1
|
Greco C, Pares O, Pimentel N, Louro V, Santiago I, Vieira S, Stroom J, Mateus D, Soares A, Marques J, Freitas E, Coelho G, Seixas M, Lopez-Beltran A, Fuks Z. Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer: Results From the PROSINT Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:700-708. [PMID: 33704378 DOI: 10.1001/jamaoncol.2021.0039] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Ultra-high single-dose radiotherapy (SDRT) represents a potential alternative to curative extreme hypofractionated stereotactic body radiotherapy (SBRT) in organ-confined prostate cancer. Objective To compare toxic effect profiles, prostate-specific antigen (PSA) responses, and quality-of-life end points of SDRT vs extreme hypofractionated SBRT. Design, Setting, and Participants The PROSINT single-institution phase 2 randomized clinical trial accrued, between September 2015 and January 2017, 30 participants with intermediate-risk prostate cancer to receive SDRT or extreme hypofractionated SBRT. Androgen deprivation therapy was not permitted. Data were analyzed from March to May 2020. Interventions Patients were randomized in a 1:1 ratio to receive 5 × 9 Gy SBRT (control arm) or 24 Gy SDRT (test arm). Main Outcomes and Measures The primary end point was toxic effects; the secondary end points were PSA response, PSA relapse-free survival, and patient-reported quality of life measured with the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaires. Results A total of 30 men were randomized; median (interquartile range) age was 66.3 (61.2-69.9) and 73.6 (64.7-75.9) years for the SBRT and SDRT arms, respectively. Time to appearance and duration of acute and late toxic effects were similar in the 2 trial arms. Cumulative late actuarial urinary toxic effects did not differ for grade 1 (hazard ratio [HR], 0.41; 90% CI, 0.13-1.27) and grade 2 or greater (HR, 1.07; 90% CI, 0.21-5.57). Actuarial grade 1 late gastrointestinal (GI) toxic effects were comparable (HR, 0.37; 90% CI, 0.07-1.94) and there were no grade 2 or greater late GI toxic effects. Declines in PSA level to less than 0.5 ng/mL occurred by 36 months in both study arms. No PSA relapses occurred in favorable intermediate-risk disease, while in the unfavorable category, the actuarial 4-year PSA relapse-free survival values were 75.0% vs 64.0% (HR, 0.76; 90% CI, 0.17-3.31) for SBRT vs SDRT, respectively. The EPIC-26 median summary scores for the genitourinary and GI domains dropped transiently at 1 month and returned to pretreatment scores by 3 months in both arms. The IPSS-derived transient late urinary flare symptoms occurred at 9 to 18 months in 20% (90% CI, 3%-37%) of patients receiving SDRT. Conclusions and Relevance In this randomized clinical trial among patients with intermediate-risk prostate cancer, SDRT was safe and associated with low toxicity, and the tumor control and quality-of-life end points closely match the SBRT arm outcomes. Further studies are encouraged to explore indications for SDRT in the cure of prostate cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02570919.
Collapse
Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Santiago
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - João Marques
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elda Freitas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Graça Coelho
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Manuela Seixas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
2
|
Peigne C, Fournier G, Dissaux G, Delage F, Coquet JB, Boussion N, Goasduff G, Malhaire JP, Pradier O, Schick U, Valeri A. Minimal channel GreenLight photovaporization before permanent implant prostate brachytherapy for patients with obstructive symptoms: Technically feasible and safe. Brachytherapy 2020; 20:50-57. [PMID: 32891570 DOI: 10.1016/j.brachy.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Brachytherapy (BrT) is a standard treatment for low-risk to favorable-intermediate-risk prostate cancer but is a relative contraindication for patients with obstructive symptoms. We aimed to assess the feasibility and urinary toxicity of a minimal photovaporization (mPVP) before implantation. MATERIALS AND METHODS Between 04/2009 and 08/2016, 50 patients candidates for BrT but with International Prostate Symptom Score (IPSS)>15, uroflowmetry <15 mL/s, obstructive prostate or large median lobe underwent a mPVP (GreenLight Laser) at least 6 weeks (median 8.5) before permanent seed implantation (loose seeds, 125I, 160 Gy). RESULTS Two patients (4%) did not have sufficient improvement and did not undergo BrT, although it would have been possible at 3 months. For the 48 (96%) other patients, at the baseline, mean IPSS was 15.5 (±5.3), vs. 8.6 (±4.4) after mPVP (p = 1 × 10-6), and uroflowmetry 11.7 mL/s (±4), vs. 17.4 (±5.4) (p = 1.4 × 10-5). We did not experience any difficulty for BrT. Mean IPSS did not significantly increase 1, 3, or 6 months after BrT. With a median followup of 60 months [30-120], (92% assessed at last followup), only 4 patients (4/48 = 8.3%) experienced urinary retention and 5 (10.4%) needed surgery for urinary toxicity. In addition, only 2 patients (4%) needed medical treatment at last followup. Considering the 8 patients with de novo incontinence at 1 year, only 2 (4%) had persistent mild symptoms at last followup (36 months) (ICS1-2). CONCLUSIONS These results suggest that a two-step approach with an mPVP at least 6 weeks before BrT is feasible, with no excessive urinary toxicity, and may be a good strategy for obstructive patients seeking BrT.
Collapse
Affiliation(s)
| | - Georges Fournier
- Urology Department, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France
| | | | | | | | - Nicolas Boussion
- LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France; Radiation Oncology Department, CHU, Brest, France
| | | | | | - Olivier Pradier
- Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France; Radiation Oncology Department, CHU, Brest, France
| | - Ulrike Schick
- Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France; Radiation Oncology Department, CHU, Brest, France
| | - Antoine Valeri
- Urology Department, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, INSERM, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France.
| |
Collapse
|
3
|
Moran BJ, Rice SR, Chhabra AM, Amin N, Braccioforte M, Agarwal M. Long-term biochemical outcomes using cesium-131 in prostate brachytherapy. Brachytherapy 2019; 18:800-805. [PMID: 31427178 DOI: 10.1016/j.brachy.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Long-term outcomes reveal equivalent biochemical outcomes with low-dose-rate (LDR) brachytherapy (BT) compared with radical prostatectomy and external-beam radiotherapy for the management of prostate cancer. Iodine-125, the most commonly used isotope, may be associated with long-term urinary consequences. Cesium-131 (131Cs) has a higher dose rate and shorter dose delivery time, predicting a shorter duration of urinary morbidity. We report our institution's high-volume experience and the most mature data to date on outcomes with 131Cs prostate BT. METHODS AND MATERIALS 571 men (median age: 65.38 years) with low (55%)-, intermediate (36%)-, and high-risk disease (9%) received monobrachytherapy, dual-modality, or trimodality using 131Cs at a single institution. Risk groups were defined according to the National Comprehensive Cancer Network definition. Median prescription dose for definitive LDR-BT and LDR-BT boost was 115 Gy and 70 Gy, respectively. Median initial PSA was 6.1 ng/mL (IQR: 4.6-8.7). RESULTS Median followup time was 5 years. 5/7-year overall survival for low-, intermediate-, and high-risk patients was 96.9%/96/9%, 92.8%/89.7%, and 95.8%/87.1%, respectively (p = 0.02). 5/7-year freedom from biochemical failure for low-, intermediate-, and high-risk patients was 98.5%/96.3%, 94.1%/86.4%, and 93.2%/74.5%, respectively (p < 0.01). 5/7-year prostate cancer -specific survival was 100%/100%, 99.3%/99.3%, and 98.0%/98.0% for low-, intermediate-, and high-risk patients, respectively (p < 0.01). CONCLUSIONS 131Cs is a viable alternative isotope for prostate brachytherapy for organ-confined disease. Long-term biochemical control and survival outcomes are excellent and on par with those attained with the use of 125I or 103Pd. This report therefore supports the continued use of 131Cs as an effective and comparable alternative isotope.
