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Local Recurrence Confirmed by Mapping Biopsy Following I-125 Prostate Brachytherapy for 980 Patients
S58
Abstracts / Brachytherapy 15 (2016) S21eS204
PP34 Presentation Time: 10:18 AM 6 Years’ Experience with HDR Brachytherapy in Bladder Implantations Performed Laparoscopically in Solitary Bladder Tumors. A Prospective Study Elzbieta van der Steen-Banasik, MD1, Geert Smits, MD, PhD2, Bernard Oosterveld, PhD1, Theo Janssen, RTT1, Marie A.D. Haverkort, MD1, Carl Wijburg, MD2, Andries Visser, PhD1. 1Radiotherapiegroep, Arnhem, Netherlands; 2Rijnstate Hospital, Arnhem, Netherlands. Purpose: In our institution laparoscopic bladder implantations were performed since June 2009. In December 2009 a HDR schedule was introduced, replacing the former PDR schedule. In addition laparoscopy was modernized with the introduction of a robot. Here we report our 6 year experience. Materials and Methods: The indication for bladder sparing treatment is a solitary tumor, pT2, grade 3, no carcinoma in situ, tumor size # 5 cm. The treatment consists of a combination of TURB, external beam irradiation (EBI) and HDR brachytherapy. After a course of EBI, 20 fractions of 2 Gy, 5 fractions/week, a laparoscopic robot-assisted implantation procedure takes place within 10 days. In selected cases (thick residual scar, diverticulum, distant ureter or urachus localization) partial cystectomy (PC) is performed. A partial lymph node dissection (PLND) is performed only if lymph node metastases are suspected. HDR schedules were calculated to be biologically equivalent to the historical LDR schedule of 30 Gy in 60 h (see Table). We chose for 10 fractions of 2.5 Gy with an interval of $ 4 h, 3 fractions/day. The source dwell times were calculated by prescribing to the average of the dose points at 5 mm from the catheters at the inner surface of the bladder wall. To avoid high dose areas the dwell times were manually optimized. An afterloader with an Ir-192 source with activity 37-13 GBq was used. Post-treatment cystoscopies and urine cytology were performed every 3 months. Results: Until December 2015 67 patients with tumors of average diameter 2.6 cm were treated. In 21 patients PC was performed, residual tumor was found in 13 patients. In 15 patients a selective PLND was performed, in 83 resected lymph nodes 2 metastatic nodes were found. 2-6 catheters were inserted, mean V100 was 12 cc. Dose to organs at risk was reported for bowel: average D2cc was 0.8 Gy and D0.1cc was 1.5 Gy per fraction. The average hospitalization time of 6 days was mostly determined by the irradiation time, which is significantly reduced compared to the open procedure (15.4 d). There was practically no blood loss, acute wound healing problems did not occur, none of the patients developed medication requiring urgency. Compared to the open procedure there was also a significant reduction of catheter accessibility problems during irradiation. Implant quality parameters were comparable to the open procedure. Adverse Events: N511 patients developed acute toxicity, 3 patients G3-5: delirium, pulmonary embolism and fatal myocardial infarction. N58 patients developed late toxicity, G2: hematuria (N53), cystitis (N51), lymphedema (N52), G3: bladder necrosis (N51), recurrent cystitis (N51). The average duration of the follow up was 2.0 y (range 1 m-6.0 y). Survival analysis was performed using the Kaplan Meier method. 2-y local control (LC) was 81% and 2-y disease specific survival (DSS) was 86%. Table BEDa/b is the Biologically Effective Dose, for tumor effect a/b5 10 Gy, for late effects a/b5 3 Gy. EQD2 is the Equivalent Dose in fractions of 2 Gy.
Schedule
BED10 [Gy] BED3 [Gy] EQD2 [Gy] EQD2 [Gy] tumor late tumor late effects effects effects effects
LDR reference 33 30 Gy in 60 h HDR schedule 31 25 Gy, 10 fractions
46
27
27
46
26
27
Conclusions: With the use of the HDR schedule we achieved satisfactory results with mild toxicity. The patient’s well-being was improved by preventing isolated hospitalization. Minimally invasive surgery reduced the amount of perioperative adverse events, treatment disturbances due to catheter accessibility and shortened the hospitalization time substantially.
