scholarly journals The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200548
Author(s):  
Gayan Chetiyawardana ◽  
Peter J. Hoskin ◽  
Yat Man Tsang
Keyword(s):  
Prostate Cancer ◽  
Treatment Time ◽  
External Beam ◽  
Bladder Filling ◽  
Full Bladder ◽  
Early Results ◽  
Gu Toxicity ◽  
The Impact ◽  
Empty Bladder

Objective: To examine the impact of an empty bladder filling protocol on patients receiving radical RT for localised prostate cancer on post RT toxicity and biochemical progression free survival (bPFS). Methods and materials: Records of patients receiving radical external beam RT (EBRT) for localised prostate cancer with a full or empty bladder were reviewed. These included the bladder size on planning CT, daily online image guided RT (IGRT) setup data, treatment time and post treatment follow up data.These included bPFS, gastrointestinal(GI) and genitourinary(GU) toxicity scoring post RT using the CTCAE v4.0 scoring system. All patients included in the study were planned and treated under the same departmental clinical protocol with VMAT and daily online IGRT corrections. Results: 90 patients were treated with 60 Gy in 20 fractions with a median follow up of 48 months. At 4 years bPFS in the empty bladder group was 100 and 98% in the full bladder group (p = 0.27). There were no statistically significant differences in cumulative ≥Grade 2GU (p = 0.10) and GI (p = 0.27) toxicity rates between the two bladder filling protocols. No statistically significant differences in the IGRT setup between the two groups of patients. Although the median treatment times per fraction were not statistically different between the two groups (p = 0.47), patients in the full bladder filling group were required to spend a longer time in the RT department per treatment session for bladder filling. Conclusion: An empty bladder filling protocol has non-inferior bPFS, GI and GU toxicities at 4 years in patients with localised prostate cancer using advanced RT techniques in comparison to a full bladder filling protocol. A longer follow up with a larger sample size is required to validate this approach. Advances in knowledge: This study suggests that an empty bladder filling protocol can be used in external beam EBRT for localised prostate cancer with non-inferior treatment outcomes.

PATRIOT Trial: Randomized phase II study of prostate stereotactic body radiotherapy comparing 11 versus 29 days overall treatment time.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Harvey Charles Quon ◽  
Aldrich Ong ◽  
Patrick Cheung ◽  
William Chu ◽  
Hans T. Chung ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Phase Ii ◽  
Stereotactic Body Radiotherapy ◽  
Treatment Time ◽  
Phase Ii Study ◽  
Overall Treatment Time ◽  
Randomized Phase Ii ◽  
Grade 3 ◽  
The Impact

6 Background: Stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer is rapidly increasing. Reported regimens differ in time, dose, and fractionation. We report the results of a multicentre, Canadian randomized phase II study to investigate the impact of overall treatment time on quality of life (QOL) and toxicity. Methods: Men with cT1-2b, Gleason <=7, and PSA <= 20 ng/mL prostate cancer were randomly assigned to 40 Gy in 5 fractions delivered every other day (11 days) vs. once per week (29 days) using gantry-based SBRT. QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) at baseline, weeks 2, 4, 6, 12, months 6 and 12, then annually. Toxicity was graded according to RTOG Criteria. The primary end point was the proportion of patients with a minimum clinically important change (MCIC) in bowel QOL at any time during the acute (<=12 week) period and was analyzed by Fisher’s exact test with a two-sided p < 0.05 considered significant. MCIC was defined as a decrease in EPIC score of >0.5 standard deviation of the baseline value. ClinicalTrials.gov NCT01423474. Results: 152 men from 3 centres were randomized with a median follow-up of 13.1 months. Baseline characteristics were similar in both arms except for the International Prostate Symptom Score with medians of 4 vs. 7 in the 11 and 29 day groups, respectively (p=0.02). There were significant differences between the 11 and 29 day groups in the proportion of patients with acute MCIC in bowel (90.0% vs. 69.6%, p<0.01) and urinary (95.7% vs. 74.6%, p<0.01) scores, respectively. No differences were found in acute sexual (p=0.38) or hormonal (p=0.48) QOL. Worst acute grade 1, 2, 3 toxicities were 64, 18, 0% vs. 41, 11, 0% (p<0.01) for GI and 38, 32, 1% vs. 30, 34, 3% (p=0.69) for GU in the 11 and 29 day groups, respectively. There were no late grade 3+ GI toxicities. Late grade 3 GU toxicity occurred in 1 vs. 0 patients in the 11 and 29 day arms (p=0.32). Conclusions: Prostate SBRT delivered over 29 days was associated with superior bowel and urinary QOL compared to 11 days in the first 3 months of treatment. There were few severe (grade 3+) toxicities in either group. Follow-up is continuing to compare long-term outcomes. Clinical trial information: NCT01423474.

