scholarly journals Post Intensity-Modulated Radiation Therapy Urinary Function for Prostate Cancer; A Prospective Study

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Farzad Allameh ◽  
Morteza Fallah Karkan ◽  
Amir Hossein Rahavian ◽  
Bahram Mofid ◽  
Samira Azghandi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Prospective Study ◽  
Radiation Therapy Oncology Group ◽  
Specific Antigen ◽  
Intensity Modulated Radiation Therapy ◽  
Urinary Symptoms ◽  
Intensity Modulated ◽  
The Mean

Background: At present, there is a lack of evidence concerning urinary complications caused by intensity-modulated radiation therapy (IMRT) used for the management of prostate cancer (PCa). Objectives: This study aimed at identifying the nature and severity of post-IMRT urinary symptoms in patients with PCa. Methods: This prospective study was performed with consecutive patients, who had clinically localized PCa (cT1c-cT2c) and had undergone IMRT treatment from 2016 to 2019. At 1, 6, and 12 months of follow-up, medical history, physical information, prostate-specific antigen values, International Prostate Symptom Score (IPSS), medication use, Radiation Therapy Oncology Group (RTOG), acute and late toxicity, and Q max were collected. Results: A total of 127 patients with a mean age of 71.04 ± 7.1 years received IMRT and underwent 12 months of follow-up. The mean IPSSs at baseline versus those at 1, 6, and 12 months after IMRT was 14.5 ± 6.8 versus 13.3 ± 6.1, 12.3 ± 5.3, and 10.4 ± 4.2, respectively (P < 0.000). The mean prostate volume was 38.2 ± 12.1 cc. At the last follow-up, 31 patients (24.4%) took genitourinary (GU) medications. Conclusions: This study showed that the majority of GU side effects caused by primary IMRT for PCa treatment are transient. Treatment triggered an acute increase in obstructive urinary symptoms, which peaked during the first month after IMRT. In most patients, in the course of 6 months, symptoms returned to baseline.

scholarly journals Adaptive Imaging Versus Periodic Surveillance for Intrafraction Motion Management During Prostate Cancer Radiotherapy

2019 ◽  
Vol 18 ◽  
pp. 153303381984448
Author(s):  
Xiangyu Ma ◽  
Huagang Yan ◽  
Ravinder Nath ◽  
Zhe Chen ◽  
Haiyun Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Additional Patient ◽  
Automatic Correction ◽  
Adaptive Imaging ◽  
Intensity Modulated ◽  
Arc Therapy ◽  
The Mean

Objective: To evaluate the benefits of adaptive imaging with automatic correction compared to periodic surveillance strategies with either manual or automatic correction. Methods: Using Calypso trajectories from 54 patients with prostate cancer at 2 institutions, we simulated 5-field intensity-modulated radiation therapy and dual-arc volumetric-modulated arc therapy with periodic imaging at various frequencies and with continuous adaptive imaging, respectively. With manual/automatic correction, we assumed there was a 30/1 second delay after imaging to determine and apply couch shift. For adaptive imaging, real-time “dose-free” cine-MV images during beam delivery are used in conjunction with online-updated motion pattern information to estimate 3D displacement. Simultaneous MV-kV imaging is only used to confirm the estimated overthreshold motion and calculate couch shift, hence very low additional patient dose from kV imaging. Results: Without intrafraction intervention, the prostates could on average have moved out of a 3-mm margin for ∼20% of the beam-on time after setup imaging in current clinical situation. If the time interval from the setup imaging to beam-on can be reduced to only 30 seconds, the mean over-3 mm percentage can be reduced to ∼7%. For intensity-modulated radiation therapy simulation, with manual correction, 110 and 70 seconds imaging periods both reduced the mean over-3 mm time to ∼4%. Automatic correction could give another 1% to 2% improvement. However, with either manual or automatic correction, the maximum patient-specific over-3 mm time was still relatively high (from 6.4% to 12.6%) and those patients are actually clinically most important. In contrast, adaptive imaging with automatic intervention significantly reduced the mean percentage to 0.6% and the maximum to 2.7% and averagely only ∼1 kV image and ∼1 couch shift were needed per fraction. The results of volumetric-modulated arc therapy simulation show a similar trend to that of intensity-modulated radiation therapy. Conclusions: Adaptive continuous monitoring with automatic motion compensation is more beneficial than periodic imaging surveillance at similar or even less imaging dose.

Urinary function after image-guided intensity modulated radiation therapy (IG-IMRT) of localized prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 141-141
Author(s):  
Edward Obedian ◽  
Shawn H. Zimberg ◽  
Deepak A. Kapoor ◽  
Carl A. Olsson
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Urinary Incontinence ◽  
Intensity Modulated Radiation Therapy ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
Image Guided ◽  
Intensity Modulated ◽  
And Function

141 Background: Men choosing treatment for prostate cancer risk potential urinary dysfunction or incontinence. The purpose of this study was to determine the effect of high dose image-guided intensity modulated radiation therapy (IG-IMRT) on urine control and function in such men. Methods: Between March 31, 2008 and September 28, 2012, 3,602 men received high dose IG-IMRT for localized prostate cancer with sufficient data for review, including baseline and minimum 11 month follow-up evaluation of urine control and function. The latter were determined by a urinary continence grading questionnaire and the International Prostate Symptom Score (IPSS). These questionnaires were completed by all men prior to radiation (baseline) and at every follow up visit. The continence questionnaire separated patients as G0: no incontinence, G1: minimal incontinence not requiring pads, G2: incontinence requiring pads, and G3: incontinence interfering with daily life activities. Men with IPSS scores of 0 to 7 were deemed mildly, 8 to 19 moderately, and 20 to 35 severely symptomatic. Typical therapