Quality of Care in the Treatment of Localized Intermediate and High Risk Prostate Cancer at Minority Serving Hospitals

14587 Background: To elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a cohort of intermediate- or high-risk prostate cancer patients treated by a combination of 3-D External Beam Radiotherapy (EBRT) and Brachytherapy (BT) with or without androgen deprivation (AD). Methods: A cross-sectional survey was administered to 200 consecutive patients with intermediate (Gleason 7 or PSA 10–20 or T2A-B) or high (Gleason >7 and/or PSA >20 and/or >T2B) - Risk Prostate cancer who were treated by EBRT to the prostate followed by BT to the prostate given either by permanent 125-I seeds (LDR) or high dose rate (HDR) implants before treatment and at 6 months interval during 4 years follow-up. The EORTC CLQ-C30 with the PR-25 module was employed. HRQOL was compared among therapy groups. Comparisons between therapy groups was performed using regression models to control covariates. HRQOL of treatment parameters were evaluated. Distribution of responses for bowel-, urinary- and sexual-related functions were analyzed. Results: 200 patients completed the questionnaires. Significant changes in HRQOL were found depending of the time after treatment. After a temporal decline in HRQOL, an improvement owas found during the first 18 months after end of treatment. Significant improvement in the urinary irritative-obstructive performance (p < 0.006) was found after 6 months post-treatment. Bowel domains worsened after therapies (p < 0,05) but improved after 18 months follow-up (p < 0.02). Overall sexual HRQOL deteriorated depending greatly on treatment (p < 0.008). Patients who were given AD presented a significant lower Sexual Function values, that were difficult to recover after AD cessation (p < 0.007). No differences in HRQOL were found between LDR or HDR BT implants. Satisfaction with either treatment was high. Conclusions: After a decline in HRQOL after treatment, it recovered fully during follow-up. In patients treated by AD, sexual function was the most adversely affected quality-of-life domain. Sexual impairment induced by AD was difficult to recover. These results may be of assistance to men and to clinicians when making treatment decisions, mainly relating AD. No significant financial relationships to disclose.

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Phase II Multi-institutional Clinical Trial on a New Mixed Beam RT Scheme of IMRT on Pelvis Combined with a Carbon Ion Boost for High-risk Prostate Cancer Patients

Tumori Journal ◽

10.5301/tj.5000587 ◽

2016 ◽

Vol 103 (3) ◽

pp. 314-318 ◽

Cited By ~ 6

Author(s):

Giulia Marvaso ◽

Barbara A. Jereczek-Fossa ◽

Barbara Vischioni ◽

Delia Ciardo ◽

Tommaso Giandini ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Trial ◽

High Risk ◽

Phase Ii ◽

Carbon Ions ◽

Carbon Ion ◽

High Risk Prostate Cancer ◽

Mixed Beam ◽

Risk Prostate Cancer

Purpose Definition of the optimal treatment schedule for high-risk prostate cancer is under debate. A combination of photon intensity modulated radiotherapy (IMRT) on pelvis with a carbon ion boost might be the optimal treatment scheme to escalate the dose on prostate and deliver curative dose with respect to normal tissue and quality of dose distributions. In fact, carbon ion beams offer the advantage to deliver hypofractionated radiotherapy (RT) using a significantly smaller number of fractions compared to conventional RT without increasing risks of late effects. Methods This study is a prospective phase II clinical trial exploring safety and feasibility of a mixed beam scheme of carbon ion prostate boost followed by photon IMRT on pelvis. The study is designed to enroll 65 patients with localized high-risk prostate cancer at 3 different oncologic hospitals: Istituto Europeo di Oncologia, Fondazione IRCCS Istituto Nazionale dei Tumori, and Centro Nazionale di Adroterapia Oncologica. The primary endpoint is the evaluation of safety and feasibility with acute toxicity scored up to 1 month after the end of RT. Secondary endpoints are treatment early (3 months after the end of RT) and long-term tolerability, quality of life, and efficacy. Results The study is not yet recruiting; in silico studies are ongoing and we expect to start recruitment by 2017. Conclusions The present clinical trial aims at improving the current treatment for high-risk prostate cancer, evaluating safety and feasibility of a new RT mixed-beam scheme including photons and carbon ions. Encouraging results are coming from carbon ion facilities worldwide on the treatment of different tumors including prostate cancers. Carbon ions combine physical properties allowing for high dose conformity and advantageous radiobiological characteristics. The proposed mixed beam treatment has the advantage to combine a photon high conformity standard of care IMRT phase with a hypofractionated carbon ion RT boost delivered in a short overall treatment time.

