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Monotherapeutic High-dose-Rate Brachytherapy for Prostate Cancer: 15 years Experience of Osaka University
I. J. Radiation Oncology d Biology d Physics
S354
Volume 78, Number 3, Supplement, 2010
Conclusions: When used in combination with brachytherapy, IMRT offers less acute urinary toxicities, a higher QOL and less grade 2 or worse rectal bleeding compared to 3DCRT. Author Disclosure: K. Forsythe, None; S.R. Blacksburg, None; N.N. Stone, Prologics, LLC, E. Ownership Interest; Nihan MediPhysics, F. Consultant/Advisory Board; B&K Medical, F. Consultant/Advisory Board; R.G. Stock, None.
2336
Urinary Retention following Prostate Seed Implant Brachytherapy following Rigid Cystoscopy
K. E. Fox1, J. Choe1, T. Radivoyevitch1, D. Einstein1,2 1
Case Western Medical Center, Cleveland, OH, 2Wright State University School of Medicine, Dayton, OH
Purpose/Objective(s): Transperineal ultrasound guided prostate seed brachytherapy (PSI) is a common procedure performed for the long-term control of prostate cancer. After the completion of the procedure, a cystoscopy is often performed to ensure that no seeds were inadvertently introduced into the bladder. After the patient recovers, he is generally given a trial of voiding. If the patient cannot urinate or has significant urinary retention, a Foley catheter is generally replaced, and the patient is sent home with the catheter for 1-2 weeks to allow for a decrease in prostatic edema. Published studies have shown differences in urinary symptoms for patients who underwent rigid versus flexible cystoscopy outside of the setting of PSI. Here, we investigate possible factors including cystoscopy that may contribute to urinary toxicity, the most common form of toxicity in patients receiving PSI. Materials/Methods: A retrospective chart review was performed for 62 consecutive patients who received PSI at our institution from 12/2006 to 9/2009. Possible contributing factors were collected: whether or not cystoscopy was performed and type of cystoscopy, prostate volume, isotope type, and the number of seeds and needles used. Possible outcomes were collected: Foley catheter requirement immediately after PSI and International Prostate Symptom Score (IPSS) at the time of first follow-up (if in the first 3 months) as well as the change from the pre-procedure IPSS. Results: There was a large and significant difference (p = 0.0000454) between rates if Foley catheter requirement after rigid cystoscopy (75.0%) versus flexible cystoscopy (17.2%) and no cystoscopy (12.5%) by Chi-square analysis. There was no statistical difference between flexible and no cystoscopy. Foley catheter requirement was not associated with prostate volume, isotope, or the number of seeds and needles. No factors were associated with post-implant IPSS. Conclusions: We report a strong singular association between rigid cystoscopy and Foley catheter requirement after PSI in our institutional experience. Although rigid cystoscopy is often favored by urologists for better visualization, flexible cystoscopy should be performed instead whenever possible to reduce the risk of urinary retention and Foley catheter requirement after PSI. Author Disclosure: K.E. Fox, None; J. Choe, None; T. Radivoyevitch, None; D. Einstein, None.
