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Toxicity after Intensity Modulated and Image Guided Radiation Therapy for Localized Prostate Cancer
Proceedings of the 53rd Annual ASTRO Meeting
2364
Linked Dual Nomograms That Consider Radiation Dose and Length of Androgen Deprivation in the Estimation of Biochemical Failure at Five Years
V. N. Patel1, R. Stoyanova1, R. Guruju1, B. L. Egleston2, A. Pollack1 1
University of Miami Miller School of Medicine, Miami, FL, 2Fox Chase Cancer Center, Philadelphia, PA
Purpose/Objective(s): The balance between external beam radiotherapy (RT) dose escalation and length of androgen deprivation therapy (ADT) for the treatment of prostate cancer has not been addressed sufficiently in randomized trials and is, therefore, problematic in applying to individual patients. We refined and expanded a dual linked nomogram method to estimate biochemical failure (BF) under varying RT and ADT conditions, and then applied the model to an independent data set of patients treated at two institutions. Materials/Methods: The linked nomograms included 2073 patients treated at Fox Chase Cancer Center (FCCC) with RT ± ADT using 3DCRT or IMRT from 1989 to 2005. The patients were subdivided into four groups based on the length of ADT: 0 months (n = 1613), #6 months (n = 150), .6 to \24 months (n = 145) and $24 months (n = 165). Covariates entered into the model were palpation T-category, biopsy Gleason score, pretreatment prostate-specific antigen level, ADT duration, RT dose, percent Gleason pattern 4/5, and percent positive tissue. The nomograms, one comprised of all patients receiving ADT and one from those not receiving ADT, were created from a single Fine and Gray competing risks model using the PSA nadir+2 ng/mL definition of BF to estimate 5 yr outcome. We tested the model in two independent patient populations; one from patients in FCCC trial 02-602 not included in the original nomogram (n = 148) and one from the University of Miami database (UM; n = 111) for patients with all the covariates. Results: There were 25 and 36 BFs in the FCCC and UM groups. We investigated the concordance between the nomogram estimated probabilities and the rates of BF within ranked quartiles. The predicted probability of BF and the observed rates were strongly correlated (R = 0.99, p = 0.007). A linear regression suggested that the model under-predicted observed rates by a constant 7% (intercept = 7%, 95% CI 4% to 10%, slope = 1.0%, 95% CI 0.9%-1.1%). This difference was related in great part to the UM data. Conclusions: The dual linked nomograms provide estimates of 5 yr BF that were statistically concordant with actual BF in an independent patient cohort from two institutions with two different treatment approaches. There was greater concordance with the FCCC patients. Author Disclosure: V.N. Patel: None. R. Stoyanova: None. R. Guruju: None. B.L. Egleston: None. A. Pollack: None.
2365
Biochemical Failure After Radiation Therapy for Prostate Cancer: An Analysis of Risk Factors for Progression Including Comorbidity Index
E. C. Osmundson, R. Kunnavakkam, S. L. Liauw University of Chicago, Chicago, IL Purpose/Objective(s): Limited data are available which describe prostate cancer progression after post-radiation therapy (RT) biochemical failure (BF), and no data exist in this setting which incorporates patient comorbidity. The objective was to identify factors which influence disease progression, and assess whether patient comorbidity may be an important adjunct that can inform decisions regarding salvage therapy at the time of BF. Materials/Methods: From a series of 786 consecutive patients with prostate cancer treated with curative-intent RT between 1988 and 2006, 152 had BF. Patients with incomplete medical history at BF were excluded, leaving 135 patients in the study cohort. The median age at BF was 68 years. By NCCN risk category, patients initially had low (16%), intermediate (35%), or high-risk (49%) disease. The median RT dose was 74 Gy; 41% received concurrent hormonal therapy. Comorbidity scores were retrospectively assigned by extraction of medical history in the hospital chart at the time of BF, according to the Charlson comorbidity index (CCI) and the ACE27 comorbidity index, with cancer diagnosis excluded from the scoring. PSA doubling time (PSADT) was calculated according to first order kinetics based on all PSA values either 1 (n = 128) or 2 years (n = 7) immediately prior to BF. The log-rank test was performed to test for the association of prognostic variables with freedom from distant metastasis (FFDM), cause specific survival (CSS), and overall survival (OS). Multivariable analyses (MVA) were then performed including all significant covariates on univariate (UVA) analysis, in addition to the CCI or ACE27 index. Results: Median follow-up was 48 mo after BF. At 5 and 10 years, FFDM was 84/74%, CSS was 87/81%, and OS was 82/58%. The median PSADT, interval to BF (IBF), CCI, and ACE27 index were 6.8 mo, 35 mo, 3 (range 0-9), and 1 (range 0-3), respectively. UVA and MVA revealed an association with PSADT\6 mo and IBF\3 y with lower FFDM, CSS, and OS (all p\0.01). CCI (#3) and ACE27 index (#1) did not impact FFDM or CSS, but were associated with improved OS on univariate analysis (p = 0.05 and p\0.01, respectively), and MVA. Stratifying patients based on the CCI or ACE27 index improved the predictive value of PSADT\6 mo and IBF\3 y for OS. For example, men with CCI #3 had an OS-10y of 100% for neither factor, vs. 57% for both factors; men with CCI .3 had corresponding rates of 69% vs. 21%. A competing risks regression model indicated that men with CCI .3 were significantly more likely to die from other causes (HR 3.0, 95% CI 1.5-6.1) than men with CCI#3. Conclusions: Men with a rapid PSADT and short IBF are at the greatest risk of progression after BF. Comorbidity index (either CCI or ACE27) may be useful to help select men for aggressive post-RT salvage therapy. Author Disclosure: E.C. Osmundson: None. R. Kunnavakkam: None. S.L. Liauw: None.
2366
Toxicity after Intensity Modulated and Image Guided Radiation Therapy for Localized Prostate Cancer
G. K. Hunter, K. Brockway, C. Reddy, S. Rehman, K. Stephans, J. Ciezki, P. Xia, R. Tendulkar Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients (pts) treated definitively with intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT).
S385
I. J. Radiation Oncology d Biology d Physics
S386
Volume 81, Number 2, Supplement, 2011
Materials/Methods: The records of 333 pts treated from 2003-2009 for prostate cancer with IMRT and IGRT were retrospectively examined to evaluate GI and GU toxicity profiles .1 year from completion of treatment, using the CTCAE version 4.0. Pts were treated with various IGRT techniques including ultrasound, cone-beam computed tomography, and the Calypso system. For 233 patients, full dosimetric data was available. Pts treated with a hypofractionated regimen of 2.5 Gy/fraction underwent a biologic equivalent dose correction to evaluate dosimetric parameters in comparison to those patients treated at 1.8-2.0 Gy/fraction. Cox proportional hazards regression analyses were performed for late GI and GU toxicities. Results: Median follow-up was 40.7 months (3.5-94 months). 218 pts (66%) were treated with .76 Gy, 115 (34%) were treated with 72-76 Gy. No late grade 4 or 5 GI or GU toxicities were observed. The rate of late GI toxicity at 3 years was 12.5% (all grades), with 4.9% being grade 2-3. The most common GI toxicity was rectal bleeding. Of the 41 pts with any late GI toxicity, 68% completely resolved upon subsequent follow up or intervention. The rate of late GU toxicity at 3 years was 18.9% (all grades), with 4.5% being grade 2-3. The most common GU toxicity was increased frequency/urgency. Of the 64 pts with any late GU toxicity 61% completely resolved upon subsequent follow up or intervention. For the 233 pts with full dosimetric data, the median bladder V70 and V50 were 13.4% and 28.7%, and the median rectal V70 and V50 were 11.9% and 31.7%, respectively. On univariate analysis, use of Coumadin (HR 2.5, p = 0.02) or aspirin (HR 1.9, p = 0.05) were significantly associated with all grade GI toxicity, but for grade 2-3 GI toxicity only Coumadin use was significant (HR 5.7, p = 0.0006). The rate of grade 2-3 GI toxicity at 3 years was 4% for patients not on Coumadin vs. 13.5% with Coumadin (p = 0.0001, log-rank test). No dosimetric value correlated with late GI toxicity. On univariate analysis, only older age (HR 1.05, p = 0.003) and bladder V50 (HR 1.03 p = 0.04) were significantly associated with any grade late GU toxicity. On multivariate analysis, both older age (HR 1.04, p = 0.04) and bladder V50 (HR 1.03, p = 0.05) remained significant. For grade 2-3 GU toxicity, only older age was significant (HR = 1.09, p = 0.03). Conclusions: IMRT with IGRT for definitive radiation therapy for prostate cancer achieved very low rates of late GI and GU toxicity. The use of Coumadin significantly increases the risk of late GI toxicity. Older age and bladder V50 were significantly associated with late GU toxicity. Author Disclosure: G.K. Hunter: None. K. Brockway: None. C. Reddy: None. S. Rehman: None. K. Stephans: None. J. Ciezki: None. P. Xia: None. R. Tendulkar: None.
2367
Diffusion Weighted and Dynamic Contrast Enhanced MRI of Prostate in Response to RT 1,2
N. Pervez , K. Wachowicz3,2, A. Yahya3,2, M. Younis1,2, B. Fallone3,2 1 Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada, 2Department of Oncology, University of Alberta, Edmonton, AB, Canada, 3Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
Purpose/Objective(s): To investigate the utility of diffusion weighted (DW) and dynamic contrast enhanced (DCE) MRI in assessing the impact of radiation treatment (RT) in high risk prostate cancer treated with a hypofractionated RT protocol. Materials/Methods: Data from 14 patients enrolled in an ongoing phase II prospective study for high-risk prostate cancer (clinical stage $ T3a or initial prostate-specific antigen $ 20ng/ml or Gleason score 8 -10) were analyzed. Patients underwent DW and DCE MRI scans before, during, and 3 months after RT. For 6 patients, a 12 month time point was also available. Patients were scanned in a 3T Philips scanner using a 6 element coil. All scans were acquired with 12 slices having a common position and orientation. The DW images were obtained using a single-shot echo-planar imaging sequence with b-values of 0, 125, 251, 376, and 501 s/mm2. Apparent diffusion coefficient (ADC) maps were generated using Philips software. The DCE protocol was acquired using a 3D T1-weighted gradient-echo sequence. Fifty 12-slice dynamic image sets were acquired, one every 7.9 s. A gadolinium contrast agent (ProHance, Bracco Diagnostics) was injected after the fourth dynamic was acquired. The volume of contrast agent was calculated at 0.2 [mL/kg](Patient Mass) and was injected at a constant rate over 20 s. DCE Analysis The signal strength of each pixel associated with prostate in the DCE image set was tracked over all dynamics and fit using inhouse software to a modified version of the Brix pharmacokinetic model. Two parameters are taken from this model: A corresponds approximately to the extravascular extracellular space (EES), and kep is the rate constant of influx from the plasma to the EES compartment. Results: Contours were drawn by an radiation oncologist to include the entire prostate. ADC, A, and kep were averaged over the contoured volume, and were normalized to the baseline pre-RT measurements. The mean of these normalized parameters was averaged over all patients at each time point, expressed as a multiple of the baseline value. It was found that A increased during RT by 1.59 ± 0.20, then dropped to 1.25 ± 0.28 three months after RT, then further dropped to 1.19 ± 0.42 a year after treatment. kep, increased to 1.39 ± 0.41 during RT, and then dropped to 1.13 ± 0.33. ADC values increased significantly during RT to 2.39 ± 1.7 and further increased three months after RT to 3.09 ± 1.83. A year after treatment ADC values dropped to 1.52 ± 1.94. Although a large trend was seen in ADC during treatment, its utility is questionable considering its large variation among the patients. Conclusions: DWI and DCE parameters exhibited significant variation with RT suggesting utility in assessing treatment response. In future work, changes in these parameters will be assessed in a larger number of patients to enhance the statistical significance of our findings. Author Disclosure: N. Pervez: None. K. Wachowicz: None. A. Yahya: None. M. Younis: None. B. Fallone: None.
