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Time Trends in Urinary Toxicity After Radiation Therapy Treatment for Prostate Cancer
S434
International Journal of Radiation Oncology Biology Physics
Conclusions: In the group of patients here presented, performing a 3TmMRI before radiation therapy treatment significantly changed our initial treatment decision based in the local tumor staging. Its routine use could induce important changes in planning radiation therapy planning and hormonotherapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue. Author Disclosure: F. Counago: None. M. Recio: None. E. del Cerro: None. A.A. Diaz: None. F.J. Marcos: None. R. Murillo: None. P. Gajate: None.
L’Hospitalet-Barcelona, Spain, 4Universitat de Barcelona, L’HospitaletBarcelona, Spain
2559 Time Trends in Urinary Toxicity After Radiation Therapy Treatment for Prostate Cancer R. Kattevilder, C.J.M. Hoekstra, C.G.J. Nie¨l, S.M.G. van de Pol, A.W.H. Minken, and R. Westendorp; RISO, Deventer, Netherlands Purpose/Objective(s): The aim of this analysis is to describe and evaluate the course of genito-urinary (GU) toxicity over time for prostate cancer patients treated with radiation therapy in a single institution. The toxicity was scored for 3 modalities: I-125 brachytherapy (I-125) , external beam radiation therapy (EBRT) and external beam and I-125 (combination therapy). Materials/Methods: Between January 2000 and October 2013 1798 patients were treated, 1246 patients with I-125 (145 Gy), 314 patients with EBRT (38 x 2 Gy/35 x 2.3 Gy/25 x 2.9 Gy) and 238 patients with the combination of EBRT (25 x 2 Gy/20 x 2.35 Gy) and I-125 (110 Gy). I-125 Implantation was performed using an intraoperative adaptive procedure, on an outpatient basis. EBRT was delivered to prostate and (base of) seminal vesicles with 3D CRT and from august 2006 onwards with helical intensity modulated radiation therapy. In the combination group, I-125 was given 2 weeks after the EBRT. GU toxicity was scored systematically, based on patient questionnaires at baseline and follow-up visits, using NCI-CTCAE v3.0 as scoring system. GU toxicity was reported by IPSS-outcome, the use of pads and patient satisfaction (not/little vs. normally/extreme satisfied). Results: Maximum evaluation time was 9 years. Median follow up time was 4 years. For all radiation schemes the IPSS score reaches its highest level between 1 and 3 months after end of treatment, IPSS returns almost to baseline for all patients after 3.5 years and stays there for rest of the follow-up period. The same pattern is observed in the satisfaction score, the lowest after 3 months and after 2 ½ years a return to baseline, even further improving towards 9 years. The use of pads gradually increases with time, from 2% at baseline to 10 % at 9 years. Comparing the 3 modalities, IPSS score is higher and returns later to baseline in the regimes using I-125, satisfaction score shows the same time pattern. The use of pads seems to increase in time: the incidence in the EBRT group from 3% baseline to 8% after 3 years, then further increasing to 15% at 9 years. In the I-125 group these percentages are 2, 10 and 10 and in the combination group 1, 20 and 0 (due to a small amount of patients) respectively. GU toxicity score is highest in the combination group and lowest in the EBRT group. The main difference is seen in grade 4 toxicity: 1.7% in the combination group, 0.4% in the I-125 and 0% in the EBRT group. Conclusions: With a follow-up of 9 years no worsening in IPSS and satisfaction was observed, the use of pads however increases from 2 to 10%. These figures were not compensated for aging, but radiation therapy certainly has a role in this. Incontinence is highest in the combination therapy group. Author Disclosure: R. Kattevilder: None. C.J.M. Hoekstra: None. C.G.J. Nie¨l: None. S.M.G. van de Pol: None. A.W.H. Minken: None. R. Westendorp: None.