2337
Long-term (potential 10 year follow-up) Toxicity after Treatment for Prostate Cancer with Either External Beam Radiation Therapy, Interstitial Brachytherapy, or Radical Prostatectomy
G. K. Hunter1, C. A. Reddy1, K. Angermeier1, J. Ulchaker1, C. Zippe2, K. Stephans1, R. Tendulkar1, P. A. Kupelian3, E. A. Klein1, J. P. Ciezki1 1 Cleveland Clinic, Cleveland, OH, 2Case Western Reserve University Hospital, Cleveland, OH, 3MD Anderson Orlando, Orlando, FL
Purpose/Objective(s): To examine gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated in 1999 with external beam radiotherapy (RT), prostate interstitial brachytherapy (PI) or radical prostatectomy (RP). Materials/Methods: The records of 454 patients treated in 1999 were retrospectively reviewed to evaluate toxicity profiles. Twenty-six percent of the patients were treated with PI, 36% with RP, and 38% with RT. Late GI and GU morbidity profiles were specifically examined and both profiles were graded according to the RTOG acute and late morbidity scoring criteria. Other factors examined in the analysis were patient age, BMI, smoking history, and medical co-morbidities including presence of diabetes mellitus (DM), peripheral vascular disease (PVD), and connective tissue disease. Due to the low event rate for late GU and GI toxicities, a competing risk regression (CRR) analysis was done with death at the competing event. Results: Median follow-up time was 8.6 years (range 0.2-11.3). Cumulative incidence rates (%) of late GU toxicity Grade $2 at 2, 5, and 10 years post-treatment were 2.4, 8.6, 11.2 for RT, 0.9, 3.5, 5.1 for PI, and 0.6, 3.2, 5.6 for RP (p = 0.0140 for RP vs. RT.; p = 0.86 for RP vs. PI, p = 0.0385 for PI vs. RT). Cumulative incidence rates of late GI toxicity Grade $2 at 2, 5, and 10 years post-treatment up was 5.4, 7.8, 8.5 for RT, 0, 1.7, 1.7 for PI, and 0, 0, 0 for RP (p = 0.002 for RP vs. RT, p = 0.15 for RP vs. PI, p = 0.0066 for PI vs. RT). On CRR univariate analysis only the presence of DM was associated with GU toxicity Grade $2 (p = 0.01, HR 2.83, 95% CI = 1.28-6.28). Since there were no events in the RP group, only the PI and RT patients were included in the CRR analysis for late GI toxicity Grade $2. On univariate analysis, RT and DM were significantly associated with late GI toxicity. On multivariable analysis, both variables remained significant (RT: p = 0.029, HR = 5.07, 95% CI = 1.18-21.8; DM: p = 0.013, HR = 3.47, 95% CI = 1.3-9.27). Conclusions: The presence of DM at the time of treatment was significantly associated with worse late GI and GU toxicity RT was significantly associated with worse late GI toxicity compared to PI and RP. Author Disclosure: G.K. Hunter, None; C.A. Reddy, None; K. Angermeier, None; J. Ulchaker, None; C. Zippe, None; K. Stephans, None; R. Tendulkar, None; P.A. Kupelian, None; E.A. Klein, None; J.P. Ciezki, None.
2338
Monotherapeutic High-dose-Rate Brachytherapy for Prostate Cancer: 15 years Experience of Osaka University
K. Konishi, Y. Yoshioka, I. Sumida, Y. Takahashi, T. Ogata, F. Isohashi, M. Koizumi, T. Inoue Departament of Radiation Oncology, Osaka University Graduate School of Medicine, Suita Osaka, Japan Purpose/Objective(s): High-dose-rate brachytherapy (HDR-BT) is at a clinical trial phase, with an expectation that it can treat even an extracapsular invaded prostate cancer with more escalated biological dose, using a precise dose distribution and extreme
Proceedings of the 52nd Annual ASTRO Meeting hypofractionation. HDR-BT had been performed only in a combination with external beam radiotherapy (EBRT) until our previously reported initial and unique experience of HDR-BT as monotherapy (Int J Radiat Oncol Biol Phys, 2000). The purpose of the current report is to evaluate the feasibility, toxicity and efficacy of monotherapeutic HDR-BT for prostate cancer, with more patient accrual and longer follow-up. Materials/Methods: From May 1995 through December 2009, 163 patients with prostate cancer without nodal or distant metastasis were treated with HDR-BT alone, without EBRT, at Osaka University Hospital, Japan. Median age was 68 (range 45-81), T1:T2:T3:T4 = 42:55:58:8, median Gleason Score 7 (range 2-10), and median pretreatment PSA level 15 ng/ml (range 3.8337). Fifteen patients were considered low-risk, 57 intermediate-risk, and 91 high-risk. Twice daily irradiation with more than 6-hour intervals was adopted, with the total dose of 48 Gy/8 fractions/5 days, 54 Gy/9 fractions/5 days, or 45.5 Gy/7 fractions/ 4 days. Of the 163 patients, 124 also received neoadjuvant and/or adjuvant hormonal therapy. Median follow-up time was 54 months. Results: All the patients completed the treatment regimen. No significant intra- or peri-operative complications occurred. Acute toxicities of Grade 3, 2, and 1 occurred in 6, 24, and 60 patients, respectively. Late toxicities of Grade 3, 2, and 1 occurred in 4, 14, and 32 patients, respectively. Acute and late toxicity of Grade 4 or more did not occur. The 5-year PSA failure-free, disease-free survival, and overall survival rate was 83%, 87%, and 96%, respectively. The 5-year PSA failure-free rate for low-, intermediate-, and high-risk patients was 91%, 93%, and 77%, respectively. Conclusions: Monotherapeutic HDR-BT associated with hormonal therapy was feasible and its toxicity was acceptable. Shortterm tumor control was promising, even for patients with locally advanced disease. The presented extreme hypofractionation regimens of 45.5-54 Gy in 7-9 fractions of 6-6.5 Gy might be referred to by other terms, such as stereotactic body radiotherapy. Studies with longer follow-up periods and from multiple institutions are needed to confirm the efficacy of this novel approach. Author Disclosure: K. Konishi, None; Y. Yoshioka, None; I. Sumida, None; Y. Takahashi, None; T. Ogata, None; F. Isohashi, None; M. Koizumi, None; T. Inoue, None.
2339
Prospective Trial of Escalating Doses of Paclitaxel, Concurrent Radiation and Androgen Deprivation in High-risk Prostate Cancer with or without Prior Prostatectomy
Y. Kwok1, Y. Wu1, A. Mirmiran1, S. DiBiase2, O. Goloubeva1, B. Bridges1, H. Mannuel1, N. Dawson3, P. Amin1, A. Hussain1 1
University of Maryland School of Medicine, Baltimore, MD, 2Cooper University Hospital, Camden, NJ, 3Georgetown University School of Medicine, Washington DC, DC Purpose/Objective(s): To evaluate the tolerability and efficacy of weekly paclitaxel, concurrent radiation and androgen deprivation (ADT) in patients with high risk prostate cancer (PC) with or without prior prostatectomy (RP). Materials/Methods: For this prospective trial, eligible post-RP patients included pathological T3 disease or rising PSA $ 0.5ng/ml post-RP. Eligible locally-advanced PC (LAPC) patients included: 1) cT2b-4N0N+, M0; 2) Gleason Score (GS) 810; 3) GS 7 + PSA 10-20ng/ml; or 4) PSA 20-150ng/ml. Treatment included ADT (4 or 24 months), weekly paclitaxel [40 (n = 10) , 50 (n = 31), or 60mg/m2/wk (n = 18)], and pelvic radiation therapy (total dose: RP = 64.8 Gy; LAPC = 70.2 Gy). Acute and late toxicities were graded via the CTC and modified RTOG-LENT scales, respectively. The freedom from biochemical failure rates were computed using the Phoenix definition (PSA nadir + 2ngm/ml) for LAPC and PSA . 0.5ng/ml for RP patients. Results: Between October 1999 and July 2006, 59 patients were enrolled [LAPC (n = 29), RP (n = 30); ADT: 4 months (n = 29), 24 months (n = 30); Race: Whites (n = 29), African Americans [AA] (n = 28); N+ (n = 7)]. The median follow-up was 75.3 months (range, 7-103 months; 95% CI: 66.8-82.3 months). Baseline characteristics [median, (range)] were: age 67 (45-86 years), PSA 5.9 (0.1-92.1ng/ml), GS 8 (6-9). At escalating doses of paclitaxel, 95-98% of doses were given with radiation and ADT, with dose modifications required primarily in RP patients. No acute grade 4 toxicities occurred. Grade 3 toxicities were diarrhea (15%), urinary urgency/incontinence (10%), tenesmus (5%), leukopenia (3%). Only 5% experienced late grade 3 (n = 2) or 4 (n = 1) GI/GU toxicities. Biochemical progression occurred in 24 (41%) patients, clinical progression in 11 (19%) patients. The 5- and 7-year OS rates were 83% and 67%, respectively. There were no differences in OS between RP and LAPC, 4- and 24-month ADT, White and AA patient categories. Conclusions: With a median follow-up of 75.3 months, this trial represents the longest follow-up of patients treated with concurrent taxane-based chemotherapy with EBRT in men with high risk prostate cancer. Concurrent ADT, radiation and weekly paclitaxel at 40mg/m2/wk in RP patients and 60mg/m2/wk in LAPC patients is feasible and well-tolerated. Author Disclosure: Y. Kwok, None; Y. Wu, None; A. Mirmiran, None; S. DiBiase, None; O. Goloubeva, None; B. Bridges, None; H. Mannuel, None; N. Dawson, None; P. Amin, None; A. Hussain, Bristol-Myers Squibb, B. Research Grant.