Collapse
Affiliation(s)
| | - Stephanie R Rice
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - Arpit M Chhabra
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - Neha Amin
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Manuj Agarwal
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
| |
Collapse
|
4
|
Chao M, Joon DL, Khoo V, Spencer S, Ho H, Guerrieri M, Foroudi F, Bolton D. Combined Low Dose Rate Brachytherapy and External Beam Radiation Therapy for Intermediate-Risk Prostate Cancer. J Med Imaging Radiat Sci 2018; 50:82-86. [PMID: 30777253 DOI: 10.1016/j.jmir.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/17/2018] [Accepted: 09/28/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This is a retrospective study conducted to report the tumor control and late toxicity outcomes of patients with intermediate-risk prostate cancer undergoing combination external beam radiation therapy and low dose rate brachytherapy (LDR-PB). METHODS AND MATERIALS Thirty-one patients received 45 Gray (Gy) of external beam radiation therapy to the prostate and seminal vesicles, together with a brachytherapy boost via a transperineal prostate implant of I125 (108 Gy). In addition, some patients received 6 months of androgen deprivation therapy depending on physician preference. Biochemical failure was defined using the Phoenix consensus definition of the nadir PSA +2 ng/mL. Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. RESULTS The biochemical progression-free survival, metastases-free survival, and overall survival at 5 years were 87.1%, 96.3%, and 92%, respectively. The incidence of late grade ≥1 and ≥2 genitourinary (GU) toxicities were 54.8% and 6.5%, respectively. The incidence of late grade 3 GU toxicity was 6.5% with urinary retention occurring in two patients requiring either a bladder neck incision or transurethral resection of the prostate. The incidence of late grade ≥1 and 2 gastrointestinal toxicities were 19.4% and 6.5%, respectively. No patients developed grade 3 gastrointestinal toxicity. CONCLUSION Our small series has shown a high biochemical progression-free survival consistent with the ASCENDE-RT and NRG Oncology/RTOG0232 LDR-PB boost arms. In addition, the risk of late grade 3 GU toxicity is far lower than that reported by the ASCENDE-RT study but comparable to other LDR-PB boost and LDR alone reports in the literature. Therefore, we are comfortable to continue offering LDR-PB boost to our patients with intermediate-risk prostate cancer.
Collapse
Affiliation(s)
- Michael Chao
- Genesis Cancer Care Victoria, Ringwood, Australia; The Austin Hospital, Heidelberg, Australia; Ringwood Private Hospital, Ringwood East, Australia; University of Melbourne, Melbourne, Australia.
| | - Daryl Lim Joon
- The Austin Hospital, Heidelberg, Australia; University of Melbourne, Melbourne, Australia
| | - Vincent Khoo
- The Austin Hospital, Heidelberg, Australia; University of Melbourne, Melbourne, Australia; Royal Marsden Hospital, London, UK
| | | | - Huong Ho
- Genesis Cancer Care Victoria, Ringwood, Australia
| | - Mario Guerrieri
- Genesis Cancer Care Victoria, Ringwood, Australia; Ringwood Private Hospital, Ringwood East, Australia
| | - Farshad Foroudi
- The Austin Hospital, Heidelberg, Australia; University of Melbourne, Melbourne, Australia
| | - Damien Bolton
- The Austin Hospital, Heidelberg, Australia; Ringwood Private Hospital, Ringwood East, Australia; University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Coquet JB, Delage F, Fourcade A, Callerot P, Goasduff G, Boussion N, Rousseau B, Serey-Eiffel S, Malhaire JP, Pradier O, Schick U, Fournier G, Valeri A. Evaluation of the "Quadrella" at 3 years: New index to assess functional and oncological performance specific to prostate brachytherapy. Brachytherapy 2018; 17:782-787. [PMID: 29936129 DOI: 10.1016/j.brachy.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE "Quadrella" index has been recently developed to assess oncological and functional outcomes after prostate brachytherapy (PB). We aimed to evaluate this index at 1, 2, and 3 years, using validated questionnaires, assessed prospectively. METHODS AND MATERIALS From 08/2007 to 01/2013, 193 patients underwent 125Iodine PB for low-risk or favorable intermediate-risk prostate adenocarcinoma. Inclusion criteria were as follows: no incontinence (International Continence Society Index initial score = 0) and good erectile function (International Index of Erectile Function-5 items: >16). One hundred patients were included (mean age: 64 y). Postimplantation intake of phosphodiesterase inhibitors was not considered as failure. The "Quadrella" index was defined by the absence of biochemical recurrence (Phoenix criteria), significant erectile dysfunction (ED) (Index of Erectile Function-5 items: >16), urinary toxicity (UT) (International Prostate Score Symptom [IPSS] <15 or IPSS> 15 with ΔIPSS <5), and rectal toxicity (RT) (Radiation Therapy Oncology Group = 0). RESULTS At 12 months, 90 patients were evaluable: 42/90 (46.7%) achieved Quadrella. The main criteria for failure were as follows: ED in 77.1% (37/48) of cases, RT in 20.8% (10/48) of cases, and UT in 12.5% (9/57) of cases. At 24 and 36 months, 59.3% (48/81) and 61.1% (44/72) of patients achieved Quadrella, respectively. The main cause of failure was ED in 69.7% (23/33) and 85.7% (24/28) of cases, while RT was involved in 21.2% (7/33) and in 3.6% (1/28) of cases, and UT in 9.1% (3/33) and 3.6% (1/28) of cases. Only one case of biochemical recurrence was observed (i.e., 1/28 = 3.6% at 3 y). CONCLUSIONS The Quadrella can be used at 1, 2, and 3 years after PB. It allows to take into account the urinary and RT specific to PB. ED was the main cause of failure. This index will be useful to assess midterm and long-term results.
Collapse
Affiliation(s)
- Jean-Baptiste Coquet
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France.
| | | | - Alexandre Fourcade
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France
| | - Pierre Callerot
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France
| | | | | | | | | | | | - Olivier Pradier
- Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CHU Brest, Service de Radiothérapie, Brest, France
| | - Ulrike Schick
- Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CHU Brest, Service de Radiothérapie, Brest, France
| | - Georges Fournier
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CeRePP, Paris, France
| | - Antoine Valeri
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CeRePP, Paris, France
| |
Collapse
|
6
|
Stone NN, Winoker JS, Kaplan SA, Stock RG. Factors influencing long-term urinary symptoms after prostate brachytherapy. BJU Int 2018; 122:831-836. [DOI: 10.1111/bju.14365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nelson N. Stone
- Department of Urology; The Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jared S. Winoker
- Department of Urology; The Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Steven A. Kaplan
- Department of Urology; The Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Richard G. Stock
- Department of Radiation Oncology; The Icahn School of Medicine at Mount Sinai; New York NY USA
| |
Collapse
|
7
|
Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ. Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study. Brachytherapy 2017; 17:265-276. [PMID: 29269207 DOI: 10.1016/j.brachy.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.
Collapse
Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Houston, TX
| | - David A Swanson
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Usama Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J Graber
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa Bruno
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
8
|
Gnep K, Lizée T, Campillo-Gimenez B, Delpon G, Droupy S, Perrier L, de Crevoisier R. [Toxicity and quality of life comparison of iodine 125 brachytherapy and stereotactic radiotherapy for prostate cancers]. Cancer Radiother 2017; 21:478-490. [PMID: 28888746 DOI: 10.1016/j.canrad.2017.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
Quality of life is a major issue for good prognostic prostate cancer, for which brachytherapy is one of the reference treatments. Stereotactic Body Radiotherapy (SBRT) is a recent alternative however not yet validated as a standard treatment. This review of the literature reports and compares the toxicities and the quality of life, either after exclusive brachytherapy with iodine 125 or after SBRT. The comparison is made with the limitations of the absence of randomized trial comparing the two treatment techniques. Acute toxicity appears to be lower after SBRT compared to brachytherapy (from 10 to 40 % versus 30 to 40 %, respectively). Conversely, acute and late gastrointestinal toxicity (from 0 to 21 % and from 0 to 10 % of grade 2, respectively) appears more frequent with SBRT. Late urinary toxicity seems identical between both techniques (from 20 to 30 % of grade 2), with a possible urinary flare syndrome. Both treatments have an impact on erectile dysfunction, although it is not possible to conclude that a technique is superior because of the limited data on SBRT. SBRT has better bowel and urinary (irritation or obstruction) quality of life scores than brachytherapy; while sexual and urinary incontinence remain the same. The absence of randomized trial comparing SBRT with brachytherapy for prostate cancers does not allow to conclude on the superiority of one technique over another, thus justifying a phase III medicoeconomic evaluation.