PP35
Presentation Time: 10:27 AM
Local Recurrence Confirmed by Mapping Biopsy Following I-125 Prostate Brachytherapy for 980 Patients Atsunori Yorozu, MD1, Ryuichi Kota, MD1, Yoshiaki Takagawa, MD1, Yutaka Shiraishi, MD1, Yasuto Yagi, MD2, Toru Nishiyama, MD2, Shiro Saito, MD2. 1Radiation Oncology, Tokyo Medical Center, NHO, Tokyo, Japan; 2Urology, Tokyo Medical Center, NHO, Tokyo, Japan. Purpose: To study patterns of failure using cases of local recurrence confirmed by mapping biopsy after I-125 brachytherapy. Materials and Methods: We retrospectively and comprehensively analyzed patterns of failure for a cohort of 985 consecutive patients with localized prostate cancer receiving I-125 brachytherapy without supplemental external beam radiotherapy from 2003 to 2011. The prescription dose was 145 Gy, and the dose to 90% of the prostate (D90) was 110-130% of the prescribed dose. For post-implant dosimetric analysis, a CT scan was obtained one month after implantation. Groups of 597, 384, and four men were categorized as low-, intermediate-, and highrisk, respectively, according to National Comprehensive Cancer Network. In total, 39% of patients received neoadjuvant androgen deprivation therapy. Biochemical failure was determined by the Phoenix definition; PSA nadir plus 2 ng/mL. Imaging studies following biochemical failure were obtained sequentially by body CT scan and bone scan, or PET-CT scan. Finally transperineal template-guided mapping prostate biopsy was performed, and the studies were repeated until intervention started. The median of the biopsy cores was 38; the range was eight to 50. Among patients with definitive biochemical failure, local recurrence was defined as a final positive post-treatment biopsy. Results: The median follow-up was seven years (range: two to 14 years); 41 out of 985 men (4.2%) developed biochemical failure. The actuarial rate of failure was 4.5% at seven years. Biopsies were performed in 34 of the 41 cases (83%) with failure; in which 19 were positive and 15 were negative. The median time from seed implantation to biochemical failure was 4.3 years. Median time from implantation to final positive biopsy was five years (range 2.4 to 11 years), and the median PSA values for positive biopsies was 3.3 ng/mL. The median PSA doubling time (PSA-DT) for all 41 men with relapse was 10 months; range two to 27 months. For men whose biopsies were positive and negative, the median postimplant D90 was 169Gy and 188Gy (p!0.01), respectively: the median positive core rate was 34% and 22% (p50.042), respectively. Factors such as age, initial PSA, T-stage, Gleason score, neoadjuvant androgen deprivation, time to biochemical failure, and PSA-DT were not associated with positive results. Of 41 men with failure, anatomical recurrent sites were identified in 26 cases. In these cases the site of first recurrence was in the prostate in 15, in the seminal vesicles alone in two, in the prostate and pelvic nodes in two, in the pelvic nodes in four, and in distant organs in three cases. In the remaining 15 men with failure, a site of recurrence could not be identified in 12, and 3 received no investigations. Of the 15 men with local recurrence alone, 10 received local salvage treatment (reseed implantation in nine, and surgery in one): PSA in the nine cases decreased for a while after the local salvage. In addition, 23 men without biochemical failure who received a post-treatment biopsy after 3 years had all negative results. Conclusions: In total, 19 out of 985 (1.9%) patients developed local recurrence confirmed by mapping prostate biopsy. Half of patients with biochemical failure had intraprostatic components in these favorable group. D90 values and positive core rates may predict local recurrence in