2340
Usefulness of MRI Findings of Prostate Cancer before and after Tomotherapy-based IMRT 1
M. Matsuo , O. Tanaka1, T. Ishihara1, Y. Nishida1, H. Nshibori1, Y. Tsuge1, M. Yoshida1, H. Kato2 1
Kizawa Memorial Hospital, Minokamo, Japan, 2Gifu University, Gifu, Japan
Purpose/Objective(s): The aim of this work was to evaluate magnetic resonance imaging (MRI) findings of 150 prostate cancer patients at pre- and post- intensity-modulated radiotherapy (IMRT). Materials/Methods: 150 patients (mean age: 69 years; range: 51-84 years) with histologically proven non-metastatic prostate cancer were included in this study. Hormonal therapy was used in 88 of the 150 patients. The TomoTherapy-based IMRT prescription was 70-78 Gy (2 Gy/fraction) to the prostate and the proximal seminal vesicles, and the patients underwent daily megavoltage CT image-guided verification prior to each treatment. All the patients received one pre IMRT MRI scan and one or more post IMRT follow-up MRI scans of the pelvis at 1.5 Tesla. The T1-weigthed (WI), T2-WI and diffusion-WI MR images were retrospectively assessed by two independent observers. The toxicity scores were recorded every 3 months post IMRT with using
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S354
Volume 78, Number 3, Supplement, 2010
Conclusions: When used in combination with brachytherapy, IMRT offers less acute urinary toxicities, a higher QOL and less grade 2 or worse rectal bleeding compared to 3DCRT. Author Disclosure: K. Forsythe, None; S.R. Blacksburg, None; N.N. Stone, Prologics, LLC, E. Ownership Interest; Nihan MediPhysics, F. Consultant/Advisory Board; B&K Medical, F. Consultant/Advisory Board; R.G. Stock, None.
2336
Urinary Retention following Prostate Seed Implant Brachytherapy following Rigid Cystoscopy
K. E. Fox1, J. Choe1, T. Radivoyevitch1, D. Einstein1,2 1
Case Western Medical Center, Cleveland, OH, 2Wright State University School of Medicine, Dayton, OH
Purpose/Objective(s): Transperineal ultrasound guided prostate seed brachytherapy (PSI) is a common procedure performed for the long-term control of prostate cancer. After the completion of the procedure, a cystoscopy is often performed to ensure that no seeds were inadvertently introduced into the bladder. After the patient recovers, he is generally given a trial of voiding. If the patient cannot urinate or has significant urinary retention, a Foley catheter is generally replaced, and the patient is sent home with the catheter for 1-2 weeks to allow for a decrease in prostatic edema. Published studies have shown differences in urinary symptoms for patients who underwent rigid versus flexible cystoscopy outside of the setting of PSI. Here, we investigate possible factors including cystoscopy that may contribute to urinary toxicity, the most common form of toxicity in patients receiving PSI. Materials/Methods: A retrospective chart review was performed for 62 consecutive patients who received PSI at our institution from 12/2006 to 9/2009. Possible contributing factors were collected: whether or not cystoscopy was performed and type of cystoscopy, prostate volume, isotope type, and the number of seeds and needles used. Possible outcomes were collected: Foley catheter requirement immediately after PSI and International Prostate Symptom Score (IPSS) at the time of first follow-up (if in the first 3 months) as well as the change from the pre-procedure IPSS. Results: There was a large and significant difference (p = 0.0000454) between rates if Foley catheter requirement after rigid cystoscopy (75.0%) versus flexible cystoscopy (17.2%) and no cystoscopy (12.5%) by Chi-square analysis. There was no statistical difference between flexible and no cystoscopy. Foley catheter requirement was not associated with prostate volume, isotope, or the number of seeds and needles. No factors were associated with post-implant IPSS. Conclusions: We report a strong singular association between rigid cystoscopy and Foley catheter requirement after PSI in our institutional experience. Although rigid cystoscopy is often favored by urologists for better visualization, flexible cystoscopy should be performed instead whenever possible to reduce the risk of urinary retention and Foley catheter requirement after PSI. Author Disclosure: K.E. Fox, None; J. Choe, None; T. Radivoyevitch, None; D. Einstein, None.