2560 External Beam Radiation Therapy Plus High-Dose-Rate Brachytherapy in the Treatment of Locally Advanced Prostate Cancer. F. Ferrer,1 A. Boladeras,1 L. Santorsa,1,2 E. Martinez,1 C. Gutierrez,1 F. Pino,1 M. Castells,3 R. Gracia,1 R. Pin˜eiro,1 J. Suarez,3 J. Pera,1 and F. Guedea1,4; 1Institut Catala` d’Oncologia, L’Hospitalet-Barcelona, Spain, 2Policlinico di Bari, Bari, Italy, 3Hospital Universitari de Bellvitge,
Purpose/Objective(s): To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. Materials/Methods: From 2002 to July 2012, 377 pts with a diagnosis of intermediate-high risk prostate cancer were treated with EBRT followed by supplemental HDRB. The patient characteristics were as follows: mean age 65.78 (41-86 years), Gleason was 7 in 191 pts (50.7%) and 8 or higher in 131 (35%), 226 pts. (60%) had a PSA >10 ng/ml, T3 stage 263 pts (70%), T2 64 (17%) and T1 49 (13%). The EBRT dose was 60.0 Gy (45-70 Gy) to the prostate and seminal vesicles for all patients. A total of 120 pts (31%) also received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Complete androgen deprivation was given to 353 pts (93.63%). Results: With a median follow-up of 48.72 months (12-126), 5 and 7-year actuarial overall survival rates were 88% (95% confidence interval [CI] Z 84-92) and 75% (95% CI Z 68-83). Cause-specific survival at 5 and 7 years were 98% (95% CI Z 97-99) and 97% (95% CI Z 96-98), respectively. The 5 and 7-year biochemical relapse free survival were 91% (95% CI Z 87-95) and 89% (95% CI Z 83-95). Gastrointestinal (GI) grade 2 and grade 3 late-toxicity was observed in 17 pts (4.6%) and 6 pts (1.6%), respectively. Genitourinary (GU) grade 2 and grade 3 toxicity was observed in 46 pts (12.2 %) and 3 pts (0.8%). Conclusions: These findings after long-term follow-up confirm that EBRT plus a single-fraction HDRB boost provides good results in terms of both treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, and the risks of anaesthesia while minimizing patient discomfort. We believe these findings support the use of single-fractionation boost techniques. Author Disclosure: F. Ferrer: None. A. Boladeras: None. L. Santorsa: None. E. Martinez: None. C. Gutierrez: None. F. Pino: None. M. Castells: None. R. Gracia: None. R. Pin˜eiro: None. J. Suarez: None. J. Pera: None. F. Guedea: None.
2561 Response of Pelvic Lymph Nodes to Neoadjuvant Hormonal Therapy in Prostate Cancer Patients: Computed Tomography for Radiation Therapy Treatment Planning as “Second Look” Imaging H. Asakura,1 K. Asakura,2 H. Ogawa,1 H. Harada,1 M. Matsuzaki,3 R. Yamashita,3 H. Fuji,4 S. Murayama,4 M. Niwakawa,3 and T. Nishimura1; 1Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan, 2Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan, 3Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan, 4Division of Proton Therapy, Shizuoka Cancer Center, Shizuoka, Japan Purpose/Objective(s): It has become standard to perform neoadjuvant hormonal therapy (HT) for high-risk prostate cancer patients treated with radiation therapy. This analysis evaluated the value of comparing computed tomography (CT) images before and after HT by analyzing the rates and characteristics of pelvic lymph nodes that shrank following HT in high-risk prostate cancer patients. Materials/Methods: We reviewed high-risk or clinical stage N1M0 prostate cancer patients treated with radiation therapy following neoadjuvant HT. High-risk prostate cancer was defined as follows: (1) initial prostatespecific antigen (PSA) of >20 ng/mL or (2) clinical stage of T3 or more or (3) Gleason score of 8. Common iliac, external iliac, internal iliac, obturator, and sacral lymph nodes with short-axis diameters of 3 mm and long-axis diameters of 5 mm on pretreatment CT were evaluated. Lymph nodes with 50% decrease in the product of the two perpendicular measurements on CT for radiation therapy treatment planning after HT were judged as positive lymph nodes. The relationships between clinical risk factors (i.e. initial PSA, T stage, and Gleason score) and the incidence of positive lymph nodes were analyzed using Mann-Whitney’s U test for
International Journal of Radiation Oncology Biology Physics
Conclusions: In the group of patients here presented, performing a 3TmMRI before radiation therapy treatment significantly changed our initial treatment decision based in the local tumor staging. Its routine use could induce important changes in planning radiation therapy planning and hormonotherapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue. Author Disclosure: F. Counago: None. M. Recio: None. E. del Cerro: None. A.A. Diaz: None. F.J. Marcos: None. R. Murillo: None. P. Gajate: None.
L’Hospitalet-Barcelona, Spain, 4Universitat de Barcelona, L’HospitaletBarcelona, Spain
2559 Time Trends in Urinary Toxicity After Radiation Therapy Treatment for Prostate Cancer R. Kattevilder, C.J.M. Hoekstra, C.G.J. Nie¨l, S.M.G. van de Pol, A.W.H. Minken, and R. Westendorp; RISO, Deventer, Netherlands Purpose/Objective(s): The aim of this analysis is to describe and evaluate the course of genito-urinary (GU) toxicity over time for prostate cancer patients treated with radiation therapy in a single institution. The toxicity was scored for 3 modalities: I-125 brachytherapy (I-125) , external beam radiation therapy (EBRT) and external beam and I-125 (combination therapy). Materials/Methods: Between January 2000 and October 2013 1798 patients were treated, 1246 patients with I-125 (145 Gy), 314 patients with EBRT (38 x 2 Gy/35 x 2.3 Gy/25 x 2.9 Gy) and 238 patients with the combination of EBRT (25 x 2 Gy/20 x 2.35 Gy) and I-125 (110 Gy). I-125 Implantation was performed using an intraoperative adaptive procedure, on an outpatient basis. EBRT was delivered to prostate and (base of) seminal vesicles with 3D CRT and from august 2006 onwards with helical intensity modulated radiation therapy. In the combination group, I-125 was given 2 weeks after the EBRT. GU toxicity was scored systematically, based on patient questionnaires at baseline and follow-up visits, using NCI-CTCAE v3.0 as scoring system. GU toxicity was reported by IPSS-outcome, the use of pads and patient satisfaction (not/little vs. normally/extreme satisfied). Results: Maximum evaluation time was 9 years. Median follow up time was 4 years. For all radiation schemes the IPSS score reaches its highest level between 1 and 3 months after end of treatment, IPSS returns almost to baseline for all patients after 3.5 years and stays there for rest of the follow-up period. The same pattern is observed in the satisfaction score, the lowest after 3 months and after 2 ½ years a return to baseline, even further improving towards 9 years. The use of pads gradually increases with time, from 2% at baseline to 10 % at 9 years. Comparing the 3 modalities, IPSS score is higher and returns later to baseline in the regimes using I-125, satisfaction score shows the same time pattern. The use of pads seems to increase in time: the incidence in the EBRT group from 3% baseline to 8% after 3 years, then further increasing to 15% at 9 years. In the I-125 group these percentages are 2, 10 and 10 and in the combination group 1, 20 and 0 (due to a small amount of patients) respectively. GU toxicity score is highest in the combination group and lowest in the EBRT group. The main difference is seen in grade 4 toxicity: 1.7% in the combination group, 0.4% in the I-125 and 0% in the EBRT group. Conclusions: With a follow-up of 9 years no worsening in IPSS and satisfaction was observed, the use of pads however increases from 2 to 10%. These figures were not compensated for aging, but radiation therapy certainly has a role in this. Incontinence is highest in the combination therapy group. Author Disclosure: R. Kattevilder: None. C.J.M. Hoekstra: None. C.G.J. Nie¨l: None. S.M.G. van de Pol: None. A.W.H. Minken: None. R. Westendorp: None.
2560 External Beam Radiation Therapy Plus High-Dose-Rate Brachytherapy in the Treatment of Locally Advanced Prostate Cancer. F. Ferrer,1 A. Boladeras,1 L. Santorsa,1,2 E. Martinez,1 C. Gutierrez,1 F. Pino,1 M. Castells,3 R. Gracia,1 R. Pin˜eiro,1 J. Suarez,3 J. Pera,1 and F. Guedea1,4; 1Institut Catala` d’Oncologia, L’Hospitalet-Barcelona, Spain, 2Policlinico di Bari, Bari, Italy, 3Hospital Universitari de Bellvitge,
Purpose/Objective(s): To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. Materials/Methods: From 2002 to July 2012, 377 pts with a diagnosis of intermediate-high risk prostate cancer were treated with EBRT followed by supplemental HDRB. The patient characteristics were as follows: mean age 65.78 (41-86 years), Gleason was 7 in 191 pts (50.7%) and 8 or higher in 131 (35%), 226 pts. (60%) had a PSA >10 ng/ml, T3 stage 263 pts (70%), T2 64 (17%) and T1 49 (13%). The EBRT dose was 60.0 Gy (45-70 Gy) to the prostate and seminal vesicles for all patients. A total of 120 pts (31%) also received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Complete androgen deprivation was given to 353 pts (93.63%). Results: With a median follow-up of 48.72 months (12-126), 5 and 7-year actuarial overall survival rates were 88% (95% confidence interval [CI] Z 84-92) and 75% (95% CI Z 68-83). Cause-specific survival at 5 and 7 years were 98% (95% CI Z 97-99) and 97% (95% CI Z 96-98), respectively. The 5 and 7-year biochemical relapse free survival were 91% (95% CI Z 87-95) and 89% (95% CI Z 83-95). Gastrointestinal (GI) grade 2 and grade 3 late-toxicity was observed in 17 pts (4.6%) and 6 pts (1.6%), respectively. Genitourinary (GU) grade 2 and grade 3 toxicity was observed in 46 pts (12.2 %) and 3 pts (0.8%). Conclusions: These findings after long-term follow-up confirm that EBRT plus a single-fraction HDRB boost provides good results in terms of both treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, and the risks of anaesthesia while minimizing patient discomfort. We believe these findings support the use of single-fractionation boost techniques. Author Disclosure: F. Ferrer: None. A. Boladeras: None. L. Santorsa: None. E. Martinez: None. C. Gutierrez: None. F. Pino: None. M. Castells: None. R. Gracia: None. R. Pin˜eiro: None. J. Suarez: None. J. Pera: None. F. Guedea: None.
2561 Response of Pelvic Lymph Nodes to Neoadjuvant Hormonal Therapy in Prostate Cancer Patients: Computed Tomography for Radiation Therapy Treatment Planning as “Second Look” Imaging H. Asakura,1 K. Asakura,2 H. Ogawa,1 H. Harada,1 M. Matsuzaki,3 R. Yamashita,3 H. Fuji,4 S. Murayama,4 M. Niwakawa,3 and T. Nishimura1; 1Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan, 2Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan, 3Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan, 4Division of Proton Therapy, Shizuoka Cancer Center, Shizuoka, Japan Purpose/Objective(s): It has become standard to perform neoadjuvant hormonal therapy (HT) for high-risk prostate cancer patients treated with radiation therapy. This analysis evaluated the value of comparing computed tomography (CT) images before and after HT by analyzing the rates and characteristics of pelvic lymph nodes that shrank following HT in high-risk prostate cancer patients. Materials/Methods: We reviewed high-risk or clinical stage N1M0 prostate cancer patients treated with radiation therapy following neoadjuvant HT. High-risk prostate cancer was defined as follows: (1) initial prostatespecific antigen (PSA) of >20 ng/mL or (2) clinical stage of T3 or more or (3) Gleason score of 8. Common iliac, external iliac, internal iliac, obturator, and sacral lymph nodes with short-axis diameters of 3 mm and long-axis diameters of 5 mm on pretreatment CT were evaluated. Lymph nodes with 50% decrease in the product of the two perpendicular measurements on CT for radiation therapy treatment planning after HT were judged as positive lymph nodes. The relationships between clinical risk factors (i.e. initial PSA, T stage, and Gleason score) and the incidence of positive lymph nodes were analyzed using Mann-Whitney’s U test for