Is it possible to get adequate dose coverage of a clinical target volume (CTV) to account for the possible extra capsular extension in early-stage prostate cancer by low dose rate (LDR) brachytherapy?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 98-98
Author(s):  
E. P. Saibishkumar ◽  
D. Iupati ◽  
J. Borg ◽  
K. Fernandes
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Univariate Analysis ◽  
Target Volume ◽  
Implantation Technique ◽  
Prostate Brachytherapy ◽  
Exact Test ◽  
Ldr Brachytherapy ◽  
Adequate Dose ◽  
The Mean

98 Background: There is no consensus for the definition and evaluation of CTV in post-implant setting for LDR prostate brachytherapy to account for extra capsular extension in clinically localized prostate cancer. In this study, we defined a CTV and evaluated its dosimetry in the post implant CT/MR scans done at 1 month after the LDR brachytherapy procedure. Methods: The initial consecutive 71 patients who underwent LDR brachytherapy under a single physician at Princess Margaret Hospital from June 2009 to July 2010 were included in this retrospective study. On the post implant MRI, the CTV was created by adding 3mm uniform margins around the prostate but respecting the anatomical boundaries like bone, bladder and rectum. Post implant dosimetry was based on CT/MR fusion using the dosimetric parameters V80, V90, V100, V150, V200, D80, D90 and D100. Implants were qualified as optimal if their V100 was >85% and D90 was >90% for both prostate and CTV. Univariate analysis was performed to evaluate associations of factors with V100 and D90 for the CTV using Wilcoxon rank sum test and Fisher's exact test. Results: The mean (SD) prostate V100 and D90 were 95.5% (4.2) and 117% (10) respectively with only 1 patient having sub optimal implant (V100 <85% and D90 <90%). The mean (SD) V100 and D90 for the CTV were also acceptable at 90.6% (4.9) and 103% (9), respectively. Six patients had V100 <85% and 7 patients had D90 <90% for the CTV. On univariate analysis, edema and seed implantation technique correlated with sub-optimal implant for the CTV. The mean (SD) edema for patients with V100 <85% was 18% (10) and with D90 <90% was 15% (12). The corresponding values for the optimal implants both in terms of V100 and D90 were 3% (13). Patients implanted with exclusively loose seeds (15 patients only) had higher incidence of sub-optimal implants (26%) compared to patients who had strands on the antero-lateral margins (56 patients; 3.5%). Conclusions: In this study, adequate dose coverage of CTV was achieved in most patients with current technique but implants with optimal dosimetry to prostate still may have sub-optimal D90 and V100 for the CTV. No significant financial relationships to disclose.

Prognostic risk factors to predict final pathohistology in patients undergoing radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15544-15544
Author(s):  
D. Pfister ◽  
C. Ohlmann ◽  
D. Sahi ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Curative Intent ◽  
Ldr Brachytherapy ◽  
Pet Ct ◽  
The Mean ◽  
Locally Recurrent ◽  
Biopsy Gleason Score

15544 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized prostate cancer (PCA). Currently, there are very few studies correlating preoperative clinical and pathohistological variables with final pathohistology of sRPE specimens. It was the purpose of our study to identify prognosticators predicting organ confined and locally advanced PCA. Methods: 45 patients with biopsy-proven locally recurrent PCA underwent sRPE and extended pelvic lymphadenectomy (epLA) via a retropubic approach. Preoperative PSA, PSA doubling time, PSA prior to initial radiation therapy, biopsy Gleason score, number of positive biopsies, cT stage, 11choline PET/CT findings, type of radiation therapy, neoadjuvant androgen deprivation were correlated with the pathohistological stage by uni- and multivariate analysis. Results: A total of 45 patients underwent sRPE and epLA; 16 (35.5%), 12 (26.6%) and 17 (37.8%) patients had undergone external beam radiation (EBRT), HDR and LDR brachytherapy, resp. The mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). We did not encounter significant intraoperative compliations, the mean blood loss was 490 (200–950) ml. A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. By multivariate analysis the parameters significantly associated with organ confined PCA sRPE are PSADT > 12 months, = 50% positive biopsy cores, biopsy Gleason score = 7 and previous LDR brachytherapy (pT1–2pN0R0 in all men); pre-radiation and preoperative PSA, PET/CT findings had no significant impact with final pTpN-stage. Conclusions: SRPE can be performed with a low morbidity in biopsy proven locally recurrent PCA after radiotherapy. The identified prognostic parameters will help to select patients most suitable for a local secondary surgical approach with curative intent. Especially in patients with local relapse following LDR brachytherapy sRPE represents a valuable treatment option. No significant financial relationships to disclose.