Collapse
Affiliation(s)
- K Gnep
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France.
| | - T Lizée
- Département de radiothérapie, centre régional de lutte contre le cancer Paul-Papin, institut de cancérologie de l'Ouest, 49100 Angers, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - B Campillo-Gimenez
- Direction de la recherche clinique, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - G Delpon
- Département de radiothérapie, centre régional de lutte contre le cancer René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - S Droupy
- Département d'urologie, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - L Perrier
- Centre Léon-Bérard, université Lyon, direction de la recherche clinique et de l'innovation GATE L-SE UMR 5824, 69008 Lyon, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| |
Collapse
|
9
|
Srougi V, Barret E, Nunes-Silva I, Baghdadi M, Garcia-Barreras S, Pierrat N, Rozet F, Galiano M, Sanchez-Salas R, Cathelineau X, Cosset JM. Focal brachytherapy for localized prostate cancer: Urinary toxicity depends on tumor location. Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Miyake M, Tanaka N, Asakawa I, Hori S, Morizawa Y, Tatsumi Y, Nakai Y, Inoue T, Anai S, Torimoto K, Aoki K, Hasegawa M, Fujii T, Konishi N, Fujimoto K. Assessment of lower urinary symptom flare with overactive bladder symptom score and International Prostate Symptom Score in patients treated with iodine-125 implant brachytherapy: long-term follow-up experience at a single institute. BMC Urol 2017; 17:62. [PMID: 28806948 PMCID: PMC5556596 DOI: 10.1186/s12894-017-0251-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 08/03/2017] [Indexed: 02/18/2023] Open
Abstract
Background The aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (125I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated. Methods Changes in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value. Results A clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce. Conclusions To our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0251-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan.
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Yoshihiro Tatsumi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan.,Department of Pathology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | | | - Tomomi Fujii
- Department of Pathology, Nara Medical University, Nara, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| |
Collapse
|
11
|
Sakayori M, Ohashi T, Momma T, Kaneda T, Nishimura S, Sutani S, Yamashita S, Shigematsu N. Quantitative analysis of genitourinary toxicity after iodine-125 brachytherapy for localized prostate cancer: Followup of the International Prostate Symptom Score and Overactive Bladder Symptom Score. Brachytherapy 2017; 16:806-814. [PMID: 28552494 DOI: 10.1016/j.brachy.2017.04.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To analyze genitourinary toxicity by followup of the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) after prostate brachytherapy. METHODS AND MATERIALS Six hundred eighty patients were treated with iodine-125 brachytherapy for localized prostate cancer. IPSS, OABSS, and two categories of IPSS questions (storage symptom score [IPSS-S] and voiding symptom score [IPSS-V]) were evaluated. RESULTS The median followup was 54 months (range, 24-108). All scales showed rapid increases followed by gradual decreases. The median times to IPSS peak and resolution were 1 and 6 months, respectively. The resolution rates of IPSS, IPSS-S, IPSS-V, and OABSS at the last followup were 84.2%, 86.3%, 89.5%, and 83.0%, respectively. The difference between IPSS baseline and peak was greater for larger preimplant prostate volumes (≥25 mL, p = 0.004). The time to resolution was longer for higher biologic effective dose (BED) (≥210 Gy, p = 0.019 [IPSS]), in those with larger prostate volumes (≥25 mL, p = 0.025 [OABSS]), in younger patients (younger than 70 years, p = 0.043 [IPSS-S]), and in those with androgen deprivation therapy (ADT) use (p = 0.049 [IPSS-V]). Urge incontinence, included in the OABSS, was observed more commonly in older patients (75 years and older, p = 0.018), with ADT use (p < 0.001), and for higher BED (≥210 Gy, p = 0.006). CONCLUSIONS The IPSS and OABSS showed similar patterns of change. Urinary symptoms improved more rapidly in those with high baseline IPSS levels. The OABSS was useful for following urinary symptoms after prostate brachytherapy. Age, ADT use, preimplant prostate volume, and BED were significantly associated with urinary outcomes.
Collapse
Affiliation(s)
- Masanori Sakayori
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan; Department of Radiology, National Hospital Organization Saitama Hospital, Saitama, Japan.
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Tomoya Kaneda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuichi Nishimura
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinya Sutani
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shoji Yamashita
- Department of Radiology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Apinorasethkul O, Lenards N, Hunzeker A. Urethral dose sparing in squamous cell carcinoma of anal canal using proton therapy matching electrons with prior brachytherapy for prostate cancer: A case study. Med Dosim 2016; 41:242-7. [PMID: 27396941 DOI: 10.1016/j.meddos.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
The purpose of this case study is to communicate a technique on treating the re-irradiation of squamous cell carcinoma (SCC) of anal canal with proton fields matched with electron fields to spare prostatic urethra. A 76-year old male presented with a secondary radiation-induced malignancy as a result of prostate brachytherapy seeds irradiation 10 years prior. A rectal examination revealed a bulky tumor at the top of the anal canal involving the left superior-most aspect of the anal canal extending superiorly into the rectum. The inferior extent was palpable approximately 3cm from the anal verge and the superior extent of the mass measured greater than 5cm in the superior-inferior dimension. Chemoradiation was suggested since the patient was opposed to abdominoperineal resection (APR) and colostomy. The use of proton therapy matching with electron fields in the re-irradiation setting could help reduce the complications. A 2 lateral proton beams were designed to treat the bulky tumor volume with 2 electron beams treating the nodal volumes. This complication of treatment fields helped spare the prostatic urethra and reduced the risk of urinary obstruction in the future.
Collapse
Affiliation(s)
- Ontida Apinorasethkul
- Medical Dosimetry Graduate Program, University of Wisconsin, La Crosse, WI; Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Nishele Lenards
- Medical Dosimetry Graduate Program, University of Wisconsin, La Crosse, WI
| | - Ashley Hunzeker
- Medical Dosimetry Graduate Program, University of Wisconsin, La Crosse, WI
| |
Collapse
|
13
|
Fernandez Ots A, Bucci J, Chin YS, Malouf D, Howie A, Enari KE. Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol. JMIR Res Protoc 2016; 5:e98. [PMID: 27296781 PMCID: PMC4923592 DOI: 10.2196/resprot.5433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way. OBJECTIVE The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT. METHODS The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years. RESULTS To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled trial (RCT). CONCLUSIONS This protocol is designed to show feasibility in delivering hemigland focal therapy with seed BT. It may answer crucial questions and obtain data which will enable downstream decisions on focal low dose rate (LDR) prostate BT. CLINICALTRIAL Clinicaltrial.gov NCT02643511; https://www.clinicaltrials.gov/ct2/show/NCT02643511 (Archived by Webcite at http://www.webcitation.org/6ghLCzIhY).
Collapse
Affiliation(s)
- Ana Fernandez Ots
- Cancer Care Centre, Radiation Oncology, St George Hospital, Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
14
|
Whiting PF, Moore TH, Jameson CM, Davies P, Rowlands MA, Burke M, Beynon R, Savovic J, Donovan JL. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. BJU Int 2016; 118:193-204. [DOI: 10.1111/bju.13499] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Penny F. Whiting
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Theresa H.M. Moore
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | | | - Philippa Davies
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Mari-Anne Rowlands
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Margaret Burke
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Rebecca Beynon
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Jelena Savovic
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Jenny L. Donovan
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| |
Collapse
|
15
|
Tward JD, Jarosek S, Chu H, Thorpe C, Shrieve DC, Elliott S. Time Course and Accumulated Risk of Severe Urinary Adverse Events After High- Versus Low-Dose-Rate Prostate Brachytherapy With or Without External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:1443-1453. [PMID: 27325475 DOI: 10.1016/j.ijrobp.2016.03.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence, and radiation cystitis. We compared the incidence of grade 3 UAEs, according to the Common Terminology Criteria for Adverse Events, after low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy, as well as after LDR plus external beam radiation therapy (EBRT) and HDR plus EBRT. METHODS AND MATERIALS Men aged >65 years with nonmetastatic prostate cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare database who were treated with LDR (n=12,801), HDR (n=685), LDR plus EBRT (n=8518), or HDR plus EBRT (n=2392). The populations were balanced by propensity weighting, and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared with those in a cohort of men not treated for prostate cancer. RESULTS Median follow-up was 4.3 years. At 8 years, the propensity-weighted cumulative UAE incidence was highest after HDR plus EBRT (26.6% [95% confidence interval, 23.8%-29.7%]) and lowest after LDR (15.7% [95% confidence interval, 14.8%-16.6%]). The absolute excess risk over nontreated controls at 8 years was 1.9%, 3.8%, 8.4%, and 12.9% for LDR, HDR, LDR plus EBRT, and HDR plus EBRT, respectively. These represent numbers needed to harm of 53, 26, 12, and 8 persons, respectively. The additional risk of development of a UAE related to treatment for LDR, LDR plus EBRT, and HDR plus EBRT was greatest within the 2 years after treatment and then continued to decline over time. Beyond 4 years, the risk of development of a new severe UAE matched the baseline risk of the control population for all treatments. CONCLUSIONS Toxicity differences were observed between LDR and HDR, but the differences did not meet statistical significance. However, combination radiation therapy (either HDR plus EBRT or LDR plus EBRT) increases the risk of severe UAEs compared with HDR alone or LDR alone. The highest increased risk of urinary toxicity occurs within the 2 years after therapy and then declines to an approximately 1% increase in incidence per year.
