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Which men choose brachytherapy for their low-risk prostate cancer?
Abstracts / Brachytherapy 7 (2008) 91e194 PO162 Morbidity and PSA control of EBRT plus LDR brachytherapy boost for intermediate and high risk prostate cancer Bridget F. Koontz, M.D.1 Carol A. Hahn, M.D.1 Mitchell S. Anscher, M.D.2 1 Radiation Oncology, Duke University Medical Center, Durham, NC; 2 Radiation Oncology, Virginia Commonwealth University, Richmond, VA. Purpose: To determine PSA control and morbidity of external beam radiation (EBRT) plus LDR brachytherapy boost in patients with intermediate and high risk prostate cancer. Methods and Materials: Between June 1997 and May 2006, 190 patients were consecutively treated at our facility with 45e46 Gy EBRT followed by 100 Gy Pd-103 or 120 Gy I-125 LDR prostate implant. Treatment characteristics and followup data were retrospectively analyzed. Intermediate risk was defined as T2b-c, GS 7, or PSA 10.1e19.9 ng/mL. High risk was defined as GS 8, PSA O20, T3+, or two intermediate risk factors. RTOG toxicity scale used to report morbidity. PSA control defined as PSA nadir below 0.5 ng/mL and the Phoenix definition of nadir + 2ng/mL. Results: Preliminary results are reported below. Mean followup is 2.8 years for all patients, 4.1 years for high risk patients. Majority of patients were intermediate risk (70%). 35% were treated with adjuvant ADT. The mean length of time since end of hormonal therapy to last followup was 1.9 years in all patients and 2.2 years for high risk patients. 59% patients developed acute urinary frequency requiring an alpha-blocker; 9% required a urinary catheter for acute urinary obstruction after the brachytherapy procedure. Late urinary toxicity was low e 4% developed grade 2 urinary toxicity; 9% developed grade 2 rectal bleeding. 30% of patients have undetectable PSAs at last followup and 74% have a PSA that is less than 0.5 ng/mL. Only 9% failed by Phoenix definition. High risk patients had an excellent outcome, with 67% having an undetectable PSA and 100% with a PSA !0.5 ng/mL. Conclusions: EBRT plus LDR brachytherapy has reasonable morbidity and provides excellent PSA control even in high risk patients.
PO163 Which men choose brachytherapy for their low-risk prostate cancer? Daniel Taussky, M.D.1 Fred Saad, M.D.2 Aihua Liu, M.D.3 Eve LegerBelanger1 Marie-Claude Beauchemin, M.D.1 Thu Van Nguyen, M.D.1 Jean-Paul Bahary, M.D.1 David Donath, M.D.1 1Radiation Oncology, University of Montreal Medical Centre, Montreal, QC, Canada; 2Urology, University of Montreal Medical Centre, Montreal, QC, Canada; 3 Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada. Purpose: Analysis of factors influencing the treatment choice of brachytherapy (PB) in patients diagnosed with low risk prostate cancer within the publicly funded Canadian health system and referred for permanent seed prostate PB. Methods and Materials: We analyzed 110 patients with mostly low-risk prostate cancer consecutively seen between November 2006 and June 2007 to discuss PB. Our hospital is the only center offering this option in a metropolitan area of 3.6 millions. Influence of the following factors on treatment decision was analyzed: patient referral by urologist from a center offering external beam radiotherapy (EBRT), referral by another radiation oncologist offering EBRT only, age, marital status, profession as well as the distance and the time requested to drive to our medical center from the patients home. Results: Of the 110 patients referred to us, 48.2% chose PB, 31.8% Expectant Management (ExpM), 10.9% EBRT and 9.1% radical prostatectomy (RP). Patients who chose PB were significantly younger compared to patients choosing EBRT (p 5 0.011). Patients living further away from our hospital were more likely to choose PB when compared to ExpM (p 5 0.017) . In a multivariate regression analysis, patients younger than 70 years (p 5 0.01) as well as patients living at a greater distance from the hospital than the median of 19.85 miles (p 5 0.005) were significantly associated with choosing PB. Education and marital status had no influence on treatment decision.
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Conclusions: Patients referred to us for discussion of prostate brachytherapy are an already highly selected population, eighty percent of them choose either PB or ExpM. Patients who choose PB typically live further away from the hospital than patients opting for ExpM and are younger than patients choosing EBRT.
