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Multi-institutional Outcome Following LDR Brachytherapy in Patients with Higher Risk Prostate Cancer
Abstracts / Clinical Oncology 24 (2012) 152e157 Late grade 2 rectal toxicity in 3 patients, grade 3 toxicity in 1 patient and no grade 4 toxicities. Conclusions: This retrospective series suggests that pelvic EBRT with HDRB boost provides robust local/pelvic control in the treatment of high risk prostate cancer with an acceptable toxicity profile.
Acute Toxicity Rates in Patients Receiving Salvage Radical Prostate Irradiation Following Primary High Intensity Focused Ultrasound (HIFU) for Localised Prostate Cancer A. Aggarwal, R. Davda, M. Emberton, H. Payne University College Hospital NHS Foundation Trust, London, UK Introduction: HIFU is used in the treatment of primary prostate cancer. It aims to achieve cancer control while offering a potentially more favourable toxicity profile [1]. Long term randomised data are currently unavailable to support this [2]. Approximately 15% of patients receiving primary HIFU will require additional treatment [3], depending on the stage and grade at relapse. There are no published UK data on efficacy or safety of radical radiotherapy after primary HIFU. We present a case series reporting acute radiotherapy toxicity in patients treated with primary HIFU. Materials and methods: Our study included 14 consecutive patients treated with salvage radiotherapy between 2009 and 2011 post-primary HIFU. Baseline demographic data were collected, including initial stage, PSA nadir, number of HIFU treatments and interval until relapse. All patients received hormone therapy and radiotherapy to 74 Gy either conformally or with IMRT using departmental PTV margins. Weekly IGRT was performed and patients followed strict bladder and rectal protocols. Acute genitourinary (GU) and lower gastrointestinal (GI) toxicity was graded prospectively at the end of treatment and 4 weeks after completion using RTOG acute morbidity scoring criteria [4]. Results: Median age was 72 (61e79). 12 patients had received prior whole gland HIFU and 2 partial gland. Median interval to radiotherapy treatment was 16 months (8e39). Acute GU toxicity rate at end of treatment: G1 (35%), G2 (21%), G3 (0%). Acute GI toxicity rate at end of treatment: G1 (42%), G2 (14%), G3 (0%). Four weeks post radiotherapy 14% had persistent G1 GU toxicity and 21% G1 GI toxicity. Conclusions: Acute toxicity outcomes in our series are comparable with other published studies [5] and suggest that radical radiotherapy is well tolerated in patients who have received primary whole gland/partial HIFU [6]. There is a need for long term outcome and toxicity data in this setting. References [1] Ahmed H, Zacharakis E, Dudderidge T, et al. Highintensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series. Br J Cancer 2009;101:19e26. [2] Lukka H, Waldron T, Chin J, et al. High-intensity focused ultrasound for prostate cancer: a systematic review. Clin Oncol (R Coll Radiol) 2011;23(2):117e127. € roff S, Murat F-J, et al. Long-term results with high intensity [3] Blana A, Thu focused ultrasound (HIFU) in 140 patients with localized prostate cancer [abstract]. Eur Urol Suppl 2007;6:199. [4] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5): 1341e1364. [5] Matzinger O, Duclos F, Bergh Avd, et al. Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991. Eur J Cancer 2009;45:2825e2834. [6] Riviere J, Bernhard J-C, Robert G, et al. Salvage radiotherapy after high-intensity focussed ultrasound for recurrent localised prostate cancer. Eur Urol 2010;58:567e573.
Multi-institutional Outcome Following LDR Brachytherapy in Patients with Higher Risk Prostate Cancer R. Conroy *, P. Hoskin y, D. Bottomley z, P. Mandall *, R. Swindell *, J. Wylie * * The Christie NHS Foundation Trust, Manchester, UK
y z
155
Mount Vernon Cancer Centre, Northwood, Middlesex, UK St James' Institute of Oncology, Leeds, UK
Introduction: We report the outcomes for a cohort of men with higher risk prostate adenocarcinoma treated with LDR brachytherapy in a multi-institutional UK practice. Materials and methods: 217 men treated between 2003 and 2007 with iodine125 brachytherapy at Christie, Leeds and Mount Vernon were identified from a multi-institutional database. Higher risk was defined as patients with 2 D'Amico intermediate risk factors (PSA 10e20, GS 7 or clinical T2c) or 1 high risk factor (PSA > 20, GS 8). KaplaneMeier methods were used to estimate biochemical relapse free survival (BRFS) defined using both Phoenix and ASTRO definitions. A univariate analysis was performed to assess the significance of Gleason score, PSA, T-stage, pre- or post-implant dosimetry, and additional hormones on BRFS. Results: The median age was 65 years (43e79 years) with a median PSA follow up of 4 years (14e90 months). Median pre-implant doses (ranges) were: V150 59.6 (43.7e89.8), V200 20.1 (11.6e36). 75 patients had postimplant dosimetry, median dose (range) was: D90 132.8 Gy (75e192 Gy). No patients had external beam radiotherapy. 67 patients had additional hormone treatment, median duration 7 months (3e22 months). The 3 and 5 year BRFS as defined by Phoenix were 84.8% and 70.7% and as defined by ASTRO were 79% and 74%. On univariate analysis there were no statistically significant predictors of inferior outcome. Conclusions: LDR brachytherapy is well established as a treatment for low risk prostate adenocarcinoma. Although it has not been established as a suitable single modality treatment for high-intermediate/high risk patients our results suggest that the outcomes are comparable with other treatment modalities available to these patients. Although long-term analysis and further work is required it may be that LDR brachytherapy is a suitable treatment for selected higher risk patients.
