scholarly journals Clinical Outcomes from Dose-Reduced Radiotherapy to the Prostate in Elderly Patients with Localized Prostate Cancer

2021 ◽  
Vol 28 (5) ◽  
pp. 3729-3737
Author(s):  
Nina Samson ◽  
Rutvij A. Khanolkar ◽  
Sarah Quirk ◽  
Harvey Quon ◽  
Michael Roumeliotis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Elderly Patients ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
Survival Outcomes ◽  
Low Grade ◽  
Free Survival ◽  
Kaplan Meier ◽  
Gi Toxicity

Radical treatment of localized prostate cancer in elderly patients may lead to unacceptable treatment-associated toxicities that adversely impact quality of life without improving survival outcomes. This study reports on a cohort of 54 elderly (>70 years) patients that received 4000–5000 cGy of palliative external beam radiotherapy (EBRT) as an alternative to androgen deprivation therapy (ADT). The primary outcome of interest was the period of ADT-free survival, and secondary outcomes included overall survival (OS) and metastases-free survival (MFS). Kaplan–Meier regression was used to estimate survival outcomes. Thirty-six (67%) patients achieved a break in ADT post-radiotherapy, with a median time to ADT reinitiation of 20 months. Common Terminology Criteria for Adverse Events (CTCAE) were limited to low-grade gastrointestinal (GI) or genitourinary (GU) toxicities, with no skin toxicities observed. Grade 1 GI toxicity was observed in 9 (17%) patients, and grades 1 and 2 GU toxicities were observed in 13 (24%) and 3 (6%) patients, respectively, with no higher-grade toxicities reported. Five-year MFS and OS were 56% and 78%, respectively. In summary, the treatment regimen was well-tolerated and achieved durable ADT-free survival in most patients. Dose-reduced EBRT appears to be a viable alternative to ADT in elderly patients with localized prostate cancer.

scholarly journals Two-Weekly High-Dose-Rate Brachytherapy Boost After External Beam Radiotherapy for Localized Prostate Cancer: Long-Term Outcome and Toxicity Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Jörg Tamihardja ◽  
Paul Lutyj ◽  
Johannes Kraft ◽  
Dominik Lisowski ◽  
Stefan Weick ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
High Dose Rate Brachytherapy ◽  
Brachytherapy Boost ◽  
Gi Toxicity

PurposeEvaluation of clinical outcome of two-weekly high-dose-rate brachytherapy boost after external beam radiotherapy (EBRT) for localized prostate cancer.Methods338 patients with localized prostate cancer receiving definitive EBRT followed by a two-weekly high-dose-rate brachytherapy boost (HDR-BT boost) in the period of 2002 to 2019 were analyzed. EBRT, delivered in 46 Gy (DMean) in conventional fractionation, was followed by two fractions HDR-BT boost with 9 Gy (D90%) two and four weeks after EBRT. Androgen deprivation therapy (ADT) was added in 176 (52.1%) patients. Genitourinary (GU)/gastrointestinal (GI) toxicity was evaluated utilizing the Common Toxicity Criteria for Adverse Events (version 5.0) and biochemical failure was defined according to the Phoenix definition.ResultsMedian follow-up was 101.8 months. 15 (4.4%)/115 (34.0%)/208 (61.5%) patients had low-/intermediate-/high-risk cancer according to the D`Amico risk classification. Estimated 5-year and 10-year biochemical relapse-free survival (bRFS) was 84.7% and 75.9% for all patients. The estimated 5-year bRFS was 93.3%, 93.4% and 79.5% for low-, intermediate- and high-risk disease, respectively. The estimated 10-year freedom from distant metastasis (FFM) and overall survival (OS) rates were 86.5% and 70.0%. Cumulative 5-year late GU toxicity and late GI toxicity grade ≥ 2 was observed in 19.3% and 5.0% of the patients, respectively. Cumulative 5-year late grade 3 GU/GI toxicity occurred in 3.6%/0.3%.ConclusionsTwo-weekly HDR-BT boost after EBRT for localized prostate cancer showed an excellent toxicity profile with low GU/GI toxicity rates and effective long-term biochemical control.

Nomogram predicting treatment-related sexual dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 51-51
Author(s):  
Joseph C. Klink ◽  
Martin G. Sanda ◽  
Mark S. Litwin ◽  
Montserrat Ferrer ◽  
Meredith M. Regan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Multivariable Analysis ◽  
Sexual Problems ◽  
Localized Prostate Cancer ◽  
Patient Counseling ◽  
Patient Reported ◽  
Prospective Longitudinal

51 Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact sexual function. Predictions of treatment-related sexual problems from patient-reported, prospective data may be useful in decision-making. Methods: Patient-reported data on treatment-related sexual problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quality and frequency of erections were identical among the studies. Only those patients with quality of erections sufficient for intercourse were included in the model. The endpoint of the model was erections suitable for intercourse on at least half of attempts at 2 years after treatment, with or without the use of oral medications. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 931 (74%), 249 (42%), and 323 (45%) patients treated by RP, EBRT, and PI were considered to be potent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The potency rate at 2 years for 1,215 patients who were potent at baseline and had complete follow-up data was 38%, 51%, and 61% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p < 0.001), baseline frequency of erections (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), PSA (p = 0.001), and institution (p = 0.006), were associated with potency. A nomogram based on the predictive parameters had a concordance index of 0.72 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts 2-year potency after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.

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