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.

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.

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.

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.

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.

Stereotactic Radiosurgical Salvage Treatment for Locally Recurrent Esthesioneuroblastoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 332-340 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Matthew L. Carlson ◽  
Bruce E. Pollock ◽  
Eric J. Moore ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Additional Patient ◽  
Median Dose ◽  
Single Institution ◽  
Treatment Volume ◽  
Locally Recurrent ◽  
Assess Treatment Response ◽  
Grade 3

Abstract BACKGROUND: Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available. OBJECTIVE: To determine whether SRS is effective in providing local control for recurrent ENB. METHODS: This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962–2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported. RESULTS: The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm3 (mean, 18.9 cm3; range, 1.4-76.3 cm3), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS. CONCLUSION: SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.

The effect of prostate brachytherapy technique on quality of life outcomes: 5-year outcomes of a prospective cohort study.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 166-166
Author(s):  
James Austin Talcott ◽  
Jack A. Clark ◽  
Judith Manola ◽  
Irving D. Kaplan ◽  
Anthony L. Zietman ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Target Volume ◽  
Prostate Brachytherapy ◽  
Life Outcomes ◽  
Early Results ◽  
Urinary Morbidity ◽  
Clinical Trial Information

166 Background: Brachytherapy (BT) is widely used to treat clinically localized prostate cancer, but techniques vary and may affect patient outcomes. Methods: We prospectively studied three Boston-area patient cohorts who received different BT techniques: MRI guided, target volume avoids transition zone (MRBT) and two cohorts using standard imaging and planning techniques (USBT1 and USBT2). We surveyed patients pretreatment and at intervals after, using the validated PCSI scales for urinary incontinence (incont), obstruction/irritation (obstir) bowel problems, sexual dysfunction and the effect of incont on their lives (incontQOL). Based on early results showing increased acute urinary toxicity, USBT2 providers adopted an element of USBT1 technique. We report final 5-year follow-up. Results: Of 286 eligible patients, 73 MRBT patients and 190 USBT patients (99 USBT1 and 91 USBT2 patients) completed at least 3-month surveys. Patient differed by age (median: MRBT 65.3 years vs. USBT 68.3 p=0.005, USBT2 65.3 vs. USBT1 68.3 p=0.004) and education (MRBT 8%≤high school vs. USBT 23%, p<0.001) but other demographic and clinical variables were similar. MRBT patients had more pretreatment obstir symptoms and better sexual function pretreatment. USBT2 patients had greater increases in acute (3-month) obstir (28.8 vs. 20.0, p=0.01) and incont (12.2 vs. 7.1, p=0.01) than USBT1 but not bowel or sexual dysfunction, and all outcomes were similar at 5 years. Changing USBT2 technique eliminated the acute urinary differences. Compared to MRBT, USBT patients had greater increases in acute urinary morbidity (obstir 28.8 vs. 20.0, p=0.01; incont 9.6 vs. 2.2, p=0.002; incontQOL 10.2 vs. 2.4, p=0.0002) and long-term incontinence (incont 7.5 vs. 3.3, p=0.05; incontQOL 5.6 vs. 1.2, p=0.01). Other outcomes did not differ. Conclusions: QOL outcomes vary by BT technique. Measuring QOL may provide useful information for patients choosing treatment and providers assessing their technique. Clinical trial information: NCT00681694.

Three Year Results of a Prospective Study on Focal Salvage HDR Prostate Brachytherapy After Previous Definitive External Beam Radiotherapy (XRT)

Brachytherapy ◽  
2017 ◽  
Vol 16 (3) ◽  
pp. S63
Author(s):  
Hans Chung ◽  
Laura D'Alimonte ◽  
Andrew Loblaw ◽  
Ananth Ravi ◽  
Matt Wronski ◽  
...  
Keyword(s):  
Prospective Study ◽  
External Beam Radiotherapy ◽  
Prostate Brachytherapy ◽  
External Beam ◽  
A Prospective Study

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.

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