Abstracts / Brachytherapy 15 (2016) S21eS204 patients with biochemical failure. Longer-term and more through followups are needed to identify local recurrence without extraprostatic components in order to consider relevant salvage options. PP36 Presentation Time: 10:36 AM Population-Based Urinary Intervention Rates Following Intraoperatively Planned I-125 Low Dose Rate Prostate Brachytherapy Michael Peacock, MD1, Kevin Martell, MD1, Amandeep Taggar, MD1, Farhan Husain, BSc1, Michael Sia, MD2, Steve Angyalfi, MD1, Siraj Husain, MD1. 1Tom Baker Cancer Centre, Calgary, AB, Canada; 2BC Cancer Agency, Abbotsford, BC, Canada. Purpose: To determine the rates of urinary intervention for patients with low and low-tier intermediate risk prostate cancer treated with intraoperatively planned low dose rate prostate brachytherapy. Materials and Methods: From 2003-2012, 723 consecutive patients were treated with intraoperatively planned LDR prostate brachytherapy without external beam radiotherapy at our center. Dosimetric planning targets were uniform with a goal of D90 prostateO180 Gy, V150O74%, V200O37%, V140 urethra!24% and V150 urethra!3%. Patients were followed according to a protocol every 6 months for the first 3 years then annually. For each patient, all data were entered into a central database prospectively and retrospectively verified by reviewing a centralized electronic health record that comprehensively captures all interventions performed and visitations to any medical center in the province of Alberta, Canada. Urinary interventions included cystoscopy, transurethral resection of the prostate, urethral dilatation or catheterization for urinary retention or hematuria attributable to brachytherapy. These patients were then isolated and compared with the remaining control cohort using tests of proportions and multivariate analysis as appropriate. Results: Median follow-up was 7.1 years (range: 2.5 - 12.5). Intervention for RTOG grade 3 toxicity was encountered in 51 patients (7%). Cystoscopy was done in 31 patients (4.3%) for RT related hematuria or obstruction. TURP was performed in 14 patients (1.9%) with a median time from implant of 20.4 months (range, 3-86) and dilatation for RT toxicity in 6 patients (0.8%) with a median time of 29 months (range, 2085) . Median pre-implant volume was 37.1cc (20.2 - 53.0) in patients having intervention for grade 3 toxicity and 33.7 cc (13.2 - 66.9) in those without [p!0.05]. Time from biopsy to implant, pre-treatment AUA symptom score, PSA, clinical stage, use of hormones, and urethral dosimetry did not predict for urinary intervention in our analysis. Conclusions: Urinary intervention rates following intraoperatively planned LDR prostate brachytherapy are low overall at 7%. The strength of our study is the ability to review all hospital records in our health region to completely capture any urinary intervention due to an integrated electronic health records system. PP37 Presentation Time: 10:45 AM Dose Escalation with High-Dose-3D-Conformal/ IMRT (HD-3D-CRT/IMRT) Compared with LowDose 3D-Conformal/IMRT Plus HDR Brachytherapy (LD-3D-CRT/IMRTDHDR-B) for Intermediate- or High-Risk Prostate Cancer: Higher Disease Control and Survival with Lower Toxicity Benjamin Guix, MD, PhD, MBA, Jose Maria Bartrina, MD, PhD, MBA, Ines Guix, MD, PhD, MBA, Jose Ignacio Tello, PhD, Ivan Henriquez, MD, PhD, Luis Quinzanos, MD, Ivan Garcia, MD, Joel Mases, MD, Teresamaria Lacorte, PhD, Guillermo Galdon, MD, Teresa Guix, BCHS. Radiation Oncology, IMOR Foundation, Medical Institiute for Radiotherapy and Oncology, Barcelona, Spain. Purpose: To report early and late toxicity and biochemical outcome in a prospective series of 1343 patients with intermediate- or high-risk
S59
clinically localized prostate cancer treated with either HD-3D-CRT/IMRT or with LD-3D-CRT/IMRTþHDR-B. Materials/Methods: Between 12/1999 and 10/2010, 1343 patients (pts) with PSAi10, Gleason scorei6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT or IMRT to the prostate in 38 fractions (group 1; 673 patients) or 46 Gy LD-3D-CRT or IMRT followed by 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 672 patients), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. 86 pts of group 1 (12.8%) and 18 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 45 pts in group 1 (6.7%) and 9 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 102 months, the 10-year free-from-failure survival was 90.7% and 98.3% (p!0.002) in group 1 and 2 respectively; free-from-metastases survival 95.9% and 97.8% (p!0,006)for group 1 and 2 respectively; and cause-specific survival 97.1% and 98.2% (p!0.08). Conclusions: High-dose 3D-EBRT þ HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiotherapy. Control rates were significantly better with in the HDR-boosted patients as expected by higher effective-dose.
