The impact of simultaneous dose escalation VMAT to the focal lesion micro boost of localized prostate cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16592-e16592
Author(s):  
Radwa Fawzy Saleh Ahmed ◽  
Raafat Ragaie Abdel Malek ◽  
Mohamed Metwaly ◽  
Omar Abdel Aziz ◽  
Samy Al sirafy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Dose Escalation ◽  
Localized Prostate Cancer ◽  
Focal Lesion ◽  
Rectal Toxicity ◽  
Gu Toxicity ◽  
Gi Toxicity

e16592 Background: Dose Escalation to the prostate is showing promising results of increasing local control. The study aims to assess biochemical failure free survival (BFF) after dose escalation to the prostate 78Gy with simultaneous integrated boost (SIB) 87Gy to the focal lesion. Genito-urinary (GU) & gastro-intestinal (GI) toxicity was assessed by comparing investigational toxicity score & patient outcome reports. Methods: Thirty intermediate & high risk localized prostate cancer patients were treated with dose escalated VMAT protocol of 78 Gy/35 fractions to prostate & 87Gy boost to focal lesion detected by baseline multi-parametric MRI & TRUS as well. Neo-adjuvant, Concurrent & adjuvant hormonal therapy was applied. Risk structures dose statistics were matched to modified Quantec with EQD2 equation. For each patient, daily online fiducial markers image guided verification was done. Toxicity profile was assessed by RTOG for subjective assessment and FACIT quality of life protocol for objective assessment during the radiotherapy course & follow up period. Results: About 80% of patients received the pre-determined protocol, however three patients received 76Gy to prostate & 84Gy to the focal lesion to comply with the risk structure constrains. At median follow up period of 18 months-BFF was 93.3 %. By the end of radiotherapy, 80% developed G3 GU toxicity while 30% developed G2 GI toxicity. Correlation between bladder V40 (≥or≤ 40%) & GU toxicity (≤ G3 vs G3) was of border line statistical significance (P = 0.05). After radiotherapy, GU toxicity dropped to 17.2% G2 & 13% G3 at the 3rd month while 0 % G3 afterwards. Three patients developed G4 rectal toxicity (bleeding per rectum); one at 9th month of ending treatment & two at 12th month; two of them needed cautery for angio-dysplasia as post radiation sequelae confirmed by colonoscopy. However, the correlation between V40 of the rectum ≥ 40% was significant with rectal toxicity (G0 vs G4) (P = 0.02). Comparing FACIT assessment during radiotherapy or in follow up showed no significant difference affecting the quality of life. Conclusions: Dose Escalation with SIB should be done using advanced technique like VMAT with image guidance. Re-validation of risk structure & rectal dose constrains should be considered especially for dose escalation ≥ 72Gy. Clinical trial information: NCT03384199.

Virtual HDR SBRT for localized prostate carcinoma: Efficacy and quality-of-life assessment.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 45-45 ◽  
Author(s):  
Donald B. Fuller ◽  
Reza Shirazi ◽  
John Naitoh ◽  
George Mardirossian
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Disease Free Survival ◽  
Life Assessment ◽  
Intermediate Risk ◽  
Gu Toxicity ◽  
Gi Toxicity ◽  
Grade 3

45 Background: We designed a CyberKnife (CK) prostate Stereotactic Body Radiotherapy (SBRT) method to recapitulate HDR fractionation and target volume coverage (“Virtual HDR”). We report 4 year efficacy, toxicity and quality of life (QoL) outcomes. Methods: Eligible patients had low- (Gleason < 6, PSA < 10 ng/mL, < T2bN0) or intermediate-risk (Gleason < 6 with PSA 10.01 – 20 ng/mL or Gleason 7 with PSA < 10 ng/mL, < T2bN0) prostate cancer. A dose of 38 Gy/4 fractions was given to > 95% of the PTV; with “HDR-like” bladder, urethral and rectal dose constraints, and “HDR-like” dose escalation in the PTV. Toxicities were assessed using CTCAE3.0 criteria. QoL was assessed using the Expanded Prostate Cancer Index Composite (EPIC). Results: Since July 2006, 59 patients were treated. Two were lost to follow-up and 6 have been followed < 6 months, leaving 51 (32 low- and 19 intermediate-risk) patients for analysis. Median f/u is 42 months (range, 6-60). 4-year actuarial biochemical-disease free survival is 98% (ASTRO, Phoenix). Freedom from local and distant relapse is 100% and 98%. Median baseline PSA of 6.3 ng/mL (range 1.0 – 14.1) decreased to 0.1 ng/mL by 48 months. Acute grade 2 GU and GI toxicity rates were 22% and 4%, respectively (0% Grade 3+). Three (6%) late Grade 3 GU toxicities occurred at 18, 48 and 48 months. No grade 3+ GI toxicity occurred. Late grade 2 GU and GI toxicity rates were 18% and 2%, respectively. Only 2 patients (4%) had ongoing late > grade 2 GU toxicity at last follow-up (0% GI). Mean EPIC urinary and bowel scores decreased at 2 months, with subsequent improvement and stability to 48 months. Mean EPIC sexual scores gradually declined to 48 months. Of patients potent at baseline, 63% were potent at 3 years, including 100% < age 60, 64% age 61-70 and 60% > age 70. Conclusions: To 4 years, HDR-like CK SBRT for low- and intermediate-risk prostate cancer results in a very low PSA nadir and relapse rate, minimal toxicity and a favorable QoL outcome, with an age-dependent potency preservation rate. The occasional occurrence of late grade 3 urethral stricture can likely be reduced by better patient selection (caution re: patients with significant pre-existing uropathy). Acute and late grade 2 GU toxicity usually resolves with conservative management.