Collapse
Affiliation(s)
- Jonathan D Tward
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
| | | | - Haitao Chu
- University of Minnesota, Minneapolis, Minnesota
| | - Cameron Thorpe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Dennis C Shrieve
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | |
Collapse
|
16
|
Outcomes for prostate glands >60 cc treated with low-dose-rate brachytherapy. Brachytherapy 2016; 15:163-8. [DOI: 10.1016/j.brachy.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 11/24/2022]
|
17
|
Ashida S, Yamasaki I, Tamura K, Shimamoto T, Inoue K, Kariya S, Kobayashi K, Yamagami T, Shuin T. Feasibility and early outcome of high-dose-rate Ir-192 brachytherapy as monotherapy in two fractions within 1 day for high-/very high-risk prostate cancer. Mol Clin Oncol 2016; 4:789-793. [PMID: 27123280 DOI: 10.3892/mco.2016.786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/09/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to evaluate the feasibility and preliminary outcomes of high-dose-rate (HDR)-brachytherapy as a monotherapy in two fractions within 1 day for localized prostate cancer, including high-/very high-risk cases. Among the 68 patients treated with HDR monotherapy between July 2011 and December 2014, 65 had a minimal follow-up of 12 months without adjuvant androgen deprivation therapy and were enrolled in the present study [42/65 (64.6%) exhibited high-/very high-risk diseases]. HDR monotherapy was performed in two fractions with a minimal interval of 6 h and the prescribed dose was 13.5 Gy (×2). Adverse events (AEs) were assessed using Common Terminology Criteria for Adverse Events (version 4; http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40), and biochemical failure was assessed by the Phoenix definition. The median follow-up time was 30.1 months. The majority of patients had Grade 0-1 acute AEs. Four patients (6.2%) exhibited urinary retention, requiring a Foley catheter. Grade 3 acute AEs occurred at a frequency of 3.1% and hematuria at 1.5%. The majority of patients also exhibited Grade 0-1 chronic AEs. Grade 3 chronic AEs occurred at a frequency of 1.5% and urethral stricture at 1.5%, for which endoscopic treatment was indicated. Acute and chronic gastrointestinal AEs were uncommon, and no Grade 3 or above AEs developed. Biochemical failure occurred in 4 patients who all exhibited high-/very high-risk diseases. Kaplan-Meier estimated that 3 year biochemical failure-free survival was 91.6% overall and 88.0% in high-/very high-risk cases. The present two-fraction 1 day HDR monotherapy is feasible with minimal AEs and achieved acceptable biochemical control of localized prostate cancer, including high-/very high-risk cases, although long-term follow-up is required.
Collapse
Affiliation(s)
- Shingo Ashida
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Ichiro Yamasaki
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kenji Tamura
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Tsutomu Shimamoto
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Shinji Kariya
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kana Kobayashi
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Taro Shuin
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| |
Collapse
|
18
|
Grimm M, Wenz F. [Localized prostate cancer: Radiotherapeutic concepts]. Urologe A 2016; 55:326-32. [PMID: 26895435 DOI: 10.1007/s00120-016-0042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation therapy is an established cornerstone in the treatment of prostate cancer. Significant advances in the techniques and therapeutic concepts have been made in recent decades. OBJECTIVES The objective of this article is to provide an overview of current standards of care and recent technical and conceptional developments. CONCLUSIONS Three-dimensional conformal radiotherapy has long been the standard of care for percutaneous radiotherapy. The development of intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) have increased the precision of treatment, thus, reducing side effects and allowing dose escalation. LDR (low dose rate) and HDR (high dose rate) brachytherapy alone or in combination are a treatment option in localized prostate cancer with a distinct side effect profile. The roles of proton therapy and stereotactic radiotherapy should be further investigated in prospective trials.
Collapse
Affiliation(s)
- M Grimm
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
| | - F Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland
| |
Collapse
|
19
|
Chao MW, Grimm P, Yaxley J, Jagavkar R, Ng M, Lawrentschuk N. Brachytherapy: state-of-the-art radiotherapy in prostate cancer. BJU Int 2015; 116 Suppl 3:80-8. [DOI: 10.1111/bju.13252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Peter Grimm
- Prostate Cancer Center of Seattle; Seattle WA USA
| | | | - Raj Jagavkar
- St Vincent's Hospital; Darlinghurst NSW Australia
| | - Michael Ng
- Radiation Oncology Victoria; Epping Vic. Australia
| | - Nathan Lawrentschuk
- Department of Surgery and Olivia Newton John Cancer Research Institute; Austin Hospital; Heidelberg Vic. Australia
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
| |
Collapse
|
20
|
Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
Collapse
Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
| |
Collapse
|
21
|
Kittel JA, Reddy CA, Smith KL, Stephans KL, Tendulkar RD, Ulchaker J, Angermeier K, Campbell S, Stephenson A, Klein EA, Wilkinson DA, Ciezki JP. Long-Term Efficacy and Toxicity of Low-Dose-Rate 125 I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 92:884-93. [DOI: 10.1016/j.ijrobp.2015.02.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 11/16/2022]
|
22
|
Ohashi T, Yorozu A, Saito S, Tanaka N, Katayama N, Kojima S, Maruo S, Kikuchi T, Dokiya T, Fukushima M, Yamanaka H. Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study. Int J Radiat Oncol Biol Phys 2015; 93:141-9. [PMID: 26279031 DOI: 10.1016/j.ijrobp.2015.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). METHODS AND MATERIALS Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy. RESULTS Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. CONCLUSIONS The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.
Collapse
Affiliation(s)
| | - Atsunori Yorozu
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shiro Saito
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kole TP, Tong M, Wu B, Lei S, Obayomi-Davies O, Chen LN, Suy S, Dritschilo A, Yorke E, Collins SP. Late urinary toxicity modeling after stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2015; 55:52-8. [PMID: 25972264 DOI: 10.3109/0284186x.2015.1037011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Late urinary symptom flare has been shown to occur in a small subset of men treated with ultra- hypofractionated stereotactic body radiotherapy (SBRT) for prostate cancer. The purpose of this study was to use normal tissue complication probability modeling in an effort to derive SBRT specific dosimetric predictor's of late urinary flare. MATERIAL AND METHODS Two hundred and sixteen men were treated for localized prostate cancer using ultra- hypofractionated SBRT. A dose of 35-36.25 Gy in 5 fractions was delivered to the prostate and proximal seminal vesicles. Functional surveys were conducted before and after treatment to assess late toxicity. Phenomenologic NTCP models were fit to bladder DVHs and late urinary flare outcomes using maximum likelihood estimation. RESULTS Twenty-nine patients experienced late urinary flare within two years of completion of treatment. Fitting of bladder DVH data to a Lyman NTCP model resulted in parameter estimates of m, TD50, and n of 0.19 (0-0.47), 38.7 Gy (31.1-46.4), and 0.13 (-0.14-0.41), respectively. Subsequent fit to a hottest volume probit model revealed a significant association of late urinary flare with dose to the hottest 12.7% of bladder volume. Multivariate analysis resulted in a final model that included patient age and hottest volume probit model predictions. Kaplan-Meier analysis demonstrated a two-year urinary flare free survival of 95.7% in patients 65 years or older with a bladder D12.7% of 33.5 Gy or less, compared to 74.5% in patients meeting none of these criteria. CONCLUSION NTCP modeling of late urinary flare after ultra-hypofractionated prostate SBRT demonstrates a relatively small volume effect for dose to the bladder, suggesting that reduction of volume receiving elevated dose will result in decreased incidence of late urinary toxicity. Future studies will be needed to examine the impact of dose to other potential sources of late genitourinary toxicity.