Correlation of percent of core biopsies positive for prostate cancer and biochemical outcome following I-125 prostate brachytherapy or external beam radiation.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 40-40
Author(s):  
R. D. Tendulkar ◽  
K. L. Stephans ◽  
C. A. Reddy ◽  
K. Martires ◽  
A. R. Patel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Gleason Score ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Prostate Brachytherapy ◽  
Beam Radiation ◽  
T Stage ◽  
Psa Testing ◽  
Biopsy Gleason Score

40 Background: The percentage of positive cores (PPC) on biopsy for prostate cancer has been identified as a predictor of outcome following definitive local treatment. We aim to identify whether this observation holds true for a modern cohort of patients (pts) treated at Cleveland Clinic with permanent prostate brachytherapy (PB) or external beam radiation therapy (EBRT). Methods: We retrospectively reviewed pathology reports of pts treated with either PB or EBRT from our IRB-approved prospective prostate cancer registry. No pts underwent both PB and EBRT. The number of biopsy cores sampled, number of cores positive for prostate cancer, and maximum length of any core positive for prostate cancer were collected. Cox proportional hazards regression was used to analyze biochemical relapse free survival (bRFS) using the nadir + 2 ng/ml definition. Results: We identified 1253 PB and 879 EBRT pts with complete pathology and clinical information. Among PB pts, 46% were low risk, 40% intermediate risk, and 14% high risk, while 78% had <50% PPC, and 22% had >=50% PPC. The 5-year bRFS for PB was 92.0% for <50% PPC, vs. 83.1% for >=50% PPC (HR 2.1, p=0.0005). For PB pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following PB. Among EBRT pts, 11% were low risk, 36% intermediate risk, and 53% high risk, while 55% had <50% PPC, and 45% had >=50% PPC. The 5-year bRFS for EBRT was 85.6% for <50% PPC, vs. 77.1% for >=50% PPC (HR 1.8, p<0.0001). For EBRT pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, EBRT dose, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following EBRT. Conclusions: Following PB or EBRT, the percent of positive cores for prostate cancer was a significant predictor of bRFS on multivariate analysis, more so than conventional predictors such as T stage and PSA. No significant financial relationships to disclose.

Long-term experience with 181 patients who received transperineal I-125 implants for prostate cancer: Efficacy and urinary toxicity

2011 ◽  
Vol 11 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Eliahu Gez ◽  
Joshua Genesin ◽  
Daniel Shahar ◽  
Valeriya Semenisty ◽  
Tanya Mashiac ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hormonal Therapy ◽  
Treatment Plan ◽  
Prostate Gland ◽  
Target Volume ◽  
Low Risk ◽  
Prostate Brachytherapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

AbstractBackground: In low-risk prostate cancer, the target volume for radiotherapy is the prostate gland only and prostate brachytherapy with an I-125 implant provides the most conformal radiotherapy.Methods: Patients underwent a pre-implant prostate volume study from which a treatment plan was developed 2 weeks prior to implant. A dosimetric study was performed 1 month following the implant. The prescription dose was 145 Gy with the 95% isodose line covering the entire target volume. The maximal dose to the urethra was less than 210 Gy. Follow-up included serum PSA and IPSS evaluation every 3 months during the first year and then every 6 months beginning in the second year.Results: During December 2000–March 2009, 181 patients with early prostate cancer underwent I-125 implant. The median post-implant PSA value of the entire cohort was 0.7 ng/ml. No patient developed clinical failure. In the follow-up, nine patients had biochemical failure according to the RTOG-ASTRO Phoenix definition (Nadir + 2.0 ng/ml). Of these, one patient refused hormonal therapy desiring to preserve sexual potency, and eight patients received hormonal therapy with a decreased serum PSA to 0.0 ng/ml. The treatment side effects were primarily urinary disturbances.Conclusion: An I-125 implant is an effective and well-tolerated treatment and should be recommended for patients with low-risk prostate cancer.

scholarly journals Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

2020 ◽  
Author(s):  
Soraiya Manji ◽  
Jasmit Shah ◽  
Ahmed Twahir ◽  
Ahmed Sokwala
Keyword(s):  
Weight Gain ◽  
Univariate Analysis ◽  
Sodium Concentration ◽  
University Hospital ◽  
Exact Test ◽  
Interdialytic Weight Gain ◽  
Significant Difference ◽  
Blood Pressures ◽  
The Mean ◽  
Dialysate Sodium

Abstract BackgroundChronic kidney disease is highly prevalent across the globe with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137meq/l and 140meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results41 patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137meq/l group and 2.35 for the 140meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain although further studies with a larger sample size are warranted.