2337
Long-term (potential 10 year follow-up) Toxicity after Treatment for Prostate Cancer with Either External Beam Radiation Therapy, Interstitial Brachytherapy, or Radical Prostatectomy
G. K. Hunter1, C. A. Reddy1, K. Angermeier1, J. Ulchaker1, C. Zippe2, K. Stephans1, R. Tendulkar1, P. A. Kupelian3, E. A. Klein1, J. P. Ciezki1 1 Cleveland Clinic, Cleveland, OH, 2Case Western Reserve University Hospital, Cleveland, OH, 3MD Anderson Orlando, Orlando, FL
Purpose/Objective(s): To examine gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated in 1999 with external beam radiotherapy (RT), prostate interstitial brachytherapy (PI) or radical prostatectomy (RP). Materials/Methods: The records of 454 patients treated in 1999 were retrospectively reviewed to evaluate toxicity profiles. Twenty-six percent of the patients were treated with PI, 36% with RP, and 38% with RT. Late GI and GU morbidity profiles were specifically examined and both profiles were graded according to the RTOG acute and late morbidity scoring criteria. Other factors examined in the analysis were patient age, BMI, smoking history, and medical co-morbidities including presence of diabetes mellitus (DM), peripheral vascular disease (PVD), and connective tissue disease. Due to the low event rate for late GU and GI toxicities, a competing risk regression (CRR) analysis was done with death at the competing event. Results: Median follow-up time was 8.6 years (range 0.2-11.3). Cumulative incidence rates (%) of late GU toxicity Grade $2 at 2, 5, and 10 years post-treatment were 2.4, 8.6, 11.2 for RT, 0.9, 3.5, 5.1 for PI, and 0.6, 3.2, 5.6 for RP (p = 0.0140 for RP vs. RT.; p = 0.86 for RP vs. PI, p = 0.0385 for PI vs. RT). Cumulative incidence rates of late GI toxicity Grade $2 at 2, 5, and 10 years post-treatment up was 5.4, 7.8, 8.5 for RT, 0, 1.7, 1.7 for PI, and 0, 0, 0 for RP (p = 0.002 for RP vs. RT, p = 0.15 for RP vs. PI, p = 0.0066 for PI vs. RT). On CRR univariate analysis only the presence of DM was associated with GU toxicity Grade $2 (p = 0.01, HR 2.83, 95% CI = 1.28-6.28). Since there were no events in the RP group, only the PI and RT patients were included in the CRR analysis for late GI toxicity Grade $2. On univariate analysis, RT and DM were significantly associated with late GI toxicity. On multivariable analysis, both variables remained significant (RT: p = 0.029, HR = 5.07, 95% CI = 1.18-21.8; DM: p = 0.013, HR = 3.47, 95% CI = 1.3-9.27). Conclusions: The presence of DM at the time of treatment was significantly associated with worse late GI and GU toxicity RT was significantly associated with worse late GI toxicity compared to PI and RP. Author Disclosure: G.K. Hunter, None; C.A. Reddy, None; K. Angermeier, None; J. Ulchaker, None; C. Zippe, None; K. Stephans, None; R. Tendulkar, None; P.A. Kupelian, None; E.A. Klein, None; J.P. Ciezki, None.