Sunitinib Malate in the Treatment of Metastatic Renal Cell Carcinoma: the North of England Cancer Network (NECN) Experience R.A. Goranova *, B.B. Goranov y, I.D. Pedley *, A. Azzabi *, A. Humphreys y, R. McMenemin *, J.A. Frew * * Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK y James Cook University Hospital, Middlesborough, UK Introduction: Metastatic renal cell carcinoma (mRCC) has a poor prognosis. Treatment aims to improve progression free survival (PFS) and overall survival (OS). Sunitinib gained NICE approval in March 2009 as first line treatment and experience with it is growing. The NECN was the first in the UK to approve the use of Sunitinib in July 2007. This retrospective re-audit compares the NECN patient outcomes with published literature, updating previous NECN work from 2008. Materials and methods: Data were collected and analysed regarding all patients started on Sunitinib from 01/07/2007 to 30/09/2010. Follow up extended to 28/02/2011. Results: 129 patients were identified with a median age of 63 years (range 21e87), 67% were male and WHO performance status was 0, 1 or 2 (33%, 51%, 16%). 80% of patients had nephrectomy (60% radical, 40% cytoreductive) and 22% of patients had prior systemic treatment, predominantly with interferon-a. The median PFS was 10 months (range 0.25e27). The median OS (from Sunitinib initiation) was 17 months (range 0.25e47). The median number of treatment cycles was 5 (range 0.25e27). 64% of patients had a dose modification. 9% of patients had a schedule modification to reduce toxicity. 21% of all patients had a delay of 4 weeks or more, which was not detrimental to median PFS. 60% of patients experienced CTC V3 grade 2 or more toxicity, of which 41% were gastrointestinal. 8.5% of all patients stopped treatment due to side effects. 15% of patients required treatment for hypothyroidism, which was associated with a doubling of PFS (P ¼ 0.055). Conclusions: PFS in the NECN population is similar to trial data. Treatment of PS 2 patients is associated with similar outcomes suggesting this is a good therapeutic option. Strategies to deal with side effects, including dose reduction, treatment delay and schedule changes, did not adversely affect PFS.
Acute Toxicity Rates in Patients Receiving Salvage Radical Prostate Irradiation Following Primary High Intensity Focused Ultrasound (HIFU) for Localised Prostate Cancer A. Aggarwal, R. Davda, M. Emberton, H. Payne University College Hospital NHS Foundation Trust, London, UK Introduction: HIFU is used in the treatment of primary prostate cancer. It aims to achieve cancer control while offering a potentially more favourable toxicity profile [1]. Long term randomised data are currently unavailable to support this [2]. Approximately 15% of patients receiving primary HIFU will require additional treatment [3], depending on the stage and grade at relapse. There are no published UK data on efficacy or safety of radical radiotherapy after primary HIFU. We present a case series reporting acute radiotherapy toxicity in patients treated with primary HIFU. Materials and methods: Our study included 14 consecutive patients treated with salvage radiotherapy between 2009 and 2011 post-primary HIFU. Baseline demographic data were collected, including initial stage, PSA nadir, number of HIFU treatments and interval until relapse. All patients received hormone therapy and radiotherapy to 74 Gy either conformally or with IMRT using departmental PTV margins. Weekly IGRT was performed and patients followed strict bladder and rectal protocols. Acute genitourinary (GU) and lower gastrointestinal (GI) toxicity was graded prospectively at the end of treatment and 4 weeks after completion using RTOG acute morbidity scoring criteria [4]. Results: Median age was 72 (61e79). 12 patients had received prior whole gland HIFU and 2 partial gland. Median interval to radiotherapy treatment was 16 months (8e39). Acute GU toxicity rate at end of treatment: G1 (35%), G2 (21%), G3 (0%). Acute GI toxicity rate at end of treatment: G1 (42%), G2 (14%), G3 (0%). Four weeks post radiotherapy 14% had persistent G1 GU toxicity and 21% G1 GI toxicity. Conclusions: Acute toxicity outcomes in our series are comparable with other published studies [5] and suggest that radical radiotherapy is well tolerated in patients who have received primary whole gland/partial HIFU [6]. There is a need for long term outcome and toxicity data in this setting. References [1] Ahmed H, Zacharakis E, Dudderidge T, et al. Highintensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series. Br J Cancer 2009;101:19e26. [2] Lukka H, Waldron T, Chin J, et al. High-intensity focused ultrasound for prostate cancer: a systematic review. Clin Oncol (R Coll Radiol) 2011;23(2):117e127. € roff S, Murat F-J, et al. Long-term results with high intensity [3] Blana A, Thu focused ultrasound (HIFU) in 140 patients with localized prostate cancer [abstract]. Eur Urol Suppl 2007;6:199. [4] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5): 1341e1364. [5] Matzinger O, Duclos F, Bergh Avd, et al. Acute toxicity of curative radiotherapy for intermediate- and high-risk localised prostate cancer in the EORTC trial 22991. Eur J Cancer 2009;45:2825e2834. [6] Riviere J, Bernhard J-C, Robert G, et al. Salvage radiotherapy after high-intensity focussed ultrasound for recurrent localised prostate cancer. Eur Urol 2010;58:567e573.