Stereotactic robotic radiosurgery for localized prostate cancer: Initial evaluation of acute toxicities

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16006-e16006
Author(s):  
L. E. Ponsky ◽  
C. Lillibridge ◽  
J. Brindle ◽  
Y. Zhang ◽  
B. Wessels ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Transrectal Ultrasound ◽  
Target Volume ◽  
Post Treatment ◽  
Intermediate Risk ◽  
Rectal Pain ◽  
Robotic Radiosurgery ◽  
Risk Prostate Cancer ◽  
Pre Treatment

e16006 Background: We evaluated the initial acute toxicities experienced by patients treated with cyberknife fractionated radiosurgery for low and low-intermediate risk prostate cancer. Methods: Twenty-two patients with low or low-intermediate risk prostate cancer (T2a, GG 3+3=6 or 3+4=7, PSA <10) were enrolled prospectively on an IRB approved protocol and treated the planning target volume (PTV)(prostate+5mm margin) with cyberknife fractionated radiosurgery to a dose of 36.25 Gy in 5 fractions (7.25Gy/fraction). The target volume included the prostate and seminal vesicles. PSA values, AUA symptom scores (AUA SS), and NCI CTC acute toxicities were analyzed prior to radiosurgery and at 1 month (N=16), 3 months (N=12) and 6 months (N=5)post-treatment. Results: Patients treated on study included 12 with GG 3+3=6 cancer and 10 with GG 3+4=7 cancer. Mean patient age was 66 years old (range 49–79). Mean pre-treatment PSA was 5.29 (range 0.64–9.36) declining to 3.44 (range 0.00–10.43) at 1 month post treatment, 1.99 (range 0.31–3.99) at 3 months post-treatment and 2.08 (1.05–3.13) at 6 months post-treatment. Mean pre-treatment AUA SS was 7 (range 0.–18) increasing to 12 (range 2–29) at 1 month post treatment, decreasing to 8 (range 2–17) at 3 months post-treatment and 11 (3–17). There were 5 grade 1 acute toxicities including (diarrhea, fatigue, mild urinary frequency, hemorrhoid and a rash) and 7 grade 2 toxicities including (bladder spasms, painful urinary, bowel irregularity, rectal pain, urethritis and numbness in the upper thigh), all grade 1 and 2 toxicities resolved within three months of treatment. The one patient with grade 2 thigh numbness was not thought to be study related toxicity. Two patients developed grade 3 toxicity. One developed bacteremia after the transrectal ultrasound guided placement of the fiducials, the infection completely resolved after treatment with antibiotics. One patient on Coumadin developed hematuria which resolved with conservative management. Conclusions: Cyberknife fractionated radiosurgery for patients with early stage prostate cancer appears to be safe on our early initial assessment.Continued evaluation and longer follow-up ongoing. [Table: see text]

What is the optimum number of beams and energy for IMRT boost in prostate cancer? A plan comparison study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16158-e16158
Author(s):  
H. Kunhiparambath ◽  
R. Prabhakar ◽  
G. K. Rath ◽  
D. N. Sharma ◽  
P. Heera ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Maximum Dose ◽  
Target Volume ◽  
Seminal Vesicles ◽  
Integral Dose ◽  
Dose Volume ◽  
Carcinoma Prostate ◽  
Femoral Heads ◽  
Dose Homogeneity ◽  
The Mean

