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P107 Dosimetric evaluation of the feasibility of an intraprostatic boost according to gross-tumor-volumes (GTVs) location for prostate cancer patients treated with combined external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT)
posters / european urology supplements 11 (2012) 191–235
Material & Methods: We reviewed the clinical records of all pts with BM referred at Santa Chiara Hospital ORDs from 1994 to 2011: since DOC was introduced into our clinical practice in 2003, we separately evaluated two periods (P1: 1994–2002; P2: 2003–2011). We limited our search to male pts to avoid the bias due to the incidence of BM from breast cancer. For each pt we assess the primary tumor diagnosis and in the case of PC diagnosis we recorded all relevant issues of the clinical history. Results: In the study period 490 males with BM were referred to our ORDs (P1 = 241 pts; P2 = 249). The most frequent recognized primary tumor was lung cancer, with a similar percentage of BM for P1 and P2 (58.9 vs 60.6%). Concerning PC we collected a series of 9 pts with BM: 2 pts in P1 and 7 in P2 (0.8% and 2.8%, respectively). The median age at the diagnosis of PC was 64 yrs (range 65–78). All but 2 pts had a CRPC: among them, 6 pts developed BM during or after a DOC-based chemotherapy and 1 before first line DOC start. The median interval from the PC diagnosis and the achievement of CRPC was 25 mos (range 5–84) while the appearance of BM was documented after 0–111 mos (median 36) from diagnosis. The median survival after BM was 8 wks (range 1–54). Conclusions: Our data appear to confirm that: 1) the BM from PC pts are more frequent than in the past; 2) this finding could be related to a survival improvement due to DOC introduction in the clinical practice; 3) a special attention should be reserved to the appearance of neurological symptoms in a long-term CRPC survivor due to a possible relation with BM. P107 Dosimetric evaluation of the feasibility of an intraprostatic boost according to gross-tumor-volumes (GTVs) location for prostate cancer patients treated with combined external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) J. Helou1 , R. Verstraet2 , P. Blanchard1 , A. Rodriguez2 , D. Lefkopoulos2 , J. Bourhis1 , L. Calmel2 , F. Azoury1 , A. Bossi1 . 1 Institut Gustave Roussy, Dept. of Radiation Oncology, Villejuif, France; 2 Institut Gustave Roussy, Dept. of Medical Physics, Villejuif, France Introduction & Objectives: HDR-BT allows for dose escalation to the whole prostatic gland volume and for a selective intraprostatic GTV boost. Short and long term urethral and rectal toxicity may limit intra-prostatic dose escalation. Our study aims to identify the dosimetric feasibility and limitations of an intra-prostatic boost to different GTVs locations according to 4 dose levels. Material & Methods: The study was conducted on 18 patients treated on an institutional protocol of combined HDR-BT single fraction of 9.5 Gy (= Prescribed dose, PD) followed by EBRT delivered with Intensity modulated technique (IMRT). The GTV locations studied for the intra-prostatic boost were; posterolateral, total posterior, antero-lateral, total anterior and 3 volumes in the apical zone characterized by different heights in the apex-base direction: 15, 20 and 25 mm. All patients had a standard optimization with the 90% of the CTV receiving 100 to 105% of the PD. Four boost-dose levels were studied: 100%, 120%, 135% and 150% of the PD. The urethral and rectal D0.1 and D0.5 cc were reported for every dose level. Results: An intraprostatic dose escalation on the postero-lateral GTV had no significant impact on the urethral D0.1 cc and D0.5 cc, while a significant increase in the rectal D0.1 cc (74, 77, 80 and 84% for every dose level respectively) and D0.5 cc (68, 70, 72 and 75%) was noted (p < 0.05). Similarly, a boost on the total posterior GTV had a significant impact on the rectal D0.1 cc (74, 77, 78 and 81%) and D0.5 cc (67, 70, 71 and 73%) (p < 0.05), while the urethral D0.1 cc increased significantly only for a boost of 150% (p = 0.013). An antero-lateral and total
