consecutive patients who underwent definitive multifraction HDR treatment between May of 2001 and January of 2012 at UCSF were retrospectively identified for this analysis. All implants were performed using 16 Flexi-guide catheters inserted under transrectal ultrasound guidance. CT-based inverse planning simulated annealing (IPSA) optimization was used to deliver a total dose of 9.5 Gy in 4 fractions (n516), 10.5 Gy in 3 fractions (n522), or 9.5 Gy in 2 fractions plus 6.5 Gy in 2 fractions (n51) to the prostate and proximal seminal vesicles. A Foley catheter was used to define the prostatic urethra. All but 2 patients were treated with a single implant. Symptoms were assessed by American Urological Association (AUA) scores and urinary quality of life (QOL) score prior to HDR, as well as during acute (within 90 days of HDR) and long-term followup. Results: The median age at the time of treatment was 64 years (range 5180). 69% of men met criteria for low-risk disease, and 28% were intermediate-risk by NCCN criteria. Twenty-eight percent of men had prostate volumes greater than 60 cc. With median followup of 2.42 years there was no grade 3 or greater toxicity. Seventy-three percent and 21% of men experienced acute grade 1-2 genitourinary or gastrointestinal toxicities, respectively. In the long term, 66% and 10% of men reported grade 1-2 genitourinary and gastrointestinal toxicities, respectively. Seven men underwent cystoscopy for hematuria or obstruction on long-term followup, with 4 incidents of radiation urethritis and 2 urethral strictures. Long-term gastrointestinal side effects were limited to 3 reports of grade 1-2 hematochezia or increased stool frequency. Median pre-treatment AUA score was 9.5 with QOL 1.5. For those with quantitative followup, 74% of men reported an acute increase in AUA score after treatment. In the long term, 56% of men were found to have unchanged or improved AUA relative to pre-treatment levels. 62% of men reported an acute increase in nocturia after HDR. With long-term followup, 75% reported the same or fewer episodes of nighttime urination relative to pretreatment levels. Conclusions: The side effect profile for definitive multifraction HDR monotherapy for prostate cancer is minimal. Although a large proportion of patients experience an acute worsening of their urinary function after treatment, these symptoms resolve or may even improve with long-term followup.
PO73 Prostate Cancer Dose Escalation via Simultaneous Integrated Brachytherapy Boost Delivered via Radioactive I125 vs. Pd103 Seeds Followed by External Beam Radiation Therapy Waleed F. Mourad, MD1,2, Barry S. Rosenstein, PhD3, Rania A. Shourbaji, MPH1, Robert Ambrose, MS1, James Dolan, MS1, James Dolan, MS1, Joseph Santoro, PhD1, Rudolph Woode, MS1, Mauricio Gamez, MD1, John J. Lukens, MD1, Louis B. Harrison, MD1, Daniel Shasha, MD1. 1Radiation Oncology, Beth Israel Medical Center, New York, NY; 2Radiation Oncology, Albert Einstein College of Medicine, New York, NY; 3Radiation Oncology, Mount Sinai School of Medicine, New York, NY. Purpose: To report the dosimetric impact of simultaneous integrated brachytherapy boost (SIBB) delivered via I125 and Pd103 seeds followed by external beam radiation therapy (EBRT) on prostate cancer and normal tissue tolerance. Materials and Methods: This is a single institution retrospective study. From January 2000-2010; 125 and 50 patients with high-risk prostate cancer underwent SIBB via I125 and Pd103, respectively, followed by EBRT. Seeds were implanted on day 0 (D0) 3 weeks prior to EBRT. On day 21 (D21) and day (D58) post-implant the EBRT started and completed respectively. A dose of 50.4, at daily 1.8 Gy x 28, was delivered. The posterior bladder wall and anterior rectal wall were in the range of seeds (#1 cm) and included in the PTV during EBRT were defined as bladder and rectum at risk. The linear-quadratic model was used to determine the biological equivalent dose (BED) for EBRT