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Urinary Retention following Prostate Seed Implant Brachytherapy following Rigid Cystoscopy
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
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