Long-term results of MRI-guided partial prostate brachytherapy for favorable-risk prostate cancer: Implications for focal therapy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 114-114
Author(s):  
Paul Linh Nguyen ◽  
Ming-Hui Chen ◽  
Yuanye Zhang ◽  
Clare M. Tempany ◽  
Robert A Cormack ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Low Risk ◽  
Long Term Results ◽  
Prostate Brachytherapy ◽  
Psa Failure ◽  
Psa Velocity ◽  
Mri Guided

114 Background: To report long-term results of MRI-guided partial prostate brachytherapy and propose a definition of biochemical failure following focal therapy Methods: From 1997-2007, 318 men with cT1c, PSA < 15, Gleason ≤ 3 + 4 prostate cancer received MRI-guided brachtherapy in which only the peripheral zone was targeted. To exclude benign PSA increases due to prostatic hyperplasia, PSA failure was defined as nadir + 2 with PSA velocity >0.75 ng/mL/year. Cox multivariable analysis was used to determine factors associated with PSA failure. Results: After a median follow-up of 5.1 years (interquartile range: 2.8 to 7.3, maximum 12.1), 26 men failed. While 36 patients met nadir+2 criteria, all eight biopsy-proven local recurrences were among the 26 men who also had a PSA velocity >0.75 ng/mL/year. On multivariable analysis, having intermediate vs. low-risk disease (adjusted HR: 4.4 [95%CI: 1.3-5.5], p<0.001) was the only factor significantly associated with an increased risk of PSA failure. PSA failure-free survival at 5 and 8 years was 95.6% and 90.0% for low risk, and was 73.0% and 66.4% for intermediate risk, respectively. Conclusions: MRI-guided brachytherapy targeting the peripheral zone produced comparable cancer control rates to whole-gland treatment in men with PSA-detected low-risk disease, but may not be adequate for men with “favorable” intermediate-risk disease. Requiring a PSA velocity>0.75 in addition to nadir+2 may be a more appropriate way to define biochemical failure after therapies that target less than the whole gland.

Location of local recurrence after MRI-guided partial prostate brachytherapy targeting only the peripheral zone: Implications for focal therapy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 149-149 ◽  
Author(s):  
Konstantin Kovtun ◽  
Tobias Penzkofer ◽  
Neha Agrawal ◽  
Tina Kapur ◽  
Andriy Fedorov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Central Zone ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Prostate Brachytherapy ◽  
Local Recurrences ◽  
Endorectal Coil ◽  
Mri Scans ◽  
Mri Guided

149 Background: Prostate cancer local recurrences usually occur at the same site as the dominant primary tumor in patients treated with radiation therapy to the whole gland. We characterized location of local recurrences in patients who were treated with MRI Guided Partial Brachytherapy in which only the peripheral zone was targeted. Methods: We retrospectively reviewed ten patients with initial cT1c, Gleason score 3+4 or less prostate cancer who developed biopsy proven local recurrences and had available imaging after MRI Guided Partial Brachytherapy targeting the peripheral zone from 1998 to 2006. All 10 patients had 1.5T endorectal coil MRI at diagnosis, performed primarily for staging and not for tumor localization, while at recurrence 8 had 3T endorectal coil MRI and 2 had 1.5T endorectal coil MRI. Scans consisted of at least T1 and T2 sequences. Two radiologists (C.T. and T.P.) blinded to clinical data reviewed diagnosis MRI scans together and quantified likelihood of tumor on a 1 to 5 scale in each section of an eight part prostate in both pre-treatment and recurrence scans. Local recurrence was judged to be in the same location as the baseline tumor if at least 50% of the tumor location overlapped. Results: Only 3 of 10 patients had local recurrences at the same location as the baseline tumor with a mean overlap of 64%. 7 of 10 patients had local recurrences at a different location with a mean overlap of 5%. 5 of 10 patients had recurrences in the central zone of the prostate which did not definitively show tumor on review of the initial 1.5T staging scan. Conclusions: After MRI-guided brachytherapy targeting only the peripheral zone in men initially staged with 1.5T MRI, 50% of the local recurrences occurred at the non-targeted central zone, raising the possibility that focal therapy directed only at the dominant tumor will result in increased out-of-field recurrences. Whether the superior ability of modern 3T multiparametric MRI to detect and precisely localize occult prostate cancer foci will reduce this risk is the subject of current study.

Long-term outcomes of magnetic resonance image-guided partial prostate brachytherapy for favorable-risk prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 138-138
Author(s):  
Martin T. King ◽  
Paul L. Nguyen ◽  
Ninjiin Boldbaatar ◽  
Clare Mary Tempany ◽  
Robert A. Cormack ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Peripheral Zone ◽  
Prostate Brachytherapy ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Biochemical Progression ◽  
Cancer Specific Mortality ◽  
Mri Guided

138 Background: To report long-term outcomes of magnetic resonance image-guided partial prostate brachytherapy of the peripheral zone. Methods: We conducted an institutional-board approved retrospective review of all men who underwent 0.5 Tesla GE Signa SP MRI-guided partial prostate brachytherapy to the peripheral zone. We estimated actuarial rates of biochemical progression (nadir +2 definition), as well as cumulative incidences of biopsy proven local recurrence, distant metastasis, and prostate cancer specific mortality. Fine and Gray’s competing risk regression was utilized in order to evaluate clinical factors associated with times to metastasis and prostate cancer specific mortality. Results: Between 1997 and 2008, 354 men underwent MRI-guided partial prostate brachytherapy. The numbers of patients with low and intermediate risk disease were 295 (83%) and 59 (17%), respectively. Sixty-seven (19%) patients received supplemental external beam radiotherapy. The median follow-up was 8.6 years. For National Cancer Center Network (NCCN) low risk-disease, 8-year estimates of biochemical progression, local recurrence, metastasis, and prostate cancer specific mortality were 23.5% (17.4-29.1), 6.4% (3.6-10.2), 2.0% (0.6-4.8), and 0%. Corresponding estimates for intermediate risk disease were 51.2% (31.3-65.4), 21.2% (10.2-34.9), 6.6% (1.7-16.3), and 5.4% (0.9-16.2). Twenty of 45 biopsy proven local recurrences occurred outside of the implanted peripheral zone. Of the 22 patients who developed distant metastases, 14 events occurred more than 10 years from therapy. On multivariate analyses, biopsy proven local recurrence was the only factor to demonstrate a significant association with metastasis (hazard ratio 2.50; p = 0.05) and a trend with prostate cancer specific mortality (5.02; p = 0.09). Conclusions: MRI-guided partial prostate brachytherapy to the peripheral zone in men with favorable risk prostate cancer is suboptimal with respect to long term cancer control outcomes. Additional studies using contemporary MRI techniques including 3 Tesla based multi-parametric imaging and fusion biopsy may lead to improved outcomes.

Long Term Results from a Prospective Randomized Trial of 131Cs vs 125I Permanent Prostate Brachytherapy

Brachytherapy ◽  
2019 ◽  
Vol 18 (3) ◽  
pp. S15 ◽  
Author(s):  
Manuj Agarwal ◽  
Michelle H. Braccioforte ◽  
Neha Amin ◽  
Antony Koroulakis ◽  
Cristina Decesaris ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Prospective Randomized Trial ◽  
Long Term Results ◽  
Prostate Brachytherapy

Long-term outcomes of endovascular aneurysm repair for challenging aortic necks using the Talent endograft

Vascular ◽  
2011 ◽  
Vol 19 (3) ◽  
pp. 132-140 ◽  
Author(s):  
Jeffrey Jim ◽  
Brian G Rubin ◽  
Patrick J Geraghty ◽  
Luis A Sanchez
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Endovascular Aneurysm Repair ◽  
High Risk Group ◽  
Low Risk ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Aneurysm Repair ◽  
Related Mortality