PO164 Can we trust the prostate volume derived from computed tomography instead of transrectal ultrasound? Comparison of the prostate volumes on CT and TRUS images in permanent prostate brachytherapy Takeshi Arimura, M.D.1 Fumihiko Nakamura, M.D.1 Yoshiyuki Hiraki, M.D., Ph.D.1 Masayuki Nakajo, M.D., Ph.D.1 Hideki Enokida, M.D., Ph.D.2 Hiroshi Shimoaraiso, M.D.2 Masayuki Nakagawa, M.D., Ph.D.2 1 Radiology, Kagoshima University, Kagoshima, Japan; 2Urology, Kagoshima University, Kagoshima, Japan. Purpose: To investigate the prostate volumes on the two different modalities (CT and TRUS) and to verify whether we can substitute CT for TRUS to acquire the prostate volume before implant or not. Methods and Materials: We analyzed seventy consecutive patients who were obtained both TRUS and CT images on the same day before permanent I-125 seeds implantation. Axial TRUS images at 5 mm intervals were obtained with the patients in the lithotomy position. 3 mm interval axial CT images with the patients lying supine were obtained. The prostate volumes on the TRUS images were outlined by urologists. The prostate volumes on the CT images were delineated by a radiation oncologist. We investigated the differences between CT and TRUS volumes. Results: The median prostate volume generated with TRUS was 22.4 mL (range, 11.2e39.6 mL). The median prostate volume derived from CT was 22.4 mL (range, 10.6e37.3 mL). On average, the CT prostate volume was 0.1% (95% confidence interval, 8.3e8.5%) larger than the TRUS prostate volume. The correlation coefficient between TRUS and CT volumes was 0.96 (p!0.01), which showed extremely strong correlation. Conclusions: There were little differences between TRUS and CT prostate volumes in this study. Though there are many problems in prostate volume definition based on CT images in terms of physician bias, these results revealed the possibility of overcoming the differences between CT and TRUS prostate volumes without magnetic resonance imaging (MRI) by practice and experience. Furthermore, as far as the prostate volume is concerned, it may be possible to substitute CT for TRUS before implant.
PO165 High-dose-rate brachytherapy in an outpatient basis with local anesthesia for prostate cancer and hypofractionated external beam radiotherapy: A feasibility report Antonio C.A. Pellizzon, M.D., Ph.D., Pers Novaes, M.D., Ph.D., Doug Gides, M.D., R. Fogaroli, M. Conte Radiation Oncology, Hospital Acacamargo, Sao Paulo, SP, Brazil. Purpose: The two primary methods to deliver radiotherapy include externalbeam and brachytherapy. High-dose-rate temporary brachytherapy (HDR), performed with catheters implanted into the prostate. To date, nearly all HDR patients have been treated under general or spinal anesthesia, but one alternative involves local anesthesia. Methods and Materials: Patients classified as intermediate or high risk with locally advanced prostate cancer are encouraged to participate in an institutional protocol combining HDR and hypofractionated conformal external-beam radiotherapy. For HDR treatments, patients were submitted to 2 implants with one week interval, with two fractions of 7.5 Gy of HDR-BT per implant. Before the procedure, pain is scored according to the University of California, Los Angeles, Universal Pain Assessment Tool. One week after the end of HDR-BT regimen, the patient begins the hypofractionated conformal external-beam radiotherapy plan in which 45 Gy is administered in 3-Gy daily fractions for 3 weeks, with a total treatment time of 5 weeks.
PO163 Which men choose brachytherapy for their low-risk prostate cancer? Daniel Taussky, M.D.1 Fred Saad, M.D.2 Aihua Liu, M.D.3 Eve LegerBelanger1 Marie-Claude Beauchemin, M.D.1 Thu Van Nguyen, M.D.1 Jean-Paul Bahary, M.D.1 David Donath, M.D.1 1Radiation Oncology, University of Montreal Medical Centre, Montreal, QC, Canada; 2Urology, University of Montreal Medical Centre, Montreal, QC, Canada; 3 Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada. Purpose: Analysis of factors influencing the treatment choice of brachytherapy (PB) in patients diagnosed with low risk prostate cancer within the publicly funded Canadian health system and referred for permanent seed prostate PB. Methods and Materials: We analyzed 110 patients with mostly low-risk prostate cancer consecutively seen between November 2006 and June 2007 to discuss PB. Our hospital is the only center offering this option in a metropolitan area of 3.6 millions. Influence of the following factors on treatment decision was analyzed: patient referral by urologist from a center offering external beam radiotherapy (EBRT), referral by another radiation oncologist offering EBRT only, age, marital status, profession as well as the distance and the time requested to drive to our medical center from the patients home. Results: Of the 110 patients referred to us, 48.2% chose PB, 31.8% Expectant Management (ExpM), 10.9% EBRT and 9.1% radical prostatectomy (RP). Patients who chose PB were significantly younger compared to patients choosing EBRT (p 5 0.011). Patients living further away from our hospital were more likely to choose PB when compared to ExpM (p 5 0.017) . In a multivariate regression analysis, patients younger than 70 years (p 5 0.01) as well as patients living at a greater distance from the hospital than the median of 19.85 miles (p 5 0.005) were significantly associated with choosing PB. Education and marital status had no influence on treatment decision.