2338
Monotherapeutic High-dose-Rate Brachytherapy for Prostate Cancer: 15 years Experience of Osaka University
K. Konishi, Y. Yoshioka, I. Sumida, Y. Takahashi, T. Ogata, F. Isohashi, M. Koizumi, T. Inoue Departament of Radiation Oncology, Osaka University Graduate School of Medicine, Suita Osaka, Japan Purpose/Objective(s): High-dose-rate brachytherapy (HDR-BT) is at a clinical trial phase, with an expectation that it can treat even an extracapsular invaded prostate cancer with more escalated biological dose, using a precise dose distribution and extreme
Proceedings of the 52nd Annual ASTRO Meeting hypofractionation. HDR-BT had been performed only in a combination with external beam radiotherapy (EBRT) until our previously reported initial and unique experience of HDR-BT as monotherapy (Int J Radiat Oncol Biol Phys, 2000). The purpose of the current report is to evaluate the feasibility, toxicity and efficacy of monotherapeutic HDR-BT for prostate cancer, with more patient accrual and longer follow-up. Materials/Methods: From May 1995 through December 2009, 163 patients with prostate cancer without nodal or distant metastasis were treated with HDR-BT alone, without EBRT, at Osaka University Hospital, Japan. Median age was 68 (range 45-81), T1:T2:T3:T4 = 42:55:58:8, median Gleason Score 7 (range 2-10), and median pretreatment PSA level 15 ng/ml (range 3.8337). Fifteen patients were considered low-risk, 57 intermediate-risk, and 91 high-risk. Twice daily irradiation with more than 6-hour intervals was adopted, with the total dose of 48 Gy/8 fractions/5 days, 54 Gy/9 fractions/5 days, or 45.5 Gy/7 fractions/ 4 days. Of the 163 patients, 124 also received neoadjuvant and/or adjuvant hormonal therapy. Median follow-up time was 54 months. Results: All the patients completed the treatment regimen. No significant intra- or peri-operative complications occurred. Acute toxicities of Grade 3, 2, and 1 occurred in 6, 24, and 60 patients, respectively. Late toxicities of Grade 3, 2, and 1 occurred in 4, 14, and 32 patients, respectively. Acute and late toxicity of Grade 4 or more did not occur. The 5-year PSA failure-free, disease-free survival, and overall survival rate was 83%, 87%, and 96%, respectively. The 5-year PSA failure-free rate for low-, intermediate-, and high-risk patients was 91%, 93%, and 77%, respectively. Conclusions: Monotherapeutic HDR-BT associated with hormonal therapy was feasible and its toxicity was acceptable. Shortterm tumor control was promising, even for patients with locally advanced disease. The presented extreme hypofractionation regimens of 45.5-54 Gy in 7-9 fractions of 6-6.5 Gy might be referred to by other terms, such as stereotactic body radiotherapy. Studies with longer follow-up periods and from multiple institutions are needed to confirm the efficacy of this novel approach. Author Disclosure: K. Konishi, None; Y. Yoshioka, None; I. Sumida, None; Y. Takahashi, None; T. Ogata, None; F. Isohashi, None; M. Koizumi, None; T. Inoue, None.