e16158 Background: Intensity Modulated Radiotherapy (IMRT) is used in carcinoma prostate to achieve better target coverage with less dose to critical organs thereby permitting dose escalation and eventually better therapeutic ratio. There is scarcity of literature evaluating beam number and energy in prostate cancer treated by IMRT. Aim of our study is to identify the optimal number of beams and energy in the boost treatment of prostate cancer by IMRT. Methods: Ten patients were included in this study. Initially a dose of 45 Gy in 25 fractions was delivered to the prostate, seminal vesicles and the nodes by 3DCRT. A boost dose of 27 Gy in 15 fractions was planned to the prostate and the seminal vesicles by sliding window IMRT. Four different sets of IMRT plans: 5, 7 and 9 field with 6 MV; 7 field with 15 MV were generated. The dose constraints to the critical structures and the target volume were based on standard guidelines. The mean dose, maximum dose, volume receiving the prescribed dose (V100), volume receiving > 107% and <95% of the prescribed dose were analyzed for CTV and planning target volume (PTV). The mean dose, volume receiving 100%, 50% and 30% of the prescribed dose were analyzed for the bladder and the rectum. Similarly, the mean dose and the maximum dose to the right and left femoral heads, monitor units (MU) and the integral dose were analyzed. SPSS V10.0 software was used for statistical analysis. Results: The seven beam plan provide better dose homogeneity to PTV and lesser doses to critical structures like bladder, rectum and femoral heads when 6 MV photon is used. 15 MV photons further improve the dose homogeneity and decrease the dose to critical structures. The Monitoring Units required to deliver the treatment and the Integral dose is significantly reduced by using 15 MV compared to 6 MV. Conclusions: The optimal IMRT plan for boost planning in carcinoma prostate is that uses 7 beams and higher energy. This yields lesser dose to surrounding critical structures with better target conformity. [Table: see text] No significant financial relationships to disclose.

Dosimetric evaluation of SBRT treatment plans of non-central lung tumours: clinical experience

2020 ◽  
pp. 1-21
Author(s):  
Ernest Osei ◽  
Johnson Darko ◽  
Steph Swanson ◽  
Katrina Fleming ◽  
Ronald Snelgrove ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Early Stage ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
Conformal Radiation Therapy ◽  
Lung Sbrt ◽  
Treatment Plans ◽  
The Mean

Abstract Objectives: Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses. Methods: We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams. Results: The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT. Conclusion: The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.

Target focal therapy in early prostate cancer: Initial single institution results

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15574-15574 ◽  
Author(s):  
A. Barqawi ◽  
J. Lugg ◽  
E. D. Crawford
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Focal Therapy ◽  
Urinary Continence ◽  
Minimal Impact ◽  
Alternative Option ◽  
Early Results ◽  
The Mean ◽  
Mapping Biopsy

15574 Background: Currently the potential for over- and under-treatment using radical and watchful waiting options respectively constitutes a challenge in the management of patients with early organ-confined prostate cancer. Target focal therapy (TFT) is emerging as an intermediary alternative option for such men. The goal is to provide ablative treatment with minimal impact on morbidity. Methods: As part of an IRB approved study protocol a total of 24 patients initially underwent a 3 dimensional transperineal mapping biopsy under TRUS guidance to confirm the extent of tumor burden and localize the cancer foci within the prostate. Only 12 men qualified to undergo target focal cryotherapy. The remaining patients did not qualify due to upgrading or downgrading of their stage and opted for other treatment options. Follow- up consisted of serial PSA measurements at 3 months interval, disease specific QOL questionnaires, IPSS, and SHIM scores. Results: The mean age was 62.4 years. The mean (SD) prostate size at the time of mapping biopsy was 39 ±14.8g. After mapping biopsy all patients reported time limited hematuria and 2 patients developed urinary retention and were managed successfully with Foley’s catheter for 5 days. Mean PSA before treatment was 5.2 ± 4.1 ng/dl. 10/12 patients had Gleason score (GS) of 3+3, the remaining 2 patients had GS of 3+4. At 3 months follow-up. A median drop of PSA of 1.9 (0, 9.5) ng/dl. All patients reported full urinary continence post operatively. IPSS median drop of 0 (2, -16). Sexual health as assessed by SHIM score showed a median drop of 6 (1, -15) points. In general 4 patients reported a significant change in sexual performance. 2 of which opted for PDE inhibitor with successful regaining of erection at 6 months follow-up. Overall EPIC QOL scores showed no change in rectal, urinary and hormonal components. Sexual component registered a drop of 5 points. Conclusions: The current initial early results appear to be encouraging for future implementation of TFT on select patients with organ confined early stage cancer. Future larger randomized studies are needed to better understand the value of this alternative option in the management of prostate cancer. No significant financial relationships to disclose.