PP38 Presentation Time: 10:54 AM Clinical and Quality-of-Life Outcomes Associated with Initial Treatment of Localized Prostate Cancer: A Prospective Longitudinal Study Ned L. Williams, DO1, Jonathan Frandsen, MD1, R Jeffrey Lee, MD2, John Snyder, MS2, L Scott Chidester, MD2, Jay Bishoff, MD2, William Sauce, MD2. 1Huntsman Cancer Institute, Salt Lake City, UT, USA; 2 Intermountain Medical Center, Salt Lake City, UT, USA. Purpose: Adenocarcinoma of the prostate is effectively treated with multiple modalities including surgery, brachytherapy, and external-beam radiation therapy (EBRT). We prospectively measured longitudinal quality of life outcomes in men treated with each of these treatment modalities. Materials and Methods: We prospectively measured outcomes reported by 538 participants treated within a single health management system before and after treatment of prostate adenocarcinoma. Using EPIC and AUA questionnaires we evaluated sexual function, urinary incontinence, urinary obstruction, and bowel health in relation to primary treatment modality. Results: A total of 538 patients undergoing initial treatment for prostate adenocarcinoma participated; 331 patients were treated with surgery, 105 were treated with brachytherapy, and 102 were treated with EBRT. At 6 months, surgery patients had worse urinary incontinence (p ! 0.001), sexual function (p ! 0.001) and AUA score (p5 0.014), but improved urinary obstruction (p ! 0.001) compared to baseline. At 36 months, surgery patients continued to have worse urinary incontinence (p ! 0.001), sexual function (p ! 0.001) and AUA score (p5 0.008) and improved urinary obstruction (p ! 0.001) from baseline. At 6 months, brachytherapy patients had worse urinary incontinence (p ! 0.001), AUA score (p!0.001), and urinary obstruction (p!0.001) compared to baseline. At 36 months, brachytherapy patients continued to have worse urinary incontinence (p ! 0.001) compared to baseline and developed worse sexual function (p ! 0.001) compared to baseline, but had return to
Abstracts / Brachytherapy 15 (2016) S21eS204
PP34 Presentation Time: 10:18 AM 6 Years’ Experience with HDR Brachytherapy in Bladder Implantations Performed Laparoscopically in Solitary Bladder Tumors. A Prospective Study Elzbieta van der Steen-Banasik, MD1, Geert Smits, MD, PhD2, Bernard Oosterveld, PhD1, Theo Janssen, RTT1, Marie A.D. Haverkort, MD1, Carl Wijburg, MD2, Andries Visser, PhD1. 1Radiotherapiegroep, Arnhem, Netherlands; 2Rijnstate Hospital, Arnhem, Netherlands. Purpose: In our institution laparoscopic bladder implantations were performed since June 2009. In December 2009 a HDR schedule was introduced, replacing the former PDR schedule. In addition laparoscopy was modernized with the introduction of a robot. Here we report our 6 year experience. Materials and Methods: The indication for bladder sparing treatment is a solitary tumor, pT2, grade 3, no carcinoma in situ, tumor size # 5 cm. The treatment consists of a combination of TURB, external beam irradiation (EBI) and HDR brachytherapy. After a course of EBI, 20 fractions of 2 Gy, 5 fractions/week, a laparoscopic robot-assisted implantation procedure takes place within 10 days. In selected cases (thick residual scar, diverticulum, distant ureter or urachus localization) partial cystectomy (PC) is performed. A partial lymph node dissection (PLND) is performed only if lymph node metastases are suspected. HDR schedules were calculated to be biologically equivalent to the historical LDR schedule of 30 Gy in 60 h (see Table). We chose for 10 fractions of 2.5 Gy with an interval of $ 4 h, 3 fractions/day. The source dwell times were calculated by prescribing to the average of the dose points at 5 mm from the catheters at the inner surface of the bladder wall. To avoid high dose areas the dwell times were manually optimized. An afterloader with an Ir-192 source with activity 37-13 GBq was used. Post-treatment cystoscopies and urine cytology were performed every 3 months. Results: Until December 2015 67 patients with tumors of average diameter 2.6 cm were treated. In 21 patients PC was performed, residual tumor was found in 13 patients. In 15 patients a selective PLND was performed, in 83 resected lymph nodes 2 metastatic nodes were found. 