Quality of life (QOL) and acute toxicities of a pilot study of focal salvage high-dose rate (HDR) prostate brachytherapy in patients with local recurrence after definitive external-beam radiotherapy (XRT).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 79-79 ◽  
Author(s):  
Hans T. Chung ◽  
Laura D'Alimonte ◽  
D. Andrew Loblaw ◽  
Ananth Ravi ◽  
Matthew Wronski ◽  
...  
Keyword(s):  
Pilot Study ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Target Volume ◽  
High Dose Rate ◽  
High Dose ◽  
Prostate Brachytherapy ◽  
Hdr Brachytherapy ◽  
High Frequency Ultrasound ◽  
Risk Prostate Cancer

79 Background: Despite dose-escalated radiotherapy, studies of post-treatment biopsies of the prostate for intermediate-risk prostate cancer suggest that approximately 20% will be positive. Salvage options include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the risk of significant complications (e.g. fistula, incontinence, bladder neck contracture), is not insignificant. The objective of this pilot study is to explore the QOL, toxicities and efficacy of focal salvage HDR prostate brachytherapy. Methods: This study was approved by the institution’s research ethics board. Eligible patients included: biopsy-confirmed local recurrence >30 months after XRT, MRI demonstrating solitary recurrence confined to the prostate, negative metastatic workup, IPSS <15, post-XRT PSA <10ng/mL, prostate volume ≤50cc. Salvage ultrasound-based HDR brachytherapy was performed with a prescription dose of 27Gy divided over two implants separated by 1 week to the target volume (TV) as seen on MRI with dose constraints to the urethra and rectum. Results: Eleven patients (mean age 73 years) have been enrolled in the study. At initial presentation, there were 4, 6 and 1 low-, intermediate- and high-risk disease, and initial XRT received was 70-78Gy. The Gleason score of the local recurrence was 7 and 8-10 in 6 and 5 patients, respectively. The pre-HDR mean PSA was 5.0 (range 1.3 – 9.29). The median size of the recurrence on MRI was 10mm and median volume of the TV was 5.9cc (2.2-16.1), TV V100 96.0%, urethral D10 64.5% and rectal D1cc 42.9%. Ten patients have at least 6 months of follow-up (median 10 months), and no acute GU/GI grade 3-5 toxicities were observed, including urinary retention. The most common acute toxicity was frequency and nocturia. Mean IPSS at baseline, 1-, 3- and 6-months was 6, 8, 7 and 5. At 6-months, 9 of 10 patients had a lower PSA (mean 1.78) than baseline. There was no significant change in EPIC urinary, bowel and sexual domains within the first 6-months. Conclusions: Preliminary data suggests that focal salvage HDR brachytherapy was technically feasible with minimal acute toxicities. Clinical trial information: NCT01583920.

Pilot study of focal salvage high-dose rate (HDR) prostate brachytherapy in patients with local recurrence after definitive external-beam radiotherapy (XRT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 264-264
Author(s):  
Hans T. Chung ◽  
D. Andrew Loblaw ◽  
Laura D'Alimonte ◽  
Ananth Ravi ◽  
Masoom A. Haider ◽  
...  
Keyword(s):  
Pilot Study ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
High Dose ◽  
Prostate Brachytherapy ◽  
Intermediate Risk ◽  
Hdr Brachytherapy ◽  
Median Size ◽  
Complication Risk