Androgen deprivation therapy (ADT) and cardiovascular mortality (CVD) in men with early-stage prostate cancer (PC) receiving curative radiation therapy (RT).

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 127-127
Author(s):  
Ashley Hanlon ◽  
Steven Fleming ◽  
Ann S Hamilton ◽  
Michaela Ann Dinan ◽  
Chiara Melloni ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Univariate Analysis ◽  
Cancer Registries ◽  
Population Based ◽  
Vital Statistics ◽  
Increased Risk ◽  
Definitive Therapy ◽  
Breast And Prostate Cancer ◽  
Artery Disease

127 Background: Combined with RT, ADT is a highly effective and utilized treatment for men with localized PC, but some studies suggest that use of ADT leads to increased CVD. We explored the association between ADT and CVD in men receiving RT for localized PC in the National Program for Cancer Registry’s (NPCR) Breast and Prostate Cancer Patterns of Care (POC) study. Methods: From 7 population-based cancer registries, we constructed a sample of men with localized PC treated with definitive RT, stratified by race/ethnicity. Cases diagnosed in 2004 were followed through 2009. Comorbidity, at or before diagnosis, was quantified using the Adult Comorbidity Evaluation 27; subcategories were combined into CV disease (CVD = myocardial infarction, coronary artery disease, congestive heart failure, arrhythmia), CVD-equivalents (CVE = peripheral artery disease and stroke) and CV-risk factors (CVRF = hypertension, diabetes, obesity). Cause of death was determined from the National Death Index data and linkage with vital statistics data. Rates of CV death, in those receiving RT alone versus RT+ADT, were compared in univariate and multivariable analyses. Results: The sample included 2,413 men with mean age 67.7 years (range 39-94), 54.5% white non-Hispanic, 997 received RT alone and 1,416 received RT+ADT. Five-year CVD was 2.3% with RT alone and 3.4% with RT+ADT. In univariate analysis, the following predicted higher CVD with ADT: age < 60 (OR 1.42, p = 0.04), white (OR 2.06, p = 0.001), divorced/separated/widowed (OR 1.29, p = 0.02), insured by Medicare (OR 1.64, p = 0.04), living in mixed urban-rural area (OR 1.87, p = 0.03), higher education level (OR 1.56, p = 0.05), high socioeconomic status (OR 1.70, p = 0.03), no or mild comorbidity level (OR 2.14, p = 0.05 and OR 1.66, p = 0.02, respectively), low PSA (OR 5.44, p = 0,02), and Gleason score 3 (OR 2.12, p = 0.02). In multivariate analysis, use of ADT did not significantly predict hazard of death from heart disease (HR 1.21, p = 0.28) or PC (HR 0.76, p = 0.34). Conclusions: After controlling for confounding variables, use of ADT was not associated with increased risk of CVD in men receiving radiation as definitive therapy for localized PC.

scholarly journals HRCT features between lepidic-predominant type and other pathological subtypes in early-stage invasive pulmonary adenocarcinoma appearing as a ground-glass nodule

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pengju Zhang ◽  
Tianran Li ◽  
Xuemin Tao ◽  
Xin Jin ◽  
Shaohong Zhao
Keyword(s):  
Logistic Regression Model ◽  
Early Stage ◽  
Univariate Analysis ◽  
Pulmonary Adenocarcinoma ◽  
Vascular Change ◽  
Ct Value ◽  
Predominant Type ◽  
Ground Glass Nodule ◽  
The Mean ◽  
Pathological Subtypes

Abstract Background Different pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. It is essential to clarify IPA subtypes before operation and high-resolution computed tomography (HRCT) plays a very important role in this regard. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN). Methods We performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed IPA (invasive foci > 5 mm) appearing as pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR) ≤0.5 from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the differences of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves. Results In total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean CT values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P <  0.05). Logistic regression model was reconstructed including the mean CT value, CTR, deep lobulation, spiculation, vascular change, and bronchial change (P <  0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR. Conclusions Deep lobulation, spiculation, vascular change, and bronchial change, CT value > − 472.5 HU and CTR > 27.4% may indicate nonlepidic predominant invasive pulmonary adenocarcinoma in GGNs.

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