2-6 catheters were inserted, mean V100 was 12 cc. Dose to organs at risk was reported for bowel: average D2cc was 0.8 Gy and D0.1cc was 1.5 Gy per fraction. The average hospitalization time of 6 days was mostly determined by the irradiation time, which is significantly reduced compared to the open procedure (15.4 d). There was practically no blood loss, acute wound healing problems did not occur, none of the patients developed medication requiring urgency. Compared to the open procedure there was also a significant reduction of catheter accessibility problems during irradiation. Implant quality parameters were comparable to the open procedure. Adverse Events: N511 patients developed acute toxicity, 3 patients G3-5: delirium, pulmonary embolism and fatal myocardial infarction. N58 patients developed late toxicity, G2: hematuria (N53), cystitis (N51), lymphedema (N52), G3: bladder necrosis (N51), recurrent cystitis (N51). The average duration of the follow up was 2.0 y (range 1 m-6.0 y). Survival analysis was performed using the Kaplan Meier method. 2-y local control (LC) was 81% and 2-y disease specific survival (DSS) was 86%. Table BEDa/b is the Biologically Effective Dose, for tumor effect a/b5 10 Gy, for late effects a/b5 3 Gy. EQD2 is the Equivalent Dose in fractions of 2 Gy.
Schedule
BED10 [Gy] BED3 [Gy] EQD2 [Gy] EQD2 [Gy] tumor late tumor late effects effects effects effects
LDR reference 33 30 Gy in 60 h HDR schedule 31 25 Gy, 10 fractions
46
27
27
46
26
27
Conclusions: With the use of the HDR schedule we achieved satisfactory results with mild toxicity. The patient’s well-being was improved by preventing isolated hospitalization. Minimally invasive surgery reduced the amount of perioperative adverse events, treatment disturbances due to catheter accessibility and shortened the hospitalization time substantially.
PP35
Presentation Time: 10:27 AM
Local Recurrence Confirmed by Mapping Biopsy Following I-125 Prostate Brachytherapy for 980 Patients Atsunori Yorozu, MD1, Ryuichi Kota, MD1, Yoshiaki Takagawa, MD1, Yutaka Shiraishi, MD1, Yasuto Yagi, MD2, Toru Nishiyama, MD2, Shiro Saito, MD2. 1Radiation Oncology, Tokyo Medical Center, NHO, Tokyo, Japan; 2Urology, Tokyo Medical Center, NHO, Tokyo, Japan. Purpose: To study patterns of failure using cases of local recurrence confirmed by mapping biopsy after I-125 brachytherapy. Materials and Methods: We retrospectively and comprehensively analyzed patterns of failure for a cohort of 985 consecutive patients with localized prostate cancer receiving I-125 brachytherapy without supplemental external beam radiotherapy from 2003 to 2011. The prescription dose was 145 Gy, and the dose to 90% of the prostate (D90) was 110-130% of the prescribed dose. For post-implant dosimetric analysis, a CT scan was obtained one month after implantation. Groups of 597, 384, and four men were categorized as low-, intermediate-, and highrisk, respectively, according to National Comprehensive Cancer Network. In total, 39% of patients received neoadjuvant androgen deprivation therapy. Biochemical failure was determined by the Phoenix definition; PSA nadir plus 2 ng/mL. Imaging studies following biochemical failure were obtained sequentially by body CT scan and bone scan, or PET-CT scan. Finally transperineal template-guided mapping prostate biopsy was performed, and the studies were repeated until intervention started. The median of the biopsy cores was 38; the range was eight to 50. Among patients with definitive biochemical failure, local recurrence was defined as a final positive post-treatment biopsy. Results: The median follow-up was seven years (range: two to 14 years); 41 out of 985 men (4.2%) developed biochemical failure. The actuarial rate of failure was 4.5% at seven years. Biopsies were performed in 34 of the 41 cases (83%) with failure; in which 19 were positive and 15 were negative. The median time from seed implantation to biochemical failure was 4.3 years. Median time from implantation to final positive biopsy was five years (range 2.4 to 11 years), and the median PSA values for positive biopsies was 3.3 ng/mL. The