264 Background: Studies of post-treatment biopsies of the prostate after definitive dose-escalated XRT for intermediate-risk prostate cancer suggest that approximately 20% will be positive. Salvage options include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the complication risk, such as fistula, incontinence or bladder neck contracture, is not insignificant. The objective of this pilot study is to explore the toxicities and efficacy of focal salvage HDR prostate brachytherapy. Methods: This study was approved by the institution’s research ethics board. Eligible patients included those with biopsy-confirmed local recurrence >30 months after completing XRT, MRI of the prostate demonstrating solitary recurrence confined to the prostate, negative metastatic workup, IPSS <15, post-XRT PSA <10ng/mL, prostate volume ≤50cc. Salvage HDR brachytherapy was performed under transrectal ultrasound guidance with a prescription dose of 27Gy divided over two implants separated by 1 week to the target volume (TV) as seen on MRI with dose constraints to the urethra and rectum. Results: Six patients were enrolled in the study. The mean age was 73 years, all had either low- or intermediate-risk disease at presentation, and initial XRT received was 70-78Gy at least 5 years ago. The Gleason score of the local recurrence was 7 and 8-10 in 4 and 2 patients, respectively. The pre-HDR mean PSA was 5.5. The median size of the recurrence on MRI was 9mm and median size of the TV was 5.0cc (2.2-10.2), TV V100% 95.1%, urethral D10% 51.8% and rectal D1cc 39.2%. Four patients have at least 3 months of follow-up, and no acute GU/GI grade 3-5 toxicities were observed, including urinary retention. The most common acute toxicity was frequency and nocturia. Mean IPSS at baseline, 4-weeks, 3-months was 7, 9 and 7. Conclusions: Preliminary data suggests that focal salvage HDR brachytherapy was technically feasible with mild acute toxicities. Clinical trial information: NCT01583920.

Three year results of a prospective study on focal salvage HDR prostate brachytherapy for local recurrence after external beam radiotherapy (XRT).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e558-e558
Author(s):  
Hans T. Chung ◽  
Laura D'alimonte ◽  
Andrew Loblaw ◽  
Ananth Ravi ◽  
Melanie Davidson ◽  
...  
Keyword(s):  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Target Volume ◽  
Prostate Brachytherapy ◽  
Hdr Brachytherapy ◽  
High Frequency Ultrasound ◽  
Psa Failure ◽  
Grade 3 ◽  
A Prospective Study

e558 Background: Salvage options for those with local recurrence after XRT include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the risk of significant complications (e.g. fistula, incontinence, bladder neck contracture), is not insignificant. The sensitivity of multiparametric MRI in detecting viable cancer within the prostate is now more than 70%. The objectives of this pilot study are to explore the toxicities, QOL and efficacy of focal salvage HDR brachytherapy in patients with MRI-visible biopsy-confirmed local recurrence. Methods: Eligible patients included: multiparametric 3T MRI-visible biopsy-confirmed local recurrence > 30 months after XRT, negative metastatic workup, IPSS < 15, post-XRT PSA < 10ng/mL, prostate volume ≤ 50cc. The ultrasound-based HDR brachytherapy prescription dose was 27Gy divided over two implants separated by 1 week to the target volume (TV) with dose constraints to the urethra and rectum. Follow-up PSA, IPSS, EPIC QOL and CTCAE v4.0 toxicities were collected. Results: 15 patients (mean age 73 years) were enrolled in the study. Median follow up was 30 months (12-42). At initial presentation, there were 5, 8 and 2 low-, intermediate- and high-risk disease, and initial XRT dose was 70-78Gy. The Gleason score of the local recurrence was 6, 7 and 8-10 in 1, 7 and 6, respectively, and not classified in 1 patient. The pre-HDR median PSA was 4.13 (1.30 – 9.29). The median size of the recurrence on MRI was 9mm (7-20), TV 6.1cc (2.2-16.1), TV V100 96.3%, TV D90 110.9%, urethral D10 64.5% and rectal D10 36.0%. No acute/late GU/GI grade 3-5 toxicities, nor urinary retention, were observed. The most common acute toxicity was frequency and nocturia. Median IPSS at baseline, 1-, 3-, 6-, 12-, 18-, 24-months was 4, 8, 5, 5, 8 and 5 (p = 0.72). Three year PSA failure free rate was 71%. There was no significant change in EPIC domains. Conclusions: Early toxicity, QOL and PSA failure-freedata suggests that focal salvage HDR brachytherapy is well tolerated and effective. Clinical trial information: NCT01583920.

scholarly journals Interstitial HDR Brachytherapy in the Treatment of Non-Melanocytic Skin Cancers around the Eye

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1425
Author(s):  
Paweł Cisek ◽  
Dariusz Kieszko ◽  
Mateusz Bilski ◽  
Radomir Dębicki ◽  
Ewelina Grywalska ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Late Complication ◽  
Target Volume ◽  
Lower Eyelid ◽  
High Dose Rate ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Lateral Canthus ◽  
Skin Cancers

