Prospective follow-up of self-assessed late side effects fifteen years after external beam radiotherapy for localized prostate cancer- a comparison with age-matched controls

2004 ◽  
Vol 60 ◽  
pp. S452-S452
Author(s):  
A WIDMARK ◽  
P FRANSSON
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
External Beam ◽  
Late Side Effects ◽  
Late Side

Trends in the quality of external beam radiotherapy for elderly men with localized prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6507-6507 ◽  
Author(s):  
J. E. Bekelman ◽  
M. J. Zelefsky ◽  
T. L. Jang ◽  
E. M. Basch ◽  
D. Schrag
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Conformal Radiotherapy ◽  
Quality Measures ◽  
Localized Prostate Cancer ◽  
External Beam ◽  
Radiation Oncologist ◽  
Elderly Men ◽  
Radiation Oncologists

6507 Background: External beam radiotherapy (EBRT) is a commonly used for treatment of clinically localized prostate cancer. Yet, secular trends in the delivery of this highly technical therapy have received little attention. Methods: Using data from the linked Surveillance, Epidemiology, and End Results (SEER) Medicare program, we evaluated trends in five EBRT quality measures among 23,018 patients age 65 or older diagnosed from 1994 to 2002 with clinically localized prostate cancer and treated with primary EBRT. Using tumor registry data from SEER and Medicare claims, we excluded 6,956 patients who received brachytherapy and 7,009 patients who received combination EBRT and brachytherapy. We identified treating radiation oncologists via unique physician identification numbers reported on claims and obtained board certifications from the AMA Masterfile. We assessed the five EBRT quality measures proposed by a RAND expert panel that were amenable to analysis using SEER-Medicare data: 1) use of conformal radiotherapy treatment planning; 2) use of high-energy (=10MV) photons; 3) use of custom immobilization; 4) radiation oncologist board certification; and 5) completion of two follow-up visits with a radiation oncologist in the year following therapy. Results: As shown in the table , conformal radiotherapy increased over the study period. Approximately one-third of patients received consistent follow-up from a radiation oncologist in the year following therapy. Notably, however, claims data revealed that 80% of patients completed at least two follow-up visits with either urologists or radiation oncologists. Conclusions: Conformal radiotherapy is now routine for elderly men with localized prostate cancer. Observed practice patterns deviate from the RAND metric for patient follow-up, suggesting that this measure merits clarification. Future research should examine whether variation in receipt of these quality measures affects important clinical outcomes. No significant financial relationships to disclose. [Table: see text]

Timing of high-dose rate brachytherapy with external beam radiotherapy in intermediate and high-risk localized prostate cancer (THEPCA) patients and its effects on toxicity and quality of life: Results of a randomized feasibility trial.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 236-236
Author(s):  
Imtiaz Ahmed ◽  
Sharon Shibu Thomas ◽  
Alexander Cain ◽  
Jufen Zhang ◽  
Sreekanth Palvai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
External Beam ◽  
Hdr Brachytherapy

236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided radiotherapy have revolutionized radiotherapy delivery. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities remain a significant issue. Currently there is no European consensus on the timing of high-dose rate (HDR) brachytherapy in relation to EBRT. Schedules of HDR boost before or after EBRT vary significantly between institutions.The incidence of GI and GU toxicities was assessed in patients receiving HDR brachytherapy before and after EBRT. Methods: Men with Intermediate/high risk localized prostate cancer were randomized to Arm A (HDR brachytherapy before EBRT) or Arm B (HDR brachytherapy after EBRT). Both arms received a HDR boost of 15Gy and 46Gy in 23 fractions of EBRT. All patients received neoadjuvant and adjuvant hormone therapy for up to 2 years. Patients were followed quarterly up to a year. CTCAE scores for GU and GI toxicities were taken. IPSS, IEFL and FACT-P scores were collected. Fisher’s exact test was used to analyze the association between GU and GI toxicities. The T-test compared the mean differences in IPSS total scores at each follow-up. Analysis of variance evaluated the difference at follow up. Post-hoc testing and Bonferroni correction was applied. Results: 100 patients were randomized between 2015 and 2017. Data for 88 patients was available at cutoff. Mean age was 69 years (SD: 4.6). Age, Gleason score, TNM and clinical staging were similar in each arm. Mean IPSS Score was similar between both arms at baseline Arm A (6.52) & Arm B (6.57). 12 months follow up showed mild worsening of symptoms in both arms, but no significant difference noticed between Arm A (8.02) & Arm B (8.14) p=0.55. At 12 months, Grade 1 and 2 GU toxicities were more frequent in Arm A (22.88% & 5.28%, p=0.669) compared to Arm B (19.36% and 2.64%, p=0.485). Grade 1 GI toxicity was more common in Arm B (23.76%) than Arm A (21.2%), p=0.396. Grade 2 GI toxicities were more common in Arm A 5.28% vs 3.52%, p=0.739. Baseline mean IIEF scores were 10.9 and 10.53 in Arm A and B respectively. At 12 months this was 6.6 in Arm A and 7.11 in Arm B, but not statistically significant. FACT-P scores were not different in either arm, with good QOL scores maintained throughout. Mean score at baseline (125.18) was observed to be similar at 12 months follow up at (126.10). The PTV, CTV & OAR dose were compared and no significant differences were found. Conclusions: There were no significant differences in GI and GU related toxicities up to a year between patients receiving HDR brachytherapy before or after EBRT. There were no grade 3 or 4 toxicities. Treatment was well tolerated in both arms with good QOL scores. Longer follow up and a phase III multicenter RCT would be needed to validate findings. Clinical trial information: NCT02618161.