Treating intermediate-risk prostate cancer with hypofractionated external beam radiotherapy alone.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 93-93
Author(s):  
A. Dal Pra ◽  
S. Faria ◽  
F. L. Cury ◽  
M. David ◽  
M. Duclos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Androgen Deprivation ◽  
Biochemical Failure ◽  
External Beam ◽  
Intermediate Risk ◽  
Conventional Fractionation ◽  
Gu Toxicity ◽  
Risk Prostate Cancer

93 Background: A wide range of therapeutic alternatives is available for the treatment of intermediate-risk prostate cancer (IRPC). The use of hypofractionated external beam radiotherapy (HypoRT) in this group of patients appears to be an attractive option. Non-randomized institutional results have provided similar outcomes to conventional fractionation. For health-systems such as we have in Canada, where many patients live far, it significantly shortens treatment duration and impacts favorably in health costs. We report our results using HypoRT alone in IRPC. Methods: Between October/2002 and July/2009, 82 men with IRPC (T2b-T2c, or PSA 10–20 ng/dL, or GS=7) were treated with HypoRT, without any androgen deprivation. Ultrasound image guidance was used daily to confirm setup. The dose was 66 Gy in 22 daily fractions of 3 Gy (BED=79.4Gy/44) prescribed at the isocenter. PTV was the prostate (+/− 1cm seminal vesicles) with 7-mm margin in all directions. GI and GU toxicity were prospectively assessed every 4–6 months using the CTCAE v3 scoring system. Biochemical failure was defined as nadir PSA + 2 ng/dL. Results: 60% of patients had Gleason score 7; 43% had stage T2; median initial PSA=9 ng/ml; median age 71 years. With a median follow-up of 43 months (range: 7–89), only three patients (4%) have developed biochemical failure. All three showed metastatic disease few months after biochemical failure. Actuarial biochemical recurrence free survival (bNED) is 95.4%. There was no death related to prostate cancer. Three patients died from other causes without biochemical failure. The 5-year overall survival was 93%. At the last follow up visit, grade ≥ 2 late GI and GU toxicity rates were 2% and 7%, respectively. No grade 4 or 5 has occurred. Conclusions: Men with IRPC treated with 66Gy/22 fractions and without androgen deprivation have experienced excellent 5-year biochemical control rate with acceptable late toxicity. This regimen is very convenient because the duration of the treatment is half of the time used with conventional fractionation. Whether the addition of short-term androgen deprivation would further improve outcome remains unclear. No significant financial relationships to disclose.

Long-term toxicity and associated cost of initial treatment and subsequent toxicity-related intervention for patients treated with prostatectomy, external beam radiotherapy, or brachytherapy: A SEER/Medicare database study.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 4-4
Author(s):  
Jay P. Ciezki ◽  
Chandana A. Reddy ◽  
Kenneth Angermeier ◽  
James Ulchaker ◽  
Kevin L. Stephans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Initial Treatment ◽  
Combined Therapy ◽  
External Beam Radiotherapy ◽  
Treatment Modalities ◽  
External Beam ◽  
Gu Toxicity ◽  
Medicare Database

4 Background: Treatment-related toxicity for prostate cancer (CaP) is rarely reported more than 5 years after therapy. We examined the SEER-Medicare linked database with the potential of having 16 years of follow-up data on toxicity requiring procedural intervention. Methods: The SEER-Medicare database was queried for CaP patients treated with prostatectomy (RP), external beam radiotherapy (EBRT), or brachytherapy (PI) between 1991-2007. We identified procedural billing codes associated with toxicity-related treatments. We obtained information on the Medicare reimbursement rates for the initial treatment and any toxicity-related interventions. We then computed the cost per patient-year within each treatment modality over time. Results: A total of 137,427 patients who were 65 years or older at the time of CaP diagnosis and who had CaP as their only cancer diagnosis were retrieved from the SEER/Medicare database: 59,559 (43.3%) treated with RP, 60,806 (44.2%) treated with EBRT, and 17,062 (12.4%) treated with PI. No patient received combined therapy. The median follow-up is 71 months. Overall, 10,585 (7.3%) patients experienced a toxicity requiring intervention. Within treatment modalities, the percentages receiving toxicity-related intervention were: RP 6.9%, EBRT 8.8%, and PI 3.7%. The gastrointestinal (GI) and genitourinary (GU) toxicity comparisons are listed in the table. Dilation of a urethral stricture was the most common GU toxicity (3.6% of all patients) while cauterization of rectal bleeding was the most common GI toxicity (0.8% of all patients). Conclusions: The long-term toxicity and cost per patient-year of the major prostate cancer treatment modalities differ. EBRT is the most toxic and most costly. [Table: see text]

scholarly journals Cognitive decline in patients with prostate cancer: study protocol of a prospective cohort, NEON-PC