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anterior boost significantly increased the urethral D0.1 cc for a dose ≥135% (p = 0.007 and 0.01 respectively) while significantly decreasing the rectal doses. No significant impact of an apical dose escalation was seen on the urethra whereas the rectal doses increased significantly for a boost ≥135% (p < 0.05). No major increase on rectal and urethral doses was observed with the 120 % boost level except for the posterior GTV (D0.1 cc = 77%). However, this increase is still within acceptable limits. Conclusions: Delivering an intra-prostatic boost dose of 120 % of the PD with HDR-BT is feasible and safe regardless of the GTV location. Further increases of the intra-prostatic boost dose may be possible only by carefully evaluating the spatial distribution of the GTV as well as the rectal and urethral doses. P108 Helical tomotherapy in prostate cancer: Minimizing toxicity C. Acebedo1 , J.L. Lopez ´ Guerra1 , E. Rivin Del Campo2 , R. Matute1 , N. Isa1 , F. Puebla1 , M. Russo3 , A. Sanchez-Reyes4 , C. Beltran ´ 1, 1 5 1 J. Jaen ´ , H. Marsiglia . Instituto Madrile˜ no De Oncolog´ıa/Grupo IMO, Dept. of Radiation Oncology, Madrid, Spain; 2 Hospital General De Elche. ERESA, Dept. of Radiation Oncology, Elche, Spain; 3 Radiomedicine Institute IRAM, Dept. of Radiation Oncology, Santiago, Chile; 4 Instituto Madrile˜ no De Oncolog´ıa/Grupo IMO, Dept. of Radiation Physics, Madrid, Spain; 5 Institut De Canc´erologie Gustave Roussy, Dept. of Radiation Oncology, Villejuif, Paris, France Introduction & Objectives: Radiation-induced toxicity is an important adverse event that affects most patients receiving radiation therapy (RT) for prostate cancer (PC), especially for those who underwent prior treatment such as surgery. Intensity modulated radiation therapy has been shown to decrease acute toxicity. We present the clinical results of intensity-modulated radiation therapy with helical tomotherapy (HT) for clinically localized and recurrent PC, as well as post-prostatectomy adjuvant treatment. Material & Methods: From May 2006 to January 2011, 70 cT1-T3 cN0 cM0 PC patients were treated with HT (primary diagnosis, n = 48; post-prostatectomy biochemical recurrence, n = 15; post-brachytherapy biochemical recurrence, n = 2; and post-prostatectomy adjuvance, n = 5). The dose prescribed to the prostate ranged between 72–78 Gy, except for one case (post-brachytherapy recurrence, 66 Gy) with conventional fractionation (2 Gy/fraction). The seminal vesicles received between 50–56 Gy, the surgical bed 66–74 Gy, and the pelvic lymph nodes 46–50.4 Gy (n = 20), respectively when applicable, with conventional fractionation. Minimum follow-up was 3 months. Demographic, tumor and treatment characteristics were recorded and analyzed. The follow-up was calculated from the HT start date to the last contact date. For patients with a primary diagnosis or those receiving adjuvant HT, survival time was measured from the diagnosis date to the last contact date for alive patients or the date of death if the patient had died. For patients receiving HT for biochemical recurrence, survival time was measured from the recurrence diagnosis date to the last contact date for alive patients or the date of death for deceased patients. Genitourinary (GU) and gastrointestinal (GI) toxicity was scored using the Radiation Therapy Oncology Group (RTOG) scoring system. Results: The median age was 68 years (range 51–87 years). The median follow-up was 37 months (range 3–74 months). The mean initial Gleason score was 6±1 and the mean initial PSA was 17.11±35 ng/ml. The mean total dose was 75.48±2.88 Gy for prostate, 54.04±1.13 Gy for seminal vesicles, 67.8±3.7 Gy for the surgical bed, and 46.32±1.4 for pelvic lymph nodes. The mean vesical and rectal volumes were 149±90 cc and 79.05±28 cc, respectively. For patients with a primary diagnosis or those receiving adjuvant HT, median overall survival was 45 months (range, 8–82 months). For patients receiving HT for