The aim of the present paper is to evaluate the long-term outcomes of endovascular aneurysm repair (EVAR) for challenging aortic necks. Subgroup analyses were performed on 156 patients from the prospective multicenter Talent eLPS (enhanced Low Profile Stent Graft System) trial. Patients with high-risk aortic necks (length < 15 mm or diameter ≥28 mm) were compared with the remaining patients. Patients with high-risk ( n = 86) and low-risk necks ( n = 70) had similar age and gender distribution. Despite similar prevalences of co-morbidities, the high-risk group had higher Society for Vascular Surgery scores. The high-risk group also had larger maximum aneurysm diameters (56.6 versus 53.0 mm, P < 0.02). There were lower freedoms from major adverse events (MAEs) for the high-risk group at 30 days (84.9 versus 95.7%; P < 0.04) and 365 days (73.4 versus 89.2%; P = 0.02). Effectiveness endpoints at 12 m showed no significant differences. Freedom from all-cause mortality at 30 days (96.5 versus 100%) and aneurysm-related mortality at 365 days (96.0 versus 100%) were similar. At five years, there were no differences in endoleaks or change in aneurysm diameter. All migrations occurred in the high-risk group. The five-year freedom from aneurysm-related mortality for the high- and low-risk groups was 93.2 and 100%, respectively. In conclusion, despite a higher rate of MAEs within the first year and higher migration rates at five years, EVAR in aneurysms with challenging aortic necks can be treated with acceptable long-term results.

Long term results and patterns of recurrence from SCOPE 1: A phase II/III randomised trial of definitive chemoradiotherapy (dCRT) plus or minus cetuximab (dCRT+C) in esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 118-118 ◽  
Author(s):  
Somnath Mukherjee ◽  
Chris Hurt ◽  
Stephen Falk ◽  
Simon Gollins ◽  
John Staffurth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Phase Ii ◽  
Randomised Trial ◽  
Multivariable Analysis ◽  
Dose Intensity ◽  
Long Term Results ◽  
Full Dose ◽  
Number Of Patients ◽  
Patterns Of Recurrence

118 Background: One of the largest trials in dCRT for localised oesophageal cancer, SCOPE 1 tested the role of adding cetuximab to conventional dCRT, and showed that this was associated with greater toxicity and worse survival. Here we present the long-term outcomes. Methods: Phase II/III trial. Randomisation: cisplatin 60mg/m2 D1 and capecitabine 625mg/m2 daily D1-21 for 4 cycles with/without Cetuximab 400mg/m2 D1 followed by 250mg/m2weekly. RT: 50Gy in 25 fractions given concurrent with cycles 3 and 4. Recruitment: Feb 2008 - Feb 2012, when the IDMC recommended trial closure on the basis of futility. Results: 258 patients (dCRT = 129; dCRT+C = 129) were recruited from 36 centres. Median follow-up (IQR): 46.7 (36.0-49.0) months for all surviving pts. 65.1% (dCRT arm) and 69.8% (dCRT+C arm) of patients had died. Esophageal cancer was the cause in 82.1% and 86.7% of deaths respectively (p = 0.41). Median OS months (95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (HR 1.25, p = 0.137); corresponding 3-year OS (95% CI) was 47.2% (38.2%-55.7%) and 37.6% (29.1%-46.0%). Median PFS (95% CI): 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months respectively (HR1.28, p = 0.114). There was some evidence that local PFS (within RT field) was lower in the dCRT+C arm (HR1.38, p = 0.051). On multivariable analysis including treatment arm, Stage I-II ds (vs Stage III), full-dose RT and higher cisplatin dose intensity ( ≥ 75% vs < 75%) were associated with improved OS and PFS. Patterns of recurrence (n [%]) were similar in both arms (see table). In dCRT arm, 31/38 pts (81.6%) with local relapse within the RT field compared to 40/48 (83.3%) in the dCRT+C arm (p = 0.8). Conclusions: The mature analysis shows unprecedented survival in dCRT arm, comparable to surgical trials (e.g. 3-year OS % [95% CIs] in OE05: CF 39 [35, 44] and ECX 42 [37, 46], in OE02: 31 [27, 36]). OS inferiority of dCRT+C is no longer statistically significant. The lower PFS (within RT field) in the dCRT+C arm was consistent with the lower number of patients receiving full dose of RT in the dCRT+C arm. Clinical trial information: 47718479. [Table: see text]

Preliminary results of a study on focal low dose rate prostate brachytherapy using Cesium 131.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 151-151
Author(s):  
Brian Joseph Moran ◽  
Michelle H. Braccioforte
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Low Dose ◽  
Prostate Volume ◽  
Focal Therapy ◽  
Long Term Results ◽  
Prostate Brachytherapy ◽  
Psa Kinetics ◽  
Low Dose Rate ◽  
The Impact