Patient-reported quality of life in men with TURP undergoing proton therapy for prostate cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 220-220 ◽  
Author(s):  
Derek Lee ◽  
Bradford S. Hoppe ◽  
Tamara L. Smith ◽  
Christopher G. Morris ◽  
Romaine Charles Nichols ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Proton Therapy ◽  
Toxicity Assessment ◽  
Gu Toxicity ◽  
Significant Difference ◽  
Patient Reported ◽  
Grade 3

220 Background: We report on quality of life (QOL) and early toxicity following proton therapy (PT) among men with prostate cancer who underwent transurethral resection of the prostate (TURP) prior to treatment. Methods: Between 2006 and 2010, 1,540 patients were treated definitively with PT for prostate cancer at UFPTI and enrolled on a prospective IRB-approved outcomes protocol. One hundred of the men had received a TURP before PT. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Results: Men who had TURP prior to PT had lower EPIC scores at baseline and at all followup points for urinary function, urinary incontinence, and urinary summary (Table). The TURP group also had lower EPIC bowel bother, bowel function, and bowel summary at baseline, 6-month, and 1-year followup. EPIC urinary bother, urinary irritation/obstruction, and subscales did not show a statistically significant difference at baseline, but they did show lower scores for the TURP group at variable follow-up time points. The IPSS scores among the TURP group did not show a statistical difference from the non-TURP group, except at the 6-month follow-up time point. Toxicity assessment showed that the 2-year and 3-year cumulative incidence of grade 3 GU toxicity rate in the pretreatment TURP group were 14% and 18%, respectively. Conclusions: Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after PT treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up and further evaluation of risk factors for grade 3 GU toxicity among this cohort are needed. [Table: see text]

Quality of life impact of treatments for localized prostate cancer: Cohort study with a 5year follow-up

2013 ◽  
Vol 108 (2) ◽  
pp. 306-313 ◽  
Author(s):  
Montse Ferrer ◽  
Ferran Guedea ◽  
José Francisco Suárez ◽  
Belén de Paula ◽  
Víctor Macías ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Cohort Study ◽  
Localized Prostate Cancer ◽  
Life Impact

Assessing rectal toxicity in a pilot study using intrarectal amifostine and concurrent radiation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18579-18579 ◽  
Author(s):  
N. L. Simone ◽  
B. P. Soule ◽  
C. Menard ◽  
P. Albert ◽  
P. Guion ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Pilot Study ◽  
Cancer Treatment ◽  
Rectal Mucosa ◽  
Rectal Toxicity ◽  
Prostate Cancer Treatment ◽  
Gi Toxicity ◽  
Toxicity Score

18579 Background: There is evidence that daily intrarectal amifostine can protect rectal mucosa during prostate cancer treatment. Instruments more sensitive than the RTOG score may discriminate small but clinically important reductions in proctitis, however these tools need further evaluation. This study used both the RTOG GI toxicity score and expanded prostate cancer index composite (EPIC), a patient-administered quality of life instrument, to evaluate toxicity. Methods: In this pilot study, patients with localized prostate cancer were given daily amifostine (MedImmune, INC., Gaithersburg, MD) which was placed per rectum 30–45 min before 3D conformal radiation (66–76 Gy in 2 Gy fractions to a volume based on PSA, Gleason score and clinical stage). The first 18 patients enrolled received 1gram of amifostine and the next 12 patients were given 2 grams. Toxicity was assessed at baseline, 5, and 7 weeks during treatment and 3, 6, 12, 18, and 24 months after radiation and amifostine treatment. RTOG grading, an EPIC score and proctoscopic examination were done. The EPIC questionaire is a validated instrument that consists of 50 quality of life questions related to urinary, bowel, sexual and hormonal domains. Two subsets of the bowel domain were used: “bowel function” (BF) targets symptom severity and “bowel bother,” (BB) assesses quality of life subscales. Results: Previously reported results demonstrate a clear trend towards protection from rectal toxicity using 2 gm as compared to a 1 gm amifostine dose. Here, we report that the EPIC-BF and EPIC-BB scores are both highly correlated with the RTOG toxicity score with a pearsons coefficient of 0.98 and 0.97 respectively at a median follow up of 24 mos. There was no significant change in the RTOG GI toxicity score over the course of treatment for either amifostine dose group. There was a statistically significant decrease in EPIC-BF score at 7 weeks (p = 0.04) and the EPIC-BB score showed a trend toward improvement (p = 0.07) at the same time point. The EPIC scores at all other time points were not statistically different from baseline. Conclusions: The EPIC score may be a more sensitive measure to detect acute toxicity associated with prostate cancer treatment but needs further investigation in the acute setting. No significant financial relationships to disclose.