median PSA doubling time (PSA-DT) for all 41 men with relapse was 10 months; range two to 27 months. For men whose biopsies were positive and negative, the median postimplant D90 was 169Gy and 188Gy (p!0.01), respectively: the median positive core rate was 34% and 22% (p50.042), respectively. Factors such as age, initial PSA, T-stage, Gleason score, neoadjuvant androgen deprivation, time to biochemical failure, and PSA-DT were not associated with positive results. Of 41 men with failure, anatomical recurrent sites were identified in 26 cases. In these cases the site of first recurrence was in the prostate in 15, in the seminal vesicles alone in two, in the prostate and pelvic nodes in two, in the pelvic nodes in four, and in distant organs in three cases. In the remaining 15 men with failure, a site of recurrence could not be identified in 12, and 3 received no investigations. Of the 15 men with local recurrence alone, 10 received local salvage treatment (reseed implantation in nine, and surgery in one): PSA in the nine cases decreased for a while after the local salvage. In addition, 23 men without biochemical failure who received a post-treatment biopsy after 3 years had all negative results. Conclusions: In total, 19 out of 985 (1.9%) patients developed local recurrence confirmed by mapping prostate biopsy. Half of patients with biochemical failure had intraprostatic components in these favorable group. D90 values and positive core rates may predict local recurrence in
Abstracts / Brachytherapy 15 (2016) S21eS204 patients with biochemical failure. Longer-term and more through followups are needed to identify local recurrence without extraprostatic components in order to consider relevant salvage options. PP36 Presentation Time: 10:36 AM Population-Based Urinary Intervention Rates Following Intraoperatively Planned I-125 Low Dose Rate Prostate Brachytherapy Michael Peacock, MD1, Kevin Martell, MD1, Amandeep Taggar, MD1, Farhan Husain, BSc1, Michael Sia, MD2, Steve Angyalfi, MD1, Siraj Husain, MD1. 1Tom Baker Cancer Centre, Calgary, AB, Canada; 2BC Cancer Agency, Abbotsford, BC, Canada. Purpose: To determine the rates of urinary intervention for patients with low and low-tier intermediate risk prostate cancer treated with intraoperatively planned low dose rate prostate brachytherapy. Materials and Methods: From 2003-2012, 723 consecutive patients were treated with intraoperatively planned LDR prostate brachytherapy without external beam radiotherapy at our center. Dosimetric planning targets were uniform with a goal of D90 prostateO180 Gy, V150O74%, V200O37%, V140 urethra!24% and V150 urethra!3%. Patients were followed according to a protocol every 6 months for the first 3 years then annually. For each patient, all data were entered into a central database prospectively and retrospectively verified by reviewing a centralized electronic health record that comprehensively captures all interventions performed and visitations to any medical center in the province of Alberta, Canada. Urinary interventions included cystoscopy, transurethral resection of the prostate, urethral dilatation or catheterization for urinary retention or hematuria attributable to brachytherapy. These patients were then isolated and compared with the remaining control cohort using tests of proportions and multivariate analysis as appropriate. Results: Median follow-up was 7.1 years (range: 2.5 - 12.5). Intervention for RTOG grade 3 toxicity was encountered in 51 patients (7%). Cystoscopy was done in 31 patients (4.3%) for RT related hematuria or obstruction. TURP was performed in 14 patients (1.9%) with a median time from implant of 20.4 months (range, 3-86) and dilatation for RT toxicity in 6 patients (0.8%) with a median time of 29 months (range, 2085) . Median pre-implant volume was 37.1cc (20.2 - 53.0) in patients having intervention for grade 3 toxicity and 33.7 cc (13.2 - 66.9) in those without [p!0.05]. Time from biopsy to implant, pre-treatment AUA symptom score, PSA, clinical stage, use of hormones, and urethral dosimetry did not predict for urinary intervention in our analysis. Conclusions: Urinary intervention rates following intraoperatively