151 Background: Prostate cancer patients continue to seek out minimally invasive therapies with equal disease eradication, but with less morbidity, lower cost and multiple salvage options. Our objective was to evaluate PSA response and determine rate of prostate specific antigen (PSA) kinetics in patients undergoing permanent low dose rate (LDR) focal prostate brachytherapy at a single institution. Methods: Between 4/2015 – 1/2017, 52 patients, of which 25% of patients were diagnosed with prostate cancer using a stereotactic transperineal mapping biopsy approach, while 75% had a standard transrectal prostate biopsy, were treated with LDR focal prostate brachytherapy. Dose to target was 115 Gy using Cesium-131. 30 patients (57.7%) were considered low risk, 21 pts (40.4%) were intermediate, and 1 patient (1.9%) was high risk. Treatment was limited to the side of the gland where the cancer was diagnosed. Because there is no agreed upon standard regarding PSA control, we are choosing to call the percent change in PSA the “Impact PSA”. Results: Median pre-treatment prostate volume was 51.6 cm3 (range 18 – 129 cm3), while the median target volume was 17.8 cm3 (range 7.6 – 39.4 cm3). Additionally, the median prostate volume treated was 33.73% (range 17.6 – 95.3%). Our data demonstrates that patients in whom 25-50% of the gland treated, resulted in an Impact PSA of approximately 25% - 50% decrease in total PSA between 3 - 6 months, with continued decreases of 55% at 1 year, and 77% at 2 years. Conclusions: Focal therapy outcomes are highly variable and related to volume of ablation. For low volume disease, LDR focal brachytherapy may be a viable option for patients. Optimal outcome assessment after focal therapy is yet to be determined. Since there is untreated gland with the potential to produce PSA, perhaps stable patterns in PSA kinetics, rather than a nadir, is more valuable. We will continue to follow-up with this cohort to report long term results and closely study the Impact PSA.

Long-term results of organ preservation rate and progression risk in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with radiofrequency-induced thermochemotherapy effect (RITE) with the Synergo system.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 456-456
Author(s):  
Jill-Isabel Kilb ◽  
Arne Hauptmann ◽  
Florian Wagenlehner ◽  
Gerson Luedecke
Keyword(s):  
High Risk ◽  
Mitomycin C ◽  
Organ Preservation ◽  
Low Risk ◽  
Long Term Results ◽  
Induction Phase ◽  
Minimal Risk ◽  
Bladder Preservation ◽  
Preservation Rate

456 Background: High risk NMIBC is a dangerous BC with a challenging treatment by BCG or early cystectomy to cure. The first has bad treatment tolerance and a remission of about 35%, whereas the last offer a curing perspective of 84% with extremely bad living conditions. RITE checked prospectively the therapy in respect to organ preservation, curing rate and risk of progression over 10 years in a single institution experience. Methods: All patients were EORTC high risk NMIBC. Treatment with induction phase: 8 treatments weekly with 2x40 mg Mitomycin C, 42°C intravesically induced by RITE. Followed by a re-resection of the bladder at week 11 to ensure complete remission and maintenance with treatments every 6 weeks with 2x20 mg Mitomycin C for 6 times. Cystoscopy controls were performed first 2 years every 3 month and following in 6 month until now. Study started in 2006 ongoing until today. Results: We enrolled 67 patients (4 female, 63 male), 65.7% Cis positive rate. 85% of the patients were treated alternatively to BCG with primary RITE whereas 15% were BCG failure patients treated alternatively to indicated cystectomy. Tumor persistence at week 11 after induction therapy proven by TURB was (10/67) 14.9% resulting in early cystectomy (4/10). Mean recurrence free time 3.5 years. In case of recurrence 10.4% progressed to MIBC including 6% metastatic tumors, high risk NMIBC was observed in 6% resulting in cystectomy and low risk NMIBC recurrence was 1.5% with organ preservation. BC death rate was 1 out of 67. Incomplete treatments induced by SAE of RITE was 9%. Bladder preservation rate was 80.6% with a long-lasting effectiveness ( > 5 years) of 14/26 (53.8%). Conclusions: The RITE method is in short- and long-term manner a powerful procedure to cure and maintain a recurrence free BC status in high risk NMIBC with a very low risk for cystectomy and a minimal risk for systemic progression resulting in BC death. The organ preservation rate was achieved in 80.6% lasting for up to 11 years longest. RITE is an alternative to BCG and preferable to early cystectomy in high risk NMIBC.

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