2368
Previous Transurethral Resection of the Prostate (TURP) is not a Contraindication for Interstitial High Dose Rate (HDR) Brachytherapy for Prostate Cancer
R. J. Mark1,2, D. White1, R. Akins1, S. Mutyala3, M. Nair1 1 Joe Arrington Cancer Research Center, Lubbock, TX, 2Texas Tech University, Lubbock, TX, 3Scott and White Medical Clinic, Temple, TX
Purpose/Objective(s): Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using Low Dose Rate (LDR) and High Dose Rate (HDR) technique has been reported with results comparing favorably to surgery and External
2364
Linked Dual Nomograms That Consider Radiation Dose and Length of Androgen Deprivation in the Estimation of Biochemical Failure at Five Years
V. N. Patel1, R. Stoyanova1, R. Guruju1, B. L. Egleston2, A. Pollack1 1
University of Miami Miller School of Medicine, Miami, FL, 2Fox Chase Cancer Center, Philadelphia, PA
Purpose/Objective(s): The balance between external beam radiotherapy (RT) dose escalation and length of androgen deprivation therapy (ADT) for the treatment of prostate cancer has not been addressed sufficiently in randomized trials and is, therefore, problematic in applying to individual patients. We refined and expanded a dual linked nomogram method to estimate biochemical failure (BF) under varying RT and ADT conditions, and then applied the model to an independent data set of patients treated at two institutions. Materials/Methods: The linked nomograms included 2073 patients treated at Fox Chase Cancer Center (FCCC) with RT ± ADT using 3DCRT or IMRT from 1989 to 2005. The patients were subdivided into four groups based on the length of ADT: 0 months (n = 1613), #6 months (n = 150), .6 to \24 months (n = 145) and $24 months (n = 165). Covariates entered into the model were palpation T-category, biopsy Gleason score, pretreatment prostate-specific antigen level, ADT duration, RT dose, percent Gleason pattern 4/5, and percent positive tissue. The nomograms, one comprised of all patients receiving ADT and one from those not receiving ADT, were created from a single Fine and Gray competing risks model using the PSA nadir+2 ng/mL definition of BF to estimate 5 yr outcome. We tested the model in two independent patient populations; one from patients in FCCC trial 02-602 not included in the original nomogram (n = 148) and one from the University of Miami database (UM; n = 111) for patients with all the covariates. Results: There were 25 and 36 BFs in the FCCC and UM groups. We investigated the concordance between the nomogram estimated probabilities and the rates of BF within ranked quartiles. The predicted probability of BF and the observed rates were strongly correlated (R = 0.99, p = 0.007). A linear regression suggested that the model under-predicted observed rates by a constant 7% (intercept = 7%, 95% CI 4% to 10%, slope = 1.0%, 95% CI 0.9%-1.1%). This difference was related in great part to the UM data. Conclusions: The dual linked nomograms provide estimates of 5 yr BF that were statistically concordant with actual BF in an independent patient cohort from two institutions with two different treatment approaches. There was greater concordance with the FCCC patients. Author Disclosure: V.N. Patel: None. R. Stoyanova: None. R. Guruju: None. B.L. Egleston: None. A. Pollack: None.
2365
Biochemical Failure After Radiation Therapy for Prostate Cancer: An Analysis of Risk Factors for Progression Including Comorbidity Index
E. C. Osmundson, R. Kunnavakkam, S. L. Liauw University of Chicago, Chicago, IL Purpose/Objective(s): Limited data are available which describe prostate cancer progression after post-radiation therapy (RT) biochemical failure (BF), and no data exist in this setting which incorporates patient comorbidity. The objective was to identify factors which influence disease progression, and assess whether patient comorbidity may be an important adjunct that can inform decisions regarding salvage therapy at the time of BF. Materials/Methods: From a series of 786 consecutive patients with prostate cancer treated with curative-intent RT between 1988 and 2006, 152 had BF. Patients with incomplete medical history at BF were excluded, leaving 135 patients in the study cohort. The median age at BF was 68 years. By NCCN risk category, patients initially had low (16%), intermediate (35%), or high-risk (49%) disease. The median RT dose was 74 Gy; 41% received concurrent hormonal therapy. Comorbidity scores were retrospectively assigned by extraction of medical history in the hospital chart at the time of BF, according to the Charlson comorbidity index (CCI) and the ACE27 comorbidity index, with cancer diagnosis excluded from the scoring. PSA doubling time (PSADT) was calculated according to first order kinetics based on all PSA values either 1 (n = 128) or 2 years (n = 7) immediately prior to