planned LDR prostate brachytherapy are low overall at 7%. The strength of our study is the ability to review all hospital records in our health region to completely capture any urinary intervention due to an integrated electronic health records system. PP37 Presentation Time: 10:45 AM Dose Escalation with High-Dose-3D-Conformal/ IMRT (HD-3D-CRT/IMRT) Compared with LowDose 3D-Conformal/IMRT Plus HDR Brachytherapy (LD-3D-CRT/IMRTDHDR-B) for Intermediate- or High-Risk Prostate Cancer: Higher Disease Control and Survival with Lower Toxicity Benjamin Guix, MD, PhD, MBA, Jose Maria Bartrina, MD, PhD, MBA, Ines Guix, MD, PhD, MBA, Jose Ignacio Tello, PhD, Ivan Henriquez, MD, PhD, Luis Quinzanos, MD, Ivan Garcia, MD, Joel Mases, MD, Teresamaria Lacorte, PhD, Guillermo Galdon, MD, Teresa Guix, BCHS. Radiation Oncology, IMOR Foundation, Medical Institiute for Radiotherapy and Oncology, Barcelona, Spain. Purpose: To report early and late toxicity and biochemical outcome in a prospective series of 1343 patients with intermediate- or high-risk
S59
clinically localized prostate cancer treated with either HD-3D-CRT/IMRT or with LD-3D-CRT/IMRTþHDR-B. Materials/Methods: Between 12/1999 and 10/2010, 1343 patients (pts) with PSAi10, Gleason scorei6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT or IMRT to the prostate in 38 fractions (group 1; 673 patients) or 46 Gy LD-3D-CRT or IMRT followed by 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 672 patients), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. 86 pts of group 1 (12.8%) and 18 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 45 pts in group 1 (6.7%) and 9 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 102 months, the 10-year free-from-failure survival was 90.7% and 98.3% (p!0.002) in group 1 and 2 respectively; free-from-metastases survival 95.9% and 97.8% (p!0,006)for group 1 and 2 respectively; and cause-specific survival 97.1% and 98.2% (p!0.08). Conclusions: High-dose 3D-EBRT þ HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiotherapy. Control rates were significantly better with in the HDR-boosted patients as expected by higher effective-dose.
PP38 Presentation Time: 10:54 AM Clinical and Quality-of-Life Outcomes Associated with Initial Treatment of Localized Prostate Cancer: A Prospective Longitudinal Study Ned L. Williams, DO1, Jonathan Frandsen, MD1, R Jeffrey Lee, MD2, John Snyder, MS2, L Scott Chidester, MD2, Jay Bishoff, MD2, William Sauce, MD2. 1Huntsman Cancer Institute, Salt Lake City, UT, USA; 2 Intermountain Medical Center, Salt Lake City, UT, USA. Purpose: Adenocarcinoma of the prostate is effectively treated with multiple modalities including surgery, brachytherapy, and external-beam radiation therapy (EBRT). We prospectively measured longitudinal quality of life outcomes in men treated with each of these treatment modalities. Materials and Methods: We prospectively measured outcomes reported by 538 participants treated within a single health management system before and after treatment of prostate adenocarcinoma. Using EPIC and AUA questionnaires we evaluated sexual function, urinary incontinence, urinary obstruction, and bowel health in relation to primary treatment modality. Results: A total of 538 patients undergoing initial treatment for prostate adenocarcinoma participated; 331 patients were treated with surgery, 105 were treated with brachytherapy, and 102 were treated with EBRT. At 6 months, surgery patients had worse urinary incontinence (p ! 0.001), sexual function (p ! 0.001) and AUA score (p5 0.014), but improved urinary obstruction (p ! 0.001) compared to baseline. At 36 months, surgery patients continued to have worse urinary incontinence (p ! 0.001), sexual function (p ! 0.001) and AUA score (p5 0.008) and improved urinary obstruction (p ! 0.001) from baseline. At 6 months, brachytherapy patients had worse urinary incontinence (p ! 0.001), AUA score (p!0.001), and urinary obstruction (p!0.001) compared to baseline. At 36 months, brachytherapy patients continued to have worse urinary incontinence (p ! 0.001) compared to baseline and developed worse sexual function (p ! 0.001) compared to baseline, but had return to