Collapse
Affiliation(s)
- Thomas P. Kole
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Tong
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Binbin Wu
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | | | - Leonard N. Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
24
|
Salvage low-dose-rate permanent seed brachytherapy for locally recurrent prostate cancer: Association between dose and late toxicity. Brachytherapy 2015; 14:342-9. [DOI: 10.1016/j.brachy.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/21/2022]
|
25
|
Janowski E, Chen LN, Kim JS, Lei S, Suy S, Collins B, Lynch J, Dritschilo A, Collins S. Stereotactic body radiation therapy (SBRT) for prostate cancer in men with large prostates (≥50 cm(3)). Radiat Oncol 2014; 9:241. [PMID: 25398516 PMCID: PMC4239322 DOI: 10.1186/s13014-014-0241-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/18/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with large prostate volumes have been shown to have higher rates of genitourinary and gastrointestinal toxicities after conventional radiation therapy for prostate cancer. The efficacy and toxicity of stereotactic body radiation therapy (SBRT), which delivers fewer high-dose fractions of radiation treatment, is unknown for large prostate volume prostate cancer patients. We report our early experience using SBRT for localized prostate cancer in patients with large prostate volumes. METHODS 57 patients with prostate volumes ≥50 cm(3) prior to treatment with SBRT for localized prostate carcinoma and with a minimum follow up of two years were included in this retrospective review of prospectively collected data. Treatment was delivered using Cyberknife (Accuray) with doses of 35-36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were scored using the CTCAE v.4. Quality of life was assessed using the American Urological Association (AUA) Symptom Score and the Expanded Prostate Cancer Index Composite (EPIC)-26. RESULTS 57 patients (23 low-, 25 intermediate- and 9 high-risk according to the D'Amico classification) at a median age of 69 years (range, 54-83 years) received SBRT with a median follow-up of 2.9 years. The median prostate size was 62.9 cm(3) (range 50-138.7 cm(3)). 33.3% of patients received ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.5 ng/ml and decreased to a median PSA of 0.4 ng/ml by 2 years (p <0.0001). A mean baseline AUA symptom score of 7.5 significantly increased to 13 at 1 month (p = 0.001) and returned to baseline by 3 months (p = 0.21). 23% of patients experienced a late transient urinary symptom flare in the first two years following treatment. Mean baseline EPIC bowel scores of 95.8 decreased to 78.1 at 1 month (p <0.0001), but subsequently improved to 93.5 three months (p = 0.08). The 2-year actuarial incidence rates of GU and GI toxicity ≥ grade 2 were 49.1% and 1.8%, respectively. Two patients (3.5%) experienced grade 3 urinary toxicity, and no patient experienced grade 3 gastrointestinal toxicity. CONCLUSIONS SBRT for clinically localized prostate cancer was well tolerated in men with large prostate volumes.
Collapse
Affiliation(s)
- Einsley Janowski
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Brian Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Sean Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| |
Collapse
|
26
|
Rana Z, Cyr RA, Chen LN, Kim BS, Moures RA, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP. Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer. Front Oncol 2014; 4:290. [PMID: 25374844 PMCID: PMC4204455 DOI: 10.3389/fonc.2014.00290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background: Irritative voiding symptoms are common in elderly men and following prostate radiotherapy. There is limited clinical data on the impact of hypofractionated treatment on irritative voiding symptoms. This study sought to evaluate urgency, frequency, and nocturia following stereotactic body radiation therapy (SBRT) for prostate cancer. Methods: Patients treated with SBRT monotherapy for localized prostate cancer from August 2007 to July 2011 at Georgetown University Hospital were included in this study. Treatment was delivered using the CyberKnife® with doses of 35–36.25 Gy in five fractions. Patient-reported urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) before treatment and at 1, 3, 6, 9, and 12 months post-treatment and every 6 months thereafter. Results: Two hundred four patients at a median age of 69 years received SBRT with a median follow-up of 4.8 years. Prior to treatment, 50.0% of patients reported moderate to severe lower urinary tract symptoms (LUTS) and 17.7% felt that urinary frequency was a moderate to big problem. The mean prostate volume was 39 cc and 8% had prior procedures for benign prostatic hyperplasia. A mean baseline IPSS-irritative (IPSS-I) score of 4.8 significantly increased to 6.5 at 1 month (p < 0.0001), however returned to baseline at 3 months (p = 0.73). The IPSS-I score returned to baseline in 91% of patients by 6 months and 96% of patients by 2 years. Transient increases in irritative voiding symptoms were common at 1 year. The mean baseline IPSS-I score decreased to 4.4 at 24 months (p = 0.03) and 3.7 at 36 months (p < 0.0001). In men with moderate to severe LUTS (IPSS ≥ 8) at baseline, the mean IPSS-I decreased from a baseline score of 6.8–4.9 at 3 years post-SBRT. This decrease was both statistically (p < 0.0001) and clinically significant (minimally important difference = 1.45). Only 14.6% of patients felt that urinary frequency was a moderate to big problem at 3 years post-SBRT (p = 0.23). Conclusion: Treatment of prostate cancer with SBRT resulted in an acute increase in irritative urinary symptoms that peaked within the first month post-treatment. Irritative voiding symptoms returned to baseline in the majority of patients by 3 months post-SBRT and were actually improved from baseline at 3 years post-SBRT.
Collapse
Affiliation(s)
- Zaker Rana
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Robyn A Cyr
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Rudy A Moures
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| |
Collapse
|
27
|
Late urinary side effects 10 years after low-dose-rate prostate brachytherapy: population-based results from a multiphysician practice treating with a standardized protocol and uniform dosimetric goals. Int J Radiat Oncol Biol Phys 2014; 90:570-8. [PMID: 25151536 DOI: 10.1016/j.ijrobp.2014.06.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/10/2014] [Accepted: 06/14/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine late urinary toxicity (>12 months) in a large cohort of uniformly treated low-dose-rate prostate brachytherapy patients. METHODS AND MATERIALS From 1998 to 2009, 2709 patients with National Comprehensive Cancer Network-defined low-risk and low-tier intermediate-risk prostate cancer were treated with Iodine 125 ((125)I) low-dose-rate prostate brachytherapy; 2011 patients with a minimum of 25 months of follow-up were included in the study. Baseline patients, treatment, implant factors, and late urinary toxicity (Radiation Therapy Oncology Group [RTOG] grading system and International Prostate Symptom Score [IPSS]) were recorded prospectively. Time to IPSS resolution, late RTOG genitourinary toxicity was examined with Kaplan-Meier and log-rank tests. Cox proportional hazards regression was done for individual covariates and multivariable models. RESULTS Median follow-up was 54.5 months (range, 2-13 years). Actuarial toxicity rates reached 27% and 10% (RTOG ≥2 and ≥3, respectively) at 9-13 years. Symptoms resolved quickly in the majority of patients (88% in 6-12 months). The prevalence of RTOG 0, 1, 2, 3, and 4 toxicity with a minimum of 7 years' follow-up was 70%, 21%, 6.4%, 2.3%, and 0.08%, respectively. Patients with a larger prostate volume, higher baseline IPSS, higher D90, acute toxicity, and age >70 years had more late RTOG ≥2 toxicity (all P≤.02). The IPSS resolved slower in patients with lower baseline IPSS and larger ultrasound prostate volume, those not receiving androgen deprivation therapy, and those with higher D90. The crude rate of RTOG 3 toxicity was 6%. Overall the rate of transurethral resection of the prostate was 1.9%; strictures, 2%; incontinence, 1.3%; severe symptoms, 1.8%; late catheterization, 1.3%; and hematuria, 0.8%. The majority (80%) resolved their symptoms in 6-12 months. CONCLUSION Long-term urinary toxicity after brachytherapy is low. Although actuarial rates increase with longer follow-up (27% RTOG 2 and 10% RTOG 3 at 13 years), symptoms resolve relatively quickly; between 5 and 13 years' follow-up, >90% of patients have minimal urinary toxicity. Refining patient selection criteria, planning, and treatment delivery may further reduce toxicity.