Background: Eyelid tumors are rare skin cancers, the most common of which is basal cell carcinoma characterized primarily by local growth. In addition to surgery, radiotherapy is among the basic methods of treatment. External beam radiotherapy is associated with the risk of complications within ocular structures, especially the lens. In the case of interstitial brachytherapy, it is possible to administer a high dose to the clinical target volume (CTV), while reducing it in the most sensitive structures. Methods: This paper presents the results of an analysis of 28 patients treated with interstitial high dose rate (HDR) brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral canthus; and the cheek, nose and temples with the infiltration of ocular structures. The patients were treated according to two irradiation schedules: 49 Gy in 14 fractions of 3.5 Gy twice a day for 7 days of treatment, and 45 Gy in 5 Gy fractions twice a day for 5 days. The mean follow-up was 22 months (3–49 months). Results: two patients (6%) had a relapse: a local recurrence within the irradiated area in one of them, and metastases to lymph nodes in the other. The most common early complication was conjunctivitis (74%), and the most common late complication was dry eye syndrome (59%). Conclusions: Interstitial HDR brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral cants; and the cheek, nose and temples with infiltration of ocular structures is a highly effective, short and relatively low burden type of treatment.

scholarly journals HDR Brachytherapy in the Management of High-Risk Prostate Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Susan Masson ◽  
Raj Persad ◽  
Amit Bahl
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Large Individual ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Normal Tissues ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

High-dose-rate (HDR) brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with high-risk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom.

MRI response to focal salvage HDR prostate brachytherapy for locally recurrent prostate cancer after external-beam radiotherapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. e631-e631
Author(s):  
Hans T. Chung ◽  
Gerard Morton ◽  
Laura D'Alimonte ◽  
Andrew Loblaw ◽  
Ananth Ravi ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Prostate Volume ◽  
External Beam Radiotherapy ◽  
Significant Risk ◽  
Target Volume ◽  
Prostate Brachytherapy ◽  
External Beam ◽  
High Frequency Ultrasound ◽  
Mri Scans ◽  
Mri Characteristics

e631 Background: For local recurrence after external-beam radiotherapy, salvage therapy options include surgery, brachytherapy, cryotherapy or high-frequency ultrasound, though there is a significant risk of serious complications (e.g. fistula, incontinence, bladder neck contracture). In the meantime, MRI technology has evolved (e.g. DCE and DWI) such that the sensitivity of detecting viable cancer within the prostate is now more than 70%. Therefore, we initiated a pilot study of focal salvage HDR prostate brachytherapy in patients screened with a MRI with the hypothesis that focal treatment, rather than whole gland, would lead to less complications but similar local control. The MRI response is presented here. Methods: This study was approved by the institution’s research ethics board. Eligible patients included: biopsy-confirmed local recurrence > 30 months after completing XRT, MRI demonstrating solitary recurrence confined to the prostate, negative metastatic workup, IPSS < 15, post-XRT PSA < 10ng/mL, prostate volume ≤ 50cc. Salvage ultrasound-based HDR brachytherapy was performed with a prescription dose of 27Gy divided over two implants separated by 1 week to the target volume (TV) as seen on MRI with dose constraints to the urethra and rectum. All MRI scans were completed with 3T and included T2W, DCE and DWI. Lesions suspicious for cancer were scored using PI-RADS methodology pre-brachytherapy, and using a 5-point scale post-brachytherapy. Results: Fifteen patients were accrued. Thus far, 6 of 15 patients have completed a post-brachytherapy MRI (median 530 days; range 307-653). The baseline MRI characteristics of these 5 patients include: PI-RADS 4 (n = 1), 5 (n = 4), not specified (n = 1); median size 9 mm (range 7-9); T2 (n = 5) and T3a (n = 1); median prostate volume 28mL (20-63). In the post-brachytherapy MRI, the treated intraprostatic lesion no longer showed areas of cancer in 5 patients. Two patients developed a new focus of cancer in the prostate. Patients were not routinely biopsied after brachytherapy. Conclusions: Preliminary data from MRI suggests that there is a treatment response in most patients after focal salvage brachytherapy. Clinical trial information: NCT01583920.

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