BF. The log-rank test was performed to test for the association of prognostic variables with freedom from distant metastasis (FFDM), cause specific survival (CSS), and overall survival (OS). Multivariable analyses (MVA) were then performed including all significant covariates on univariate (UVA) analysis, in addition to the CCI or ACE27 index. Results: Median follow-up was 48 mo after BF. At 5 and 10 years, FFDM was 84/74%, CSS was 87/81%, and OS was 82/58%. The median PSADT, interval to BF (IBF), CCI, and ACE27 index were 6.8 mo, 35 mo, 3 (range 0-9), and 1 (range 0-3), respectively. UVA and MVA revealed an association with PSADT\6 mo and IBF\3 y with lower FFDM, CSS, and OS (all p\0.01). CCI (#3) and ACE27 index (#1) did not impact FFDM or CSS, but were associated with improved OS on univariate analysis (p = 0.05 and p\0.01, respectively), and MVA. Stratifying patients based on the CCI or ACE27 index improved the predictive value of PSADT\6 mo and IBF\3 y for OS. For example, men with CCI #3 had an OS-10y of 100% for neither factor, vs. 57% for both factors; men with CCI .3 had corresponding rates of 69% vs. 21%. A competing risks regression model indicated that men with CCI .3 were significantly more likely to die from other causes (HR 3.0, 95% CI 1.5-6.1) than men with CCI#3. Conclusions: Men with a rapid PSADT and short IBF are at the greatest risk of progression after BF. Comorbidity index (either CCI or ACE27) may be useful to help select men for aggressive post-RT salvage therapy. Author Disclosure: E.C. Osmundson: None. R. Kunnavakkam: None. S.L. Liauw: None.
2366
Toxicity after Intensity Modulated and Image Guided Radiation Therapy for Localized Prostate Cancer
G. K. Hunter, K. Brockway, C. Reddy, S. Rehman, K. Stephans, J. Ciezki, P. Xia, R. Tendulkar Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients (pts) treated definitively with intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT).
S385
I. J. Radiation Oncology d Biology d Physics
S386
Volume 81, Number 2, Supplement, 2011
Materials/Methods: The records of 333 pts treated from 2003-2009 for prostate cancer with IMRT and IGRT were retrospectively examined to evaluate GI and GU toxicity profiles .1 year from completion of treatment, using the CTCAE version 4.0. Pts were treated with various IGRT techniques including ultrasound, cone-beam computed tomography, and the Calypso system. For 233 patients, full dosimetric data was available. Pts treated with a hypofractionated regimen of 2.5 Gy/fraction underwent a biologic equivalent dose correction to evaluate dosimetric parameters in comparison to those patients treated at 1.8-2.0 Gy/fraction. Cox proportional hazards regression analyses were performed for late GI and GU toxicities. Results: Median follow-up was 40.7 months (3.5-94 months). 218 pts (66%) were treated with .76 Gy, 115 (34%) were treated with 72-76 Gy. No late grade 4 or 5 GI or GU toxicities were observed. The rate of late GI toxicity at 3 years was 12.5% (all grades), with 4.9% being grade 2-3. The most common GI toxicity was rectal bleeding. Of the 41 pts with any late GI toxicity, 68% completely resolved upon subsequent follow up or intervention. The rate of late GU toxicity at 3 years was 18.9% (all grades), with 4.5% being grade 2-3. The most common GU toxicity was increased frequency/urgency. Of the 64 pts with any late GU toxicity 61% completely resolved upon subsequent follow up or intervention. For the 233 pts with full dosimetric data, the median bladder V70 and V50 were 13.4% and 28.7%, and the median rectal V70 and V50 were 11.9% and 31.7%, respectively. On univariate analysis, use of Coumadin (HR 2.5, p = 0.02) or aspirin (HR 1.9, p = 0.05) were significantly associated with all grade GI toxicity, but for grade 2-3 GI toxicity only Coumadin use was significant (HR 5.7, p = 0.0006). The rate of grade 2-3 GI toxicity at 3 years was 4% for patients not on Coumadin vs. 13.5% with Coumadin (p = 0.0001, log-rank test). No dosimetric value correlated with late GI toxicity. On univariate analysis, only older age (HR 1.05, p = 0.003) and bladder V50 (HR 1.03 p = 0.04) were significantly associated with any grade late GU toxicity. On multivariate analysis, both older age (HR 1.04, p = 0.04) and bladder V50 (HR 1.03, p = 0.05) remained significant. For grade 2-3 GU toxicity, only older age was significant (HR = 1.09, p = 0.03). Conclusions: IMRT with IGRT for definitive radiation therapy for prostate cancer achieved very low rates of late GI and GU toxicity. The use of Coumadin significantly increases the risk of late GI toxicity. Older age and bladder V50 were significantly associated with late GU toxicity. Author Disclosure: G.K. Hunter: None. K. Brockway: None. C. Reddy: None. S. Rehman: None. K. Stephans: None. J. Ciezki: None. P. Xia: None. R. Tendulkar: None.