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043844
Author(s):  
Natalia Araujo ◽  
Samantha Morais ◽  
Ana Rute Costa ◽  
Raquel Braga ◽  
Ana Filipa Carneiro ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Androgen Deprivation Therapy ◽  
Survival Rates ◽  
Cardiovascular Complications ◽  
Androgen Deprivation ◽  
High Survival ◽  
The Impact

IntroductionProstate cancer is the most prevalent oncological disease among men in industrialised countries. Despite the high survival rates, treatments are often associated with adverse effects, including metabolic and cardiovascular complications, sexual dysfunction and, to a lesser extent, cognitive decline. This study was primarily designed to evaluate the trajectories of cognitive performance in patients with prostate cancer, and to quantify the impact of the disease and its treatments on the occurrence of cognitive decline.MethodsParticipants will be recruited from two main hospitals providing care to approximately half of the patients with prostate cancer in Northern Portugal (Portuguese Institute of Oncology of Porto and São João Hospital Centre), and will comprise a cohort of recently diagnosed patients with prostate cancer proposed for different treatment plans, including: (1) radical prostatectomy; (2) brachytherapy and/or radiotherapy; (3) radiotherapy in combination with androgen deprivation therapy and (4) androgen deprivation therapy (with or without chemotherapy). Recruitment began in February 2018 and is expected to continue until the first semester of 2021. Follow-up evaluations will be conducted at 1, 3, 5, 7 and 10 years. Sociodemographic, behavioural and clinical characteristics, anxiety and depression, health literacy, health status, quality of life, and sleep quality will be assessed. Blood pressure and anthropometrics will be measured, and a fasting blood sample will be collected. Participants’ cognitive performance will be evaluated before treatments and throughout follow-up (Montreal Cognitive Assessment and Cube Test as well as Brain on Track for remote monitoring). All participants suspected of cognitive impairment will undergo neuropsychological tests and clinical observation by a neurologist.Ethics and disseminationThe study was approved by the Ethics Committee of the hospitals involved. All participants will provide written informed consent, and study procedures will be developed to ensure data protection and confidentiality. Results will be disseminated through publication in peer-reviewed journals and presentation in scientific meetings.

The impact of prostate volume changes during external-beam irradiation in consequence of HDR brachytherapy in prostate cancer treatment

2009 ◽  
Vol 185 (6) ◽  
pp. 397-403 ◽  
Author(s):  
Markus Karl Alfred Herrmann ◽  
Tammo Gsänger ◽  
Arne Strauss ◽  
Tereza Kertesz ◽  
Hendrik A. Wolff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Prostate Volume ◽  
External Beam ◽  
Hdr Brachytherapy ◽  
Beam Irradiation ◽  
Volume Changes ◽  
Prostate Cancer Treatment ◽  
External Beam Irradiation ◽  
The Impact

Five-Year Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer-The Largest Experience in China

2021 ◽  
Author(s):  
Xianzhi Zhao ◽  
Yusheng Ye ◽  
Haiyan Yu ◽  
Lingong Jiang ◽  
Chao Cheng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Cox Regression Analysis ◽  
Gu Toxicity ◽  
Biochemical Progression ◽  
Grade 3 ◽  
Very High

Abstract Objective To evaluate the efficacy and toxicity of SBRT for localized prostate cancer (PCa). Moreover, it is the largest-to-date pilot study to report 5-year outcomes of SBRT for localized PCa from China. Methods In this retrospective study, 133 PCa patients in our center were treated by SBRT with CyberKnife (Accuray) from October 2012 to July 2019. Follow-up was performed every 3 months for evaluations of efficacy and toxicity. Biochemical progression-free survival (bPFS) and toxicities were assessed using the Phoenix definition and the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0 respectively. Factors predictive of bPFS were identified with COX regression analysis. Results 133 patients (10 low-, 21 favorable intermediate-, 31 unfavorable intermediate-, 45 high-, and 26 very high risk cases on the basis of the NCCN risk classification) with a median age of 76 years (range: 54–87 years) received SBRT. The median dose was 36.25Gy (range: 34-37.5Gy) in 5 fractions. Median follow-up time was 57.7 months (3.5–97.2 months). The overall 5-year bPFS rate was 83.6% for all patients. The 5-year bPFS rate of patients with low-, favorable intermediate-, unfavorable intermediate-, high-, and very high risk PCa was 87.5%, 95.2%, 90.5%, 86.3%, and 61.6% respectively. Urinary symptoms were all alleviated after SBRT. All the patients tolerated SBRT with only 1 (0.8%) and 1 (0.8%) patient reporting grade-3 acute and late genitourinary (GU) toxicity, respectively. There were no grade 4 toxicities. Gleason score (P < 0.001, HR = 7.483, 95%CI: 2.686–20.846) was the independent predictor of bPFS rate after multivariate analysis Conclusion SBRT is an efficient and safe treatment modality for localized PCa with high 5-year bPFS rates and acceptable toxicities.

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