Collapse
|
28
|
Arscott WT, Chen LN, Wilson N, Bhagat A, Kim JS, Moures RA, Yung TM, Lei S, Collins BT, Kowalczyk K, Suy S, Dritschilo A, Lynch JH, Collins SP. Obstructive voiding symptoms following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2014; 9:163. [PMID: 25056726 PMCID: PMC4118163 DOI: 10.1186/1748-717x-9-163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Obstructive voiding symptoms (OVS) are common following prostate cancer treatment with radiation therapy. The risk of urinary retention (UR) following hypofractionated radiotherapy has yet to be fully elucidated. This study sought to evaluate OVS and UR requiring catheterization following SBRT for prostate cancer. Methods Patients treated with SBRT for localized prostate cancer from February 2008 to July 2011 at Georgetown University were included in this study. Treatment was delivered using the CyberKnife® with doses of 35 Gy-36.25 Gy in 5 fractions. UR was prospectively scored using the CTCAE v.3. Patient-reported OVS were assessed using the IPSS-obstructive subdomain at baseline and at 1, 3, 6, 9, 12, 18 and 24 months. Associated bother was evaluated via the EPIC-26. Results 269 patients at a median age of 69 years received SBRT with a median follow-up of 3 years. The mean prostate volume was 39 cc. Prior to treatment, 50.6% of patients reported moderate to severe lower urinary track symptoms per the IPSS and 6.7% felt that weak urine stream and/or incomplete emptying were a moderate to big problem. The 2-year actuarial incidence rates of acute and late UR ≥ grade 2 were 39.5% and 41.4%. Alpha-antagonist utilization rose at one month (58%) and 18 months (48%) post-treatment. However, Grade 3 UR was low with only 4 men (1.5%) requiring catheterization and/or TURP. A mean baseline IPSS-obstructive score of 3.6 significantly increased to 5.0 at 1 month (p < 0.0001); however, it returned to baseline in 92.6% within a median time of 3 months. Late increases in OVS were common, but transient. Only 7.1% of patients felt that weak urine stream and/or incomplete emptying was a moderate to big problem at two years post-SBRT (p = 0.6854). Conclusions SBRT treatment caused an acute increase in OVS which peaked within the first month post-treatment, though acute UR requiring catheterization was rare. OVS returned to baseline in > 90% of patients within a median time of three months. Transient Late increases in OVS were common. However, less than 10% of patients felt that OVS were a moderate to big problem at two years post-SBRT.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
| |
Collapse
|
29
|
Woo JA, Chen LN, Bhagat A, Oermann EK, Kim JS, Moures R, Yung T, Lei S, Collins BT, Kumar D, Suy S, Dritschilo A, Lynch JH, Collins SP. Clinical characteristics and management of late urinary symptom flare following stereotactic body radiation therapy for prostate cancer. Front Oncol 2014; 4:122. [PMID: 24904833 PMCID: PMC4033266 DOI: 10.3389/fonc.2014.00122] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose: Stereotactic body radiation therapy (SBRT) is increasingly utilized as primary treatment for clinically localized prostate cancer. While acute post-SBRT urinary symptoms are well recognized, the late genitourinary toxicity of SBRT has not been fully described. Here, we characterize the clinical features of late urinary symptom flare and recommend conservative symptom management approaches that may alleviate the associated bother. Methods: Between February 2008 and August 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT at Georgetown University Hospital. Treatment was delivered using the CyberKnife with doses of 35–36.25 Gy in five fractions. The prevalence of each of five Common Terminology Criteria for Adverse Events (CTCAE) graded urinary toxicities was assessed at each follow-up visit. Medication usage was documented at each visit. Patient-reported urinary symptoms were assessed using the American Urological Association (AUA) symptom score and the Expanded Prostate Cancer Index Composite (EPIC)-26 at 1, 3, 6, 9, 12, 18, and 24 months. Late urinary symptom flare was defined as an increase in the AUA symptom score of ≥5 points above baseline with a degree of severity in the moderate to severe range (AUA symptom score ≥15). The relationship between the occurrence of flare and pre-treatment characteristics were examined. Results: For all patients, the AUA symptom score spiked transiently at 1 month post-SBRT. Of the 216 patients, 29 (13.4%) experienced a second transient increase in the AUA symptom score that met the criteria for late urinary symptom flare. Among flare patients, the median age was 66 years compared to 70 for those without flare (p = 0.007). In patients who experienced flare, CTCAE urinary toxicities including dysuria, frequency/urgency, and retention peaked at 9–18 months, and alpha-antagonist utilization increased at 1 month post-treatment, rose sharply at 12 months post-treatment, and peaked at 18 months (85%) before decreasing at 24 months. The EPIC urinary summary score of flare patients declined transiently at 1 month and experienced a second, more protracted decline between 6 and 18 months before returning to near baseline at 2-year post-SBRT. Statistically and clinically significant increases in patient-reported frequency, weak stream, and dysuria were seen at 12 months post-SBRT. Among flare patients, 42.9% felt that urination was a moderate to big problem at 12 months following SBRT. Conclusion: In this study, we characterize late urinary symptom flare following SBRT. Late urinary symptom flare is a constellation of symptoms including urinary frequency/urgency, weak stream, and dysuria that transiently occurs 6–18 months post-SBRT. Provision of appropriate anticipatory counseling and the maintenance of prophylactic alpha-antagonists may limit the bother associated with this syndrome.
Collapse
Affiliation(s)
- Jennifer A Woo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Aditi Bhagat
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Eric K Oermann
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Deepak Kumar
- Cancer Research Laboratory, Department of Biology, University of the District of Columbia , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| |
Collapse
|
30
|
Talcott JA, Manola J, Chen RC, Clark JA, Kaplan I, D'Amico AV, Zietman AL. Using patient-reported outcomes to assess and improve prostate cancer brachytherapy. BJU Int 2014; 114:511-6. [DOI: 10.1111/bju.12464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James A. Talcott
- Massachusetts General Hospital Cancer Center; Boston MA USA
- Continuum Cancer Centers of New York; New York NY USA
- Albert Einstein School of Medicine; New York NY USA
- Harvard Medical School; Boston MA USA
| | | | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Jack A. Clark
- Center for Health Quality, Outcomes, and Economic Research; Edith Nourse Rogers Memorial Veterans Hospital; Bedford MA USA
- Boston University School of Public Health; Boston MA USA
| | - Irving Kaplan
- Beth Israel-Deaconess Medical Center; Boston MA USA
- Brigham and Women's Hospital; Boston MA USA
| | - Anthony V. D'Amico
- Brigham and Women's Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| | - Anthony L. Zietman
- Department of Radiation Oncology; Massachusetts General Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| |
Collapse
|
31
|
Usmani N, Leong N, Martell K, Lan L, Ghosh S, Pervez N, Pedersen J, Yee D, Murtha A, Amanie J, Sloboda R, Murray D, Parliament M. Single-nucleotide polymorphisms studied for associations with urinary toxicity from (125)I prostate brachytherapy implants. Brachytherapy 2014; 13:285-91. [PMID: 24656733 DOI: 10.1016/j.brachy.2014.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify clinical, dosimetric, and genetic factors that are associated with late urinary toxicity after a (125)I prostate brachytherapy implant. METHODS AND MATERIALS Genomic DNA from 296 men treated with (125)I prostate brachytherapy monotherapy was extracted from saliva samples for this study. A retrospective database was compiled including clinical, dosimetric, and toxicity data for this cohort of patients. Fourteen candidate single-nucleotide polymorphism (SNPs) from 13 genes (TP53, ERCC2, GSTP1, NOS, TGFβ1, MSH6, RAD51, ATM, LIG4, XRCC1, XRCC3, GSTA1, and SOD2) were tested in this cohort for correlations with toxicity. RESULTS This study identified 217 men with at least 2 years of followup. Of these, 39 patients developed Grade ≥2 late urinary complications with a transurethral resection of prostate, urethral stricture, gross hematuria, or a sustained increase in their International Prostate Symptom Score. The only clinical or dosimetric factor that was associated with late urinary toxicity was age (p = 0.02). None of the 14 SNPs tested in this study were associated with late urinary toxicity in the univariate analysis. CONCLUSIONS This study identified age as the only variable being associated with late urinary toxicity. However, the small sample size and the candidate gene approach used in this study mean that further investigations are essential. Genome-wide association studies are emerging as the preferred approach for future radiogenomic studies to overcome the limitations from a candidate gene approach.