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Stereotactic Body Radiation Therapy for Low, Intermediate, and High-risk Prostate Cancer: Disease Control and Quality of Life

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.06.204 ◽

2011 ◽

Vol 81 (2) ◽

pp. S100 ◽

Cited By ~ 9

Author(s):

A.J. Katz ◽

M. Santoro ◽

F. DiBlasio ◽

R. Ashley

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radiation Therapy ◽

High Risk ◽

Disease Control ◽

Stereotactic Body Radiation Therapy ◽

Cancer Disease ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Does race affect the quality of treatment for intermediate-risk and high-risk prostate cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.e17678 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. e17678-e17678

Author(s):

Nina A. Bickell ◽

Simon J Hall ◽

Richard Stock ◽

Kezhen Fei ◽

Rajwanth Veluswamy ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Intermediate Risk ◽

Quality Of Treatment ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Pelvic SABR with HDR boost in intermediate- and high-risk prostate cancer (SPARE): Favorable early toxicity and quality-of-life outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.60 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 60-60 ◽

Cited By ~ 1

Author(s):

Hima Bindu Musunuru ◽

Andrea Deabreu ◽

Melanie Davidson ◽

Ananth Ravi ◽

Joelle Antoine Helou ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

High Risk ◽

Hdr Brachytherapy ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Brachytherapy Boost ◽

Early Toxicity

60 Background: ASCENDE-RT has provided level 1 evidence supporting the use of androgen deprivation therapy (ADT), external beam radiotherapy and brachytherapy boost in intermediate- and high-risk prostate cancer. The objectives of this study are to report early toxicity and quality of life (QOL) outcomes in patients treated on a hybrid protocol using five-fraction pelvic stereotactic ablative radiotherapy (SABR) with a MRI dose painted HDR brachytherapy boost (HDR-BT). Methods: A phase I/II study was performed where intermediate (IR) and high-risk (HR) prostate cancer patients received HDR-BT 15Gy in single fraction to the prostate and up to 22.5Gy to the MRI nodule. Gantry-based 25Gy SABR was delivered to pelvis, seminal vesicles and prostate in 5 weekly fractions. ADT was used for 6-18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess toxicities. QOL was captured using EPIC at every follow-up. A minimally clinically important change (MCIC) definition was triggered if the EPIC QOL score at each time point decreases > 0.5 SD, where SD is the standard deviation of baseline scores. Results: Thirty-three patients (NCCN 6.0% low IR, 45.5% high IR and 48.5% HR) completed this treatment with a median follow-up of 13.8 months (IQR 12.1, 18.8). The incidence of worst toxicities is shown in Table 1.The 3 grade 3 GU patients were due to temporary urinary catheterization in the acute period following HDR-BT. Mean (95% SD) EPIC urinary QOL scores were 82.5 (16.5), 83.2 (12.9) and 83.7 (16.3) at baseline, 3 months and 12 months and the bowel scores were 95.9 (3.8), 92.6 (8.2) and 90.5 (8.3), respectively. Proportion of patients experiencing MCIC at 3 months and 12 months were 20.8% and 14.3% for urinary domain, 47.8% and 53.9% for bowel domain; respectively (see Table). Conclusions: This novel treatment protocol incorporating MRI dose painted HDR brachytherapy boost and SABR pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible and well tolerated in the acute setting. Clinical trial information: REB 269-2014. [Table: see text]

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