2367
Diffusion Weighted and Dynamic Contrast Enhanced MRI of Prostate in Response to RT 1,2
N. Pervez , K. Wachowicz3,2, A. Yahya3,2, M. Younis1,2, B. Fallone3,2 1 Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada, 2Department of Oncology, University of Alberta, Edmonton, AB, Canada, 3Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
Purpose/Objective(s): To investigate the utility of diffusion weighted (DW) and dynamic contrast enhanced (DCE) MRI in assessing the impact of radiation treatment (RT) in high risk prostate cancer treated with a hypofractionated RT protocol. Materials/Methods: Data from 14 patients enrolled in an ongoing phase II prospective study for high-risk prostate cancer (clinical stage $ T3a or initial prostate-specific antigen $ 20ng/ml or Gleason score 8 -10) were analyzed. Patients underwent DW and DCE MRI scans before, during, and 3 months after RT. For 6 patients, a 12 month time point was also available. Patients were scanned in a 3T Philips scanner using a 6 element coil. All scans were acquired with 12 slices having a common position and orientation. The DW images were obtained using a single-shot echo-planar imaging sequence with b-values of 0, 125, 251, 376, and 501 s/mm2. Apparent diffusion coefficient (ADC) maps were generated using Philips software. The DCE protocol was acquired using a 3D T1-weighted gradient-echo sequence. Fifty 12-slice dynamic image sets were acquired, one every 7.9 s. A gadolinium contrast agent (ProHance, Bracco Diagnostics) was injected after the fourth dynamic was acquired. The volume of contrast agent was calculated at 0.2 [mL/kg](Patient Mass) and was injected at a constant rate over 20 s. DCE Analysis The signal strength of each pixel associated with prostate in the DCE image set was tracked over all dynamics and fit using inhouse software to a modified version of the Brix pharmacokinetic model. Two parameters are taken from this model: A corresponds approximately to the extravascular extracellular space (EES), and kep is the rate constant of influx from the plasma to the EES compartment. Results: Contours were drawn by an radiation oncologist to include the entire prostate. ADC, A, and kep were averaged over the contoured volume, and were normalized to the baseline pre-RT measurements. The mean of these normalized parameters was averaged over all patients at each time point, expressed as a multiple of the baseline value. It was found that A increased during RT by 1.59 ± 0.20, then dropped to 1.25 ± 0.28 three months after RT, then further dropped to 1.19 ± 0.42 a year after treatment. kep, increased to 1.39 ± 0.41 during RT, and then dropped to 1.13 ± 0.33. ADC values increased significantly during RT to 2.39 ± 1.7 and further increased three months after RT to 3.09 ± 1.83. A year after treatment ADC values dropped to 1.52 ± 1.94. Although a large trend was seen in ADC during treatment, its utility is questionable considering its large variation among the patients. Conclusions: DWI and DCE parameters exhibited significant variation with RT suggesting utility in assessing treatment response. In future work, changes in these parameters will be assessed in a larger number of patients to enhance the statistical significance of our findings. Author Disclosure: N. Pervez: None. K. Wachowicz: None. A. Yahya: None. M. Younis: None. B. Fallone: None.
2368
Previous Transurethral Resection of the Prostate (TURP) is not a Contraindication for Interstitial High Dose Rate (HDR) Brachytherapy for Prostate Cancer
R. J. Mark1,2, D. White1, R. Akins1, S. Mutyala3, M. Nair1 1 Joe Arrington Cancer Research Center, Lubbock, TX, 2Texas Tech University, Lubbock, TX, 3Scott and White Medical Clinic, Temple, TX
Purpose/Objective(s): Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using Low Dose Rate (LDR) and High Dose Rate (HDR) technique has been reported with results comparing favorably to surgery and External