Material & Methods: We reviewed the clinical records of all pts with BM referred at Santa Chiara Hospital ORDs from 1994 to 2011: since DOC was introduced into our clinical practice in 2003, we separately evaluated two periods (P1: 1994–2002; P2: 2003–2011). We limited our search to male pts to avoid the bias due to the incidence of BM from breast cancer. For each pt we assess the primary tumor diagnosis and in the case of PC diagnosis we recorded all relevant issues of the clinical history. Results: In the study period 490 males with BM were referred to our ORDs (P1 = 241 pts; P2 = 249). The most frequent recognized primary tumor was lung cancer, with a similar percentage of BM for P1 and P2 (58.9 vs 60.6%). Concerning PC we collected a series of 9 pts with BM: 2 pts in P1 and 7 in P2 (0.8% and 2.8%, respectively). The median age at the diagnosis of PC was 64 yrs (range 65–78). All but 2 pts had a CRPC: among them, 6 pts developed BM during or after a DOC-based chemotherapy and 1 before first line DOC start. The median interval from the PC diagnosis and the achievement of CRPC was 25 mos (range 5–84) while the appearance of BM was documented after 0–111 mos (median 36) from diagnosis. The median survival after BM was 8 wks (range 1–54). Conclusions: Our data appear to confirm that: 1) the BM from PC pts are more frequent than in the past; 2) this finding could be related to a survival improvement due to DOC introduction in the clinical practice; 3) a special attention should be reserved to the appearance of neurological symptoms in a long-term CRPC survivor due to a possible relation with BM. P107 Dosimetric evaluation of the feasibility of an intraprostatic boost according to gross-tumor-volumes (GTVs) location for prostate cancer patients treated with combined external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) J. Helou1 , R. Verstraet2 , P. Blanchard1 , A. Rodriguez2 , D. Lefkopoulos2 , J. Bourhis1 , L. Calmel2 , F. Azoury1 , A. Bossi1 . 1 Institut Gustave Roussy, Dept. of Radiation Oncology, Villejuif, France; 2 Institut Gustave Roussy, Dept. of Medical Physics, Villejuif, France Introduction & Objectives: HDR-BT allows for dose escalation to the whole prostatic gland volume and for a selective intraprostatic GTV boost. Short and long term urethral and rectal toxicity may limit intra-prostatic dose escalation. Our study aims to identify the dosimetric feasibility and limitations of an intra-prostatic boost to different GTVs locations according to 4 dose levels. Material & Methods: The study was conducted on 18 patients treated on an institutional protocol of combined HDR-BT single fraction of 9.5 Gy (= Prescribed dose, PD) followed by EBRT delivered with Intensity modulated technique (IMRT). The GTV locations studied for the intra-prostatic boost were; posterolateral, total posterior, antero-lateral, total anterior and 3 volumes in the apical zone characterized by different heights in the apex-base direction: 15, 20 and 25 mm. All patients had a standard optimization with the 90% of the CTV receiving 100 to 105% of the PD. Four boost-dose levels were studied: 100%, 120%, 135% and 150% of the PD. The urethral and rectal D0.1 and D0.5 cc were reported for every dose level. Results: An intraprostatic dose escalation on the postero-lateral GTV had no significant impact on the urethral D0.1 cc and D0.5 cc, while a significant increase in the rectal D0.1 cc (74, 77, 80 and 84% for every dose level respectively) and D0.5 cc (68, 70, 72 and 75%) was noted (p < 0.05). Similarly, a boost on the total posterior GTV had a significant impact on the rectal D0.1 cc (74, 77, 78 and 81%) and D0.5 cc (67, 70, 71 and 73%) (p < 0.05), while the urethral D0.1 cc increased significantly only for a boost of 150% (p = 0.013). An antero-lateral and total