191
Conclusions: Patients referred to us for discussion of prostate brachytherapy are an already highly selected population, eighty percent of them choose either PB or ExpM. Patients who choose PB typically live further away from the hospital than patients opting for ExpM and are younger than patients choosing EBRT.
PO164 Can we trust the prostate volume derived from computed tomography instead of transrectal ultrasound? Comparison of the prostate volumes on CT and TRUS images in permanent prostate brachytherapy Takeshi Arimura, M.D.1 Fumihiko Nakamura, M.D.1 Yoshiyuki Hiraki, M.D., Ph.D.1 Masayuki Nakajo, M.D., Ph.D.1 Hideki Enokida, M.D., Ph.D.2 Hiroshi Shimoaraiso, M.D.2 Masayuki Nakagawa, M.D., Ph.D.2 1 Radiology, Kagoshima University, Kagoshima, Japan; 2Urology, Kagoshima University, Kagoshima, Japan. Purpose: To investigate the prostate volumes on the two different modalities (CT and TRUS) and to verify whether we can substitute CT for TRUS to acquire the prostate volume before implant or not. Methods and Materials: We analyzed seventy consecutive patients who were obtained both TRUS and CT images on the same day before permanent I-125 seeds implantation. Axial TRUS images at 5 mm intervals were obtained with the patients in the lithotomy position. 3 mm interval axial CT images with the patients lying supine were obtained. The prostate volumes on the TRUS images were outlined by urologists. The prostate volumes on the CT images were delineated by a radiation oncologist. We investigated the differences between CT and TRUS volumes. Results: The median prostate volume generated with TRUS was 22.4 mL (range, 11.2e39.6 mL). The median prostate volume derived from CT was 22.4 mL (range, 10.6e37.3 mL). On average, the CT prostate volume was 0.1% (95% confidence interval, 8.3e8.5%) larger than the TRUS prostate volume. The correlation coefficient between TRUS and CT volumes was 0.96 (p!0.01), which showed extremely strong correlation. Conclusions: There were little differences between TRUS and CT prostate volumes in this study. Though there are many problems in prostate volume definition based on CT images in terms of physician bias, these results revealed the possibility of overcoming the differences between CT and TRUS prostate volumes without magnetic resonance imaging (MRI) by practice and experience. Furthermore, as far as the prostate volume is concerned, it may be possible to substitute CT for TRUS before implant.
PO165 High-dose-rate brachytherapy in an outpatient basis with local anesthesia for prostate cancer and hypofractionated external beam radiotherapy: A feasibility report Antonio C.A. Pellizzon, M.D., Ph.D., Pers Novaes, M.D., Ph.D., Doug Gides, M.D., R. Fogaroli, M. Conte Radiation Oncology, Hospital Acacamargo, Sao Paulo, SP, Brazil. Purpose: The two primary methods to deliver radiotherapy include externalbeam and brachytherapy. High-dose-rate temporary brachytherapy (HDR), performed with catheters implanted into the prostate. To date, nearly all HDR patients have been treated under general or spinal anesthesia, but one alternative involves local anesthesia. Methods and Materials: Patients classified as intermediate or high risk with locally advanced prostate cancer are encouraged to participate in an institutional protocol combining HDR and hypofractionated conformal external-beam radiotherapy. For HDR treatments, patients were submitted to 2 implants with one week interval, with two fractions of 7.5 Gy of HDR-BT per implant. Before the procedure, pain is scored according to the University of California, Los Angeles, Universal Pain Assessment Tool. One week after the end of HDR-BT regimen, the patient begins the hypofractionated conformal external-beam radiotherapy plan in which 45 Gy is administered in 3-Gy daily fractions for 3 weeks, with a total treatment time of 5 weeks.