Multi-institutional Outcome Following LDR Brachytherapy in Patients with Higher Risk Prostate Cancer R. Conroy *, P. Hoskin y, D. Bottomley z, P. Mandall *, R. Swindell *, J. Wylie * * The Christie NHS Foundation Trust, Manchester, UK
y z
155
Mount Vernon Cancer Centre, Northwood, Middlesex, UK St James' Institute of Oncology, Leeds, UK
Introduction: We report the outcomes for a cohort of men with higher risk prostate adenocarcinoma treated with LDR brachytherapy in a multi-institutional UK practice. Materials and methods: 217 men treated between 2003 and 2007 with iodine125 brachytherapy at Christie, Leeds and Mount Vernon were identified from a multi-institutional database. Higher risk was defined as patients with 2 D'Amico intermediate risk factors (PSA 10e20, GS 7 or clinical T2c) or 1 high risk factor (PSA > 20, GS 8). KaplaneMeier methods were used to estimate biochemical relapse free survival (BRFS) defined using both Phoenix and ASTRO definitions. A univariate analysis was performed to assess the significance of Gleason score, PSA, T-stage, pre- or post-implant dosimetry, and additional hormones on BRFS. Results: The median age was 65 years (43e79 years) with a median PSA follow up of 4 years (14e90 months). Median pre-implant doses (ranges) were: V150 59.6 (43.7e89.8), V200 20.1 (11.6e36). 75 patients had postimplant dosimetry, median dose (range) was: D90 132.8 Gy (75e192 Gy). No patients had external beam radiotherapy. 67 patients had additional hormone treatment, median duration 7 months (3e22 months). The 3 and 5 year BRFS as defined by Phoenix were 84.8% and 70.7% and as defined by ASTRO were 79% and 74%. On univariate analysis there were no statistically significant predictors of inferior outcome. Conclusions: LDR brachytherapy is well established as a treatment for low risk prostate adenocarcinoma. Although it has not been established as a suitable single modality treatment for high-intermediate/high risk patients our results suggest that the outcomes are comparable with other treatment modalities available to these patients. Although long-term analysis and further work is required it may be that LDR brachytherapy is a suitable treatment for selected higher risk patients.
Sunitinib Malate in the Treatment of Metastatic Renal Cell Carcinoma: the North of England Cancer Network (NECN) Experience R.A. Goranova *, B.B. Goranov y, I.D. Pedley *, A. Azzabi *, A. Humphreys y, R. McMenemin *, J.A. Frew * * Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK y James Cook University Hospital, Middlesborough, UK Introduction: Metastatic renal cell carcinoma (mRCC) has a poor prognosis. Treatment aims to improve progression free survival (PFS) and overall survival (OS). Sunitinib gained NICE approval in March 2009 as first line treatment and experience with it is growing. The NECN was the first in the UK to approve the use of Sunitinib in July 2007. This retrospective re-audit compares the NECN patient outcomes with published literature, updating previous NECN work from 2008. Materials and methods: Data were collected and analysed regarding all patients started on Sunitinib from 01/07/2007 to 30/09/2010. Follow up extended to 28/02/2011. Results: 129 patients were identified with a median age of 63 years (range 21e87), 67% were male and WHO performance status was 0, 1 or 2 (33%, 51%, 16%). 80% of patients had nephrectomy (60% radical, 40% cytoreductive) and 22% of patients had prior systemic treatment, predominantly with interferon-a. The median PFS was 10 months (range 0.25e27). The median OS (from Sunitinib initiation) was 17 months (range 0.25e47). The median number of treatment cycles was 5 (range 0.25e27). 64% of patients had a dose modification. 9% of patients had a schedule modification to reduce toxicity. 21% of all patients had a delay of 4 weeks or more, which was not detrimental to median PFS. 60% of patients experienced CTC V3 grade 2 or more toxicity, of which 41% were gastrointestinal. 8.5% of all patients stopped treatment due to side effects. 15% of patients required treatment for hypothyroidism, which was associated with a doubling of PFS (P ¼ 0.055). Conclusions: PFS in the NECN population is similar to trial data. Treatment of PS 2 patients is associated with similar outcomes suggesting this is a good therapeutic option. Strategies to deal with side effects, including dose reduction, treatment delay and schedule changes, did not adversely affect PFS.