227
anterior boost significantly increased the urethral D0.1 cc for a dose ≥135% (p = 0.007 and 0.01 respectively) while significantly decreasing the rectal doses. No significant impact of an apical dose escalation was seen on the urethra whereas the rectal doses increased significantly for a boost ≥135% (p < 0.05). No major increase on rectal and urethral doses was observed with the 120 % boost level except for the posterior GTV (D0.1 cc = 77%). However, this increase is still within acceptable limits. Conclusions: Delivering an intra-prostatic boost dose of 120 % of the PD with HDR-BT is feasible and safe regardless of the GTV location. Further increases of the intra-prostatic boost dose may be possible only by carefully evaluating the spatial distribution of the GTV as well as the rectal and urethral doses. P108 Helical tomotherapy in prostate cancer: Minimizing toxicity C. Acebedo1 , J.L. Lopez ´ Guerra1 , E. Rivin Del Campo2 , R. Matute1 , N. Isa1 , F. Puebla1 , M. Russo3 , A. Sanchez-Reyes4 , C. Beltran ´ 1, 1 5 1 J. Jaen ´ , H. Marsiglia . Instituto Madrile˜ no De Oncolog´ıa/Grupo IMO, Dept. of Radiation Oncology, Madrid, Spain; 2 Hospital General De Elche. ERESA, Dept. of Radiation Oncology, Elche, Spain; 3 Radiomedicine Institute IRAM, Dept. of Radiation Oncology, Santiago, Chile; 4 Instituto Madrile˜ no De Oncolog´ıa/Grupo IMO, Dept. of Radiation Physics, Madrid, Spain; 5 Institut De Canc´erologie Gustave Roussy, Dept. of Radiation Oncology, Villejuif, Paris, France Introduction & Objectives: Radiation-induced toxicity is an important adverse event that affects most patients receiving radiation therapy (RT) for prostate cancer (PC), especially for those who underwent prior treatment such as surgery. Intensity modulated radiation therapy has been shown to decrease acute toxicity. We present the clinical results of intensity-modulated radiation therapy with helical tomotherapy (HT) for clinically localized and recurrent PC, as well as post-prostatectomy adjuvant treatment. Material & Methods: From May 2006 to January 2011, 70 cT1-T3 cN0 cM0 PC patients were treated with HT (primary diagnosis, n = 48; post-prostatectomy biochemical recurrence, n = 15; post-brachytherapy biochemical recurrence, n = 2; and post-prostatectomy adjuvance, n = 5). The dose prescribed to the prostate ranged between 72–78 Gy, except for one case (post-brachytherapy recurrence, 66 Gy) with conventional fractionation (2 Gy/fraction). The seminal vesicles received between 50–56 Gy, the surgical bed 66–74 Gy, and the pelvic lymph nodes 46–50.4 Gy (n = 20), respectively when applicable, with conventional fractionation. Minimum follow-up was 3 months. Demographic, tumor and treatment characteristics were recorded and analyzed. The follow-up was calculated from the HT start date to the last contact date. For patients with a primary diagnosis or those receiving adjuvant HT, survival time was measured from the diagnosis date to the last contact date for alive patients or the date of death if the patient had died. For patients receiving HT for biochemical recurrence, survival time was measured from the recurrence diagnosis date to the last contact date for alive patients or the date of death for deceased patients. Genitourinary (GU) and gastrointestinal (GI) toxicity was scored using the Radiation Therapy Oncology Group (RTOG) scoring system. Results: The median age was 68 years (range 51–87 years). The median follow-up was 37 months (range 3–74 months). The mean initial Gleason score was 6±1 and the mean initial PSA was 17.11±35 ng/ml. The mean total dose was 75.48±2.88 Gy for prostate, 54.04±1.13 Gy for seminal vesicles, 67.8±3.7 Gy for the surgical bed, and 46.32±1.4 for pelvic lymph nodes. The mean vesical and rectal volumes were 149±90 cc and 79.05±28 cc, respectively. For patients with a primary diagnosis or those receiving adjuvant HT, median overall survival was 45 months (range, 8–82 months). For patients receiving HT for