Collapse
Affiliation(s)
- Nawaid Usmani
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
| | - Nelson Leong
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Kevin Martell
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Lanna Lan
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; Division of Experimental Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Nadeem Pervez
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - John Pedersen
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Don Yee
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Albert Murtha
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - John Amanie
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Ron Sloboda
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; Division of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - David Murray
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; Division of Experimental Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
32
|
Iodine-125 prostate seed brachytherapy in renal transplant recipients: an analysis of oncological outcomes and toxicity profile. J Contemp Brachytherapy 2014; 6:15-20. [PMID: 24790617 PMCID: PMC4003425 DOI: 10.5114/jcb.2014.40769] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/17/2014] [Accepted: 03/28/2014] [Indexed: 12/25/2022] Open
Abstract
Purpose Prostate cancer is among the most common non-cutaneous neoplasms affecting renal transplant recipients (RTRs). Available treatments including radical prostatectomy and external beam radiotherapy carry a risk of damage to the transplanted kidney, ureters, or bladder. We assessed the safety and efficacy of Iodine-125 (125I) prostate seed brachytherapy as an alternative to surgery and radiotherapy in these individuals. Material and methods We retrospectively reviewed our brachytherapy database to identify patients with a prior history of renal transplantation, who had undergone seed implantation for localized prostate cancer. Long term PSA control and treatment related toxicity, including graft dysfunction, urinary, rectal, and sexual complications, were assessed and compared with published outcomes for surgery and external beam radiotherapy. Results Of 1054 patients treated with permanent seed implantation from 2002-2012, we identified four who had a prior history of renal transplantation. Mean time from renal transplantation to prostate cancer diagnosis was 13 years. Mean follow-up after seed implantation was 44 months (range 12-60 months). All four patients remain free of PSA progression. No peri-operative complications were experienced following seed implantation, and all four patients continued to have normal graft function. Long term urinary and rectal function scores were comparable to reported outcomes for seed brachytherapy in the non-transplant population. Conclusions 125I prostate seed brachytherapy is associated with high rates of biochemical control and minimal toxicity to the renal graft in RTRs. This treatment should be considered as an alternative to surgery in managing RTRs with localized prostate cancer.
Collapse
|
33
|
Bhattasali O, Chen LN, Woo J, Park JW, Kim JS, Moures R, Yung T, Lei S, Collins BT, Kowalczyk K, Suy S, Dritschilo A, Lynch JH, Collins SP. Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer. Radiat Oncol 2014; 9:52. [PMID: 24512837 PMCID: PMC3931491 DOI: 10.1186/1748-717x-9-52] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to adjacent normal tissues. Large fraction sizes may increase the risk of functional decrements. Treatment-related bother may be more important to a patient than treatment-related dysfunction. This study reports on patient-reported outcomes following SBRT for clinically localized prostate cancer. Methods Between August 2007 and July 2011, 228 consecutive hormone-naïve patients with clinically localized prostate cancer were treated with 35–36.25 Gy SBRT delivered using the CyberKnife Radiosurgical System (Accuray) in 5 fractions. Quality of life was assessed using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite (EPIC)-26. Urinary symptom flare was defined as an AUA score 15 or more with an increase of 5 or more points above baseline 6 months after treatment. Results 228 patients (88 low-, 126 intermediate- and 14 high-risk) at a median age of 69 (44–90) years received SBRT with a minimum follow-up of 24 months. EPIC urinary and bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 9 months and 18 months before returning to near baseline 2 years post-SBRT. 14.5% of patients experienced late urinary symptom flare following treatment. Patients who experienced urinary symptom flare had poorer bowel quality of life following SBRT. EPIC scores for urinary bother declined transiently, first at 1 month and again at 12 months, before approaching pre-treatment scores by 2 years. Bowel bother showed a similar pattern, but the second decline was smaller and lasted 9 months to 18 months. EPIC sexual summary and bother scores progressively declined over the 2 years following SBRT without recovery. Conclusions In the first 2 years, the impact of SBRT on urination and defecation was minimal. Transient late increases in urinary and bowel dysfunction and bother were observed. However, urinary and bowel function and bother recovered to near baseline by 2 years post-SBRT. Sexual dysfunction and bother steadily increased following treatment without recovery. SBRT for clinically localized prostate cancer was well tolerated with treatment-related dysfunction and bother comparable to conventionally fractionated radiation therapy or brachytherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N,W,, Washington, D,C 20007, USA.
| |
Collapse
|
34
|
Williams S, Chiong E, Lojanapiwat B, Umbas R, Akaza H. Management of prostate cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013; 14:e524-34. [PMID: 24176571 DOI: 10.1016/s1470-2045(13)70451-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many local and systemic options for prostate cancer have emerged in recent years, but existing management guidelines do not account for diversity in health resources between different countries. We present recommendations for the management of prostate cancer, stratified according to the extent of resource availability-based on a four-tier system of basic, limited, enhanced, and maximum resources-to enable applicability to Asian countries with differing levels of health-care resources. This statement of recommendations was formulated by a multidisciplinary panel from Asia-Pacific countries, at a consensus session on prostate cancer that was held as part of the 2013 Asian Oncology Summit in Bangkok, Thailand.
Collapse
Affiliation(s)
- Scott Williams
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | | | | | | | | | | |
Collapse
|
35
|
Tong WY, Cohen G, Yamada Y. Focal low-dose rate brachytherapy for the treatment of prostate cancer. Cancer Manag Res 2013; 5:315-25. [PMID: 24049459 PMCID: PMC3775638 DOI: 10.2147/cmar.s33056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Whole-gland low-dose rate (LDR) brachytherapy has been a well-established modality of treating low-risk prostate cancer. Treatment in a focal manner has the advantages of reduced toxicity to surrounding organs. Focal treatment using LDR brachytherapy has been relatively unexplored, but it may offer advantages over other modalities that have established experiences with a focal approach. This is particularly true as prostate cancer is being detected at an earlier and more localized stage with the advent of better detection methods and newer imaging modalities.
Collapse
Affiliation(s)
- William Y Tong
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | |
Collapse
|
36
|
Le Fur E, Malhaire JP, Nowak E, Rousseau B, Erauso A, Pene-Baverez D, Papin G, Delage F, Perrouin-Verbe MA, Fournier G, Pradier O, Valeri A. Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation. Brachytherapy 2013; 12:589-95. [PMID: 23669150 DOI: 10.1016/j.brachy.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/05/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.
Collapse
Affiliation(s)
- Emmanuelle Le Fur
- Radiation Therapy Department, Centre Hospitalier Universitaire Morvan, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; Inserm U650, Laboratoire de Traitement de l'Information Médicale, Brest, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, Hanscom HN, Laing S, Kim JS, Lei S, Batipps GP, Kowalczyk K, Bandi G, Pahira J, McGeagh KG, Collins BT, Krishnan P, Dawson NA, Taylor KL, Dritschilo A, Lynch JH, Collins SP. Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol 2013; 8:58. [PMID: 23497695 PMCID: PMC3610192 DOI: 10.1186/1748-717x-8-58] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/25/2013] [Indexed: 12/13/2022] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Methods Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score ≥ 15 with an increase of ≥ 5 points above baseline six months after the completion of SBRT. Results One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity ≥ grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p = 0.001), however returned to baseline at 3 months (p = 0.60). Twenty one percent of patients experienced a late transient urinary symptom flare in the first two years following treatment. Of patients who were sexually potent prior to treatment, 79% maintained potency at 2 years post-treatment. Conclusions SBRT for clinically localized prostate cancer was well tolerated, with an early biochemical response similar to other radiation therapy treatments. Benign PSA bounces were common. Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment.
Collapse
Affiliation(s)
- Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC 20007, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE To characterize the incidence and clinical history of gross haematuria after prostate brachytherapy. To identify treatment risk factors for the development of gross haematuria in this setting. PATIENTS AND METHODS We reviewed haematuria outcomes collected prospectively in 2454 patients treated with transperineal prostate brachytherapy over a 20-year period at a single institution. Patients were followed for a median of 5.9 years. The association of haematuria with age, pretreatment PSA, ethnicity, clinical tumour stage, Gleason score, prostate volume, isotope (iodine 125 or palladium 103), biologically effective dose (BED), external beam radiation, androgen deprivation, development of urinary retention and occurrence of biochemical failure was investigated. RESULTS A total of 218 men (8.9%) reported gross haematuria at a median time of 772.2 days after implantation. Haematuria was associated with prostate volume >40 cm(3) (P < 0.01), use of external beam radiation (P < 0.01), Gleason score >7 (P = 0.037), Asian ethnicity (P < 0.001), BED >200 Gy (P = 0.01), and freedom from biochemical failure (P = 0.004). On multivariate analysis, prostate volume >40 cm(3) (P = 0.002), external beam radiation, (P = 0.001), and freedom from biochemical failure (P = 0.035) were predictors of haematuria. CONCLUSIONS Late gross haematuria was observed in a small proportion of men after brachytherapy and may occur with considerable latency. Larger prostate glands, freedom from biochemical failure and external beam radiation are risk factors.
Collapse
Affiliation(s)
- Michael S Leapman
- Department of Urology, Mount Sinai School of Medicine, New York, NY, USA.
| | | | | | | |
Collapse
|
39
|
Keyes M, Crook J, Morris WJ, Morton G, Pickles T, Usmani N, Vigneault E. Canadian prostate brachytherapy in 2012. Can Urol Assoc J 2013; 7:51-8. [PMID: 23671495 PMCID: PMC3650818 DOI: 10.5489/cuaj.218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy.