scholarly journals Comparison of EBRT and I-125 seed brachytherapy concerning outcome in intermediate-risk prostate cancer

2021 ◽  
Author(s):  
Matthias Moll ◽  
Andreas Renner ◽  
Christian Kirisits ◽  
Christopher Paschen ◽  
Alexandru Zaharie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Gastrointestinal Side Effects ◽  
Over Time

Abstract Purpose This study’s objective was the comparison of external beam radiotherapy (EBRT) and I‑125 seed brachytherapy regarding clinical outcome and development of side effects. Patients and methods In all, 462 localized intermediate-risk prostate cancer patients treated between 2000 and 2019 at our department using either I‑125 seed brachytherapy or EBRT with a dose of 74 or 78 Gy were included: 297 patients were treated with EBRT and 165 with seeds. Biochemical no evidence of disease (bNED) rates according to Phoenix definition as well as late gastrointestinal and urogenital side effects (EORTC/RTOG) were assessed. Results Patients were followed up yearly with a median follow-up of 54 (3–192) months. Observed bNED rates for 74 Gy, 78 Gy and seeds were 87, 92, and 88% after 5 years and 71, 85, and 76% after 9 years, respectively. No significant differences were found comparing seeds with 74 Gy (p = 0.81) and 78 Gy (p = 0.19), as well as between 74 and 78 Gy (p = 0.32). Concerning gastrointestinal side effects, EBRT showed significantly higher rates of RTOG grade ≥ 2 toxicity compared to seeds, but at no point of the follow-up more than 10% of all patients. However, genitourinary side effects were significantly more prevalent in patients treated with seeds, with 33% RTOG grade ≥ 2 toxicity 12 months after treatment. Nevertheless, both types of side effects decreased over time. Conclusion Favorable intermediate-risk prostate cancer patients can be treated either by external beam radiotherapy (74/78 Gy) or permanent interstitial seed brachytherapy.

scholarly journals Combination therapy-permanent interstitial brachytherapy and external beam radiotherapy for patients with localized prostate cancer

2005 ◽  
Vol 52 (4) ◽  
pp. 31-36 ◽  
Author(s):  
H. Matzkin ◽  
G. Keren-Paz ◽  
N.J. Mabjeesh ◽  
J. Chen
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Combination Therapy ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
Interstitial Brachytherapy ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
External Beam ◽  
Beam Radiation

Background: Combination of permanent interstitial brachytherapy based on radioactive iodine with external beam radiotherapy is an alternative to other treatment modalities, such as radical prostatectomy or external beam radiotherapy alone in patients with intermediate-risk localized prostate cancer. In this article we report our experience with this combination modality. Methods: Among patients who were treated in our institute with brachytherapy, there were 64 patients who received combination therapy for the above indication. Combination therapy enables administration of 110 Gy as brachytherapy and thereafter 45 Gy as external beam radiation. All patients received adjuvant androgen deprivation therapy for 6 months. The prospective follow-up was done with the aid of validated evaluation instruments (questionnaires). Results: Combination therapy was administered without additional urinary (IPSS-based) or sexual (IIEFbased) side effects above those with brachytherapy alone. No severe perianal and lower intestinal tract side effects were observed. Short-to-moderate-term results based on serum PSA levels are encouraging, and are not inferior to what is accepted by the literature for other radical therapies. Conclusion: Combination of permanent interstitial brachytherapy and external beam radiotherapy in the appropriate patients does not cause any additional morbidity, and its biochemical results justify its application. This modality should be offered as an accepted and good alternative to other radical treatment options, to men with prostate cancer with moderate risk factors.

scholarly journals Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study

2021 ◽  
Author(s):  
E. Sutton ◽  
◽  
J. A. Lane ◽  
M. Davis ◽  
E. I. Walsh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Qualitative Interviews ◽  
Well Being ◽  
Localized Prostate Cancer ◽  
Short Term ◽  
Age Related ◽  
Qualitative Interview Study ◽  
Long Term Treatment

Abstract Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.

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