2339
Prospective Trial of Escalating Doses of Paclitaxel, Concurrent Radiation and Androgen Deprivation in High-risk Prostate Cancer with or without Prior Prostatectomy
Y. Kwok1, Y. Wu1, A. Mirmiran1, S. DiBiase2, O. Goloubeva1, B. Bridges1, H. Mannuel1, N. Dawson3, P. Amin1, A. Hussain1 1
University of Maryland School of Medicine, Baltimore, MD, 2Cooper University Hospital, Camden, NJ, 3Georgetown University School of Medicine, Washington DC, DC Purpose/Objective(s): To evaluate the tolerability and efficacy of weekly paclitaxel, concurrent radiation and androgen deprivation (ADT) in patients with high risk prostate cancer (PC) with or without prior prostatectomy (RP). Materials/Methods: For this prospective trial, eligible post-RP patients included pathological T3 disease or rising PSA $ 0.5ng/ml post-RP. Eligible locally-advanced PC (LAPC) patients included: 1) cT2b-4N0N+, M0; 2) Gleason Score (GS) 810; 3) GS 7 + PSA 10-20ng/ml; or 4) PSA 20-150ng/ml. Treatment included ADT (4 or 24 months), weekly paclitaxel [40 (n = 10) , 50 (n = 31), or 60mg/m2/wk (n = 18)], and pelvic radiation therapy (total dose: RP = 64.8 Gy; LAPC = 70.2 Gy). Acute and late toxicities were graded via the CTC and modified RTOG-LENT scales, respectively. The freedom from biochemical failure rates were computed using the Phoenix definition (PSA nadir + 2ngm/ml) for LAPC and PSA . 0.5ng/ml for RP patients. Results: Between October 1999 and July 2006, 59 patients were enrolled [LAPC (n = 29), RP (n = 30); ADT: 4 months (n = 29), 24 months (n = 30); Race: Whites (n = 29), African Americans [AA] (n = 28); N+ (n = 7)]. The median follow-up was 75.3 months (range, 7-103 months; 95% CI: 66.8-82.3 months). Baseline characteristics [median, (range)] were: age 67 (45-86 years), PSA 5.9 (0.1-92.1ng/ml), GS 8 (6-9). At escalating doses of paclitaxel, 95-98% of doses were given with radiation and ADT, with dose modifications required primarily in RP patients. No acute grade 4 toxicities occurred. Grade 3 toxicities were diarrhea (15%), urinary urgency/incontinence (10%), tenesmus (5%), leukopenia (3%). Only 5% experienced late grade 3 (n = 2) or 4 (n = 1) GI/GU toxicities. Biochemical progression occurred in 24 (41%) patients, clinical progression in 11 (19%) patients. The 5- and 7-year OS rates were 83% and 67%, respectively. There were no differences in OS between RP and LAPC, 4- and 24-month ADT, White and AA patient categories. Conclusions: With a median follow-up of 75.3 months, this trial represents the longest follow-up of patients treated with concurrent taxane-based chemotherapy with EBRT in men with high risk prostate cancer. Concurrent ADT, radiation and weekly paclitaxel at 40mg/m2/wk in RP patients and 60mg/m2/wk in LAPC patients is feasible and well-tolerated. Author Disclosure: Y. Kwok, None; Y. Wu, None; A. Mirmiran, None; S. DiBiase, None; O. Goloubeva, None; B. Bridges, None; H. Mannuel, None; N. Dawson, None; P. Amin, None; A. Hussain, Bristol-Myers Squibb, B. Research Grant.
2340
Usefulness of MRI Findings of Prostate Cancer before and after Tomotherapy-based IMRT 1
M. Matsuo , O. Tanaka1, T. Ishihara1, Y. Nishida1, H. Nshibori1, Y. Tsuge1, M. Yoshida1, H. Kato2 1
Kizawa Memorial Hospital, Minokamo, Japan, 2Gifu University, Gifu, Japan
Purpose/Objective(s): The aim of this work was to evaluate magnetic resonance imaging (MRI) findings of 150 prostate cancer patients at pre- and post- intensity-modulated radiotherapy (IMRT). Materials/Methods: 150 patients (mean age: 69 years; range: 51-84 years) with histologically proven non-metastatic prostate cancer were included in this study. Hormonal therapy was used in 88 of the 150 patients. The TomoTherapy-based IMRT prescription was 70-78 Gy (2 Gy/fraction) to the prostate and the proximal seminal vesicles, and the patients underwent daily megavoltage CT image-guided verification prior to each treatment. All the patients received one pre IMRT MRI scan and one or more post IMRT follow-up MRI scans of the pelvis at 1.5 Tesla. The T1-weigthed (WI), T2-WI and diffusion-WI MR images were retrospectively assessed by two independent observers. The toxicity scores were recorded every 3 months post IMRT with using
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