Late toxicity and quality of life from GETUG-AFU 22 study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 331-331
Author(s):  
Igor Latorzeff ◽  
Stephane Guerif ◽  
Sandra Pelissier ◽  
Emmanuel Meyer ◽  
Julien Fraisse ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Late Toxicity ◽  
Localized Prostate Cancer ◽  
Efficacy Analysis ◽  
Prostate Bed ◽  
Gu Toxicity ◽  
Significant Difference ◽  
Grade 3

331 Background: Radical prostatectomy (RP) is recommended as a standard treatment for localized prostate cancer. However no recommendations exist for pts with immediate detectable PSA after RP. Methods: Pts with localized prostate cancer, treated by RP (R0 or R1), with a PSA level post-RP ≥0.2 ng/mL and ≤2 ng/mL at randomization and N0 M0 on imaging were included. Pts were randomized (1:1) to radiotherapy (RT) alone (RT arm) or 6 months degarelix hormone therapy (HT) with RT (RT+HT arm). RT consisted of pelvic irradiation (46 Gy in 23 Fr) with a boost on the prostate bed (66 Gy in 33 Fr). The primary endpoint was event-free survival (EFS). Acute and late toxicities were evaluated as secondary endpoints and scored using CTCAE V4.0 scale. Quality of life (QOL) was assessed with QLQ-C30 and QLQ-PR25 questionnaires at 12 and 24 months. Late toxicity was reported at 24 months. Results: From Jan-2013 to Sept-2015, 125 pts were included (RT arm: 64 pts; RT+HT arm: 61). Median follow up is 38 months (31.4; 44). The baseline characteristics are well-balanced between two arms: median age was 66 yrs (50-77), all men having an ECOG ≤1 (ECOG 0 in 92%), a median Gleason score of 7 (3-9), a median PSA of 0.3 ng/mL (0.09-1.82) post-RP and 0.6 ng/mL (0.12-3.65) at randomization. All pts received 33 Fr of RT. In the RT+HT arm 98.4% of pts received the 6 months of HT planned. All pts were eligible for safety analysis. At 24 months, no difference in late genitourinary (GU) or gastrointestinal (GI)toxicity was observed between the two arms (p=0.145) Grade 3 late toxicities were reported for 15/125 pts (12%): 8/64 pts (6.5%) in the RT arm and 7/61 pts (5.5%) in RT+HT arm (NS) and no toxicity grade >3 was observed. Evaluation of QOL was assessable at 12 and 24 months of FU for 80%/89% pts and 59%/77% pts in RT/RT-HT arms respectively. At 12 months QLQ-PR25 HT related symptoms was significantly more important in the RT-HT arm (p=0.04). At 24 months no significant difference in QLQC-30 or QLQ-PR25 analysis was reported. Conclusions:, At 24 months in this phase II trial no significant difference in GI/GU toxicity and.QOL was observed between the two arms. GETUG-AFU 22 efficacy analysis is still pending. Clinical trial information: NCT01994239.

Quality of life impact of treatments for localized prostate cancer: A 7-year follow-up study

2013 ◽  
Vol 18 ◽  
pp. S99
Author(s):  
F. Guedea Edo ◽  
Y. Pardo ◽  
M. Ferrer Fores ◽  
F. Ferrer Gonzalez ◽  
J. Suárez Novo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Localized Prostate Cancer ◽  
Follow Up Study ◽  
Life Impact

scholarly journals Five-year follow-up of health-related quality of life after primary treatment of localized prostate cancer

2005 ◽  
Vol 116 (2) ◽  
pp. 291-296 ◽  
Author(s):  
Ida J. Korfage ◽  
Marie-Louise Essink-Bot ◽  
Gerard J.J.M. Borsboom ◽  
Joanna B. Madalinska ◽  
Wim J. Kirkels ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Primary Treatment ◽  
Localized Prostate Cancer ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related
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