Collapse
Affiliation(s)
- Mira Keyes
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Juanita Crook
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Kelowna, BC
- Department of Radiation Oncology, Princes Margaret Hospital, Toronto, ON
| | - W. James Morris
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Toronto, ON
| | - Tom Pickles
- Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC
| | - Nawaid Usmani
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - Eric Vigneault
- Quebec University Hospital l’Hotel-Dieu de Quebec, Quebec City, QC
| |
Collapse
|
40
|
Implications of CT imaging for postplan quality assessment in prostate brachytherapy. Brachytherapy 2012; 11:435-40. [DOI: 10.1016/j.brachy.2012.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/04/2012] [Accepted: 05/22/2012] [Indexed: 11/20/2022]
|
41
|
Ryu B, Bax J, Edirisinge C, Lewis C, Chen J, D’Souza D, Fenster A, Wong E. Prostate Brachytherapy With Oblique Needles to Treat Large Glands and Overcome Pubic Arch Interference. Int J Radiat Oncol Biol Phys 2012; 83:1463-72. [DOI: 10.1016/j.ijrobp.2011.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/27/2011] [Accepted: 10/04/2011] [Indexed: 10/14/2022]
|
42
|
Roeloffzen EM, Crook J, Monninkhof EM, McLean M, van Vulpen M, Saibishkumar EP. External validation of the pretreatment nomogram to predict acute urinary retention after 125I prostate brachytherapy. Brachytherapy 2012; 11:256-64. [DOI: 10.1016/j.brachy.2011.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/19/2011] [Accepted: 12/28/2011] [Indexed: 10/28/2022]
|
43
|
Ghilezan M, Martinez A, Gustason G, Krauss D, Antonucci JV, Chen P, Fontanesi J, Wallace M, Ye H, Casey A, Sebastian E, Kim L, Limbacher A. High-Dose-Rate Brachytherapy as Monotherapy Delivered in Two Fractions Within One Day for Favorable/Intermediate-Risk Prostate Cancer: Preliminary Toxicity Data. Int J Radiat Oncol Biol Phys 2012; 83:927-32. [DOI: 10.1016/j.ijrobp.2011.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/19/2011] [Accepted: 05/01/2011] [Indexed: 10/14/2022]
|
44
|
Bosch JLHR, Norton P, Jones JS. Should we screen for and treat lower urinary tract dysfunction after major pelvic surgery? ICI-RS 2011. Neurourol Urodyn 2012; 31:327-9. [PMID: 22415890 DOI: 10.1002/nau.22218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 01/12/2012] [Indexed: 11/07/2022]
Abstract
AIMS Given the relative frequency of lower urinary tract dysfunction (LUTD) after major pelvic surgery, the main question for this debate is: "Should we [actively] screen for LUTD after major pelvic surgery," with the intention to treat and improve patient care. METHODS The discussants selected relevant papers from a limited review of the literature [PubMed/Medline database (January 1966 to May 2011)] and prepared the YES versus NO presentations. RESULTS The evidence was presented for the following major pelvic procedures: colorectal surgery, hysterectomy, and surgery for other benign gynecologic conditions, radical prostatectomy, brachytherapy, and primary cryotherapy for prostate cancer. Based on the presentations, the audience voted in favor of screening for LUTD after major pelvic surgery. CONCLUSIONS Irreversible treatment should be delayed in case of LUTD after major pelvic surgery. In fact, most symptoms spontaneously subside within 6 months after the surgery. Once the period of 6-12 months of conservative management has been completed and if LUTD persists, a new urodynamic screening should be followed by appropriate treatment.
Collapse
Affiliation(s)
- J L H Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | |
Collapse
|
45
|
Stone NN, Gerber NK, Blacksburg S, Stone J, Stock RG. Factors influencing urinary symptoms 10 years after permanent prostate seed implantation. J Urol 2011; 187:117-23. [PMID: 22114818 DOI: 10.1016/j.juro.2011.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE We investigated the factors that influenced urinary symptoms in the first 10 years after prostate brachytherapy. MATERIALS AND METHODS A total of 1,932 men were treated with prostate brachytherapy alone or with external beam irradiation and followed a mean of 6.8 years. The influence of pretreatment American Urological Association symptom score (7 or less, 8 to 19, 20 or greater), external beam radiotherapy, (125)I or (103)Pd, biological effective dose, age, prostate size and hormone therapy on the change in American Urological Association symptom score (11,491) was compared. RESULTS The mean change from initial score (7.4) was 11.4, 5.5, 3.3, 2.7, 1.5, 1.2, 1, 1, 1, 1, 1.3 and 1.4 points at 3, 6 months and 1 to 10 years, respectively (p <0.001). Factors that resulted in a greater increase in urinary symptoms at year 1 were low pretreatment score (p <0.001), no hormonal therapy (p <0.001), younger age (p = 0.046) and higher biological effective dose (p = 0.025). At 10 years patients with an initial score of 20 or greater had an average decrease of 11 points compared to a decrease of 0.9 for an initial score of 8 to 19 and an increase of 2.7 for an initial score of 7 or less (p <0.001). On linear regression the scores at 1 year were influenced by initial score (p <0.001), biological effective dose (p = 0.022), prostate size (p <0.001) and hormonal therapy (p = 0.009). At 10 years only the pretreatment score remained significant (p <0.001). CONCLUSIONS There is minimal change in mean American Urological Association symptom score (1.4 points) 10 years after prostate brachytherapy. Patients presenting with high initial scores have the greatest improvement from baseline. Biological effective dose, external beam radiotherapy, hormonal therapy, isotope, patient age and prostate size do not appear to influence long-term urinary symptoms.
Collapse
Affiliation(s)
- Nelson N Stone
- Department of Urology, NNS and Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.
| | | | | | | | | |
Collapse
|
46
|
An NTCP Analysis of Urethral Complications from Low Doserate Mono- and Bi-Radionuclide Brachytherapy. Prostate Cancer 2011; 2011:128360. [PMID: 22096647 PMCID: PMC3195343 DOI: 10.1155/2011/128360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/02/2011] [Indexed: 11/22/2022] Open
Abstract
Urethral NTCP has been determined for three prostates implanted with seeds based on 125I (145 Gy), 103Pd (125 Gy), 131Cs (115 Gy), 103Pd-125I (145 Gy), or 103Pd-131Cs (115 Gy or 130 Gy).
First, DU20, meaning that 20% of the urhral volume receive a dose of at least DU20, is converted into an I-125 LDR equivalent DU20 in order to use the urethral NTCP model.
Second, the propagation of uncertainties through the steps in the NTCP calculation was assessed in order to identify the parameters responsible for large data uncertainties. Two sets of radiobiological parameters were studied. The NTCP results all fall in the 19%–23% range and are associated with large uncertainties, making the comparison difficult. Depending on the dataset chosen, the ranking of NTCP values among the six seed implants studied changes. Moreover, the large uncertainties on the fitting parameters of the urethral NTCP model result in large uncertainty on the NTCP value. In conclusion, the use of NTCP model for permanent brachytherapy is feasible but it is essential that the uncertainties on the parameters in the model be reduced.
Collapse
|
47
|
Smith RP, Jones HA, Beriwal S, Gokhale A, Benoit R. Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants. Int J Radiat Oncol Biol Phys 2011; 81:745-50. [DOI: 10.1016/j.ijrobp.2010.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/08/2010] [Accepted: 06/15/2010] [Indexed: 11/25/2022]
|
48
|
Pieters BR, Rezaie E, Geijsen ED, Koedooder K, van der Grient JN, Blank LE, de Reijke TM, Koning CC. Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined With Pulsed Dose Rate Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2011; 81:758-64. [DOI: 10.1016/j.ijrobp.2010.05.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 04/07/2010] [Accepted: 05/24/2010] [Indexed: 11/29/2022]
|
49
|
Roeloffzen EM, van Vulpen M, Battermann JJ, van Roermund JG, Saibishkumar EP, Monninkhof EM. Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 81:737-44. [DOI: 10.1016/j.ijrobp.2010.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/29/2022]
|
50
|
Crook J, Borg J, Evans A, Toi A, Saibishkumar E, Fung S, Ma C. 10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients. Int J Radiat Oncol Biol Phys 2011; 80:1323-9. [DOI: 10.1016/j.ijrobp.2010.04.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/01/2010] [Accepted: 04/02/2010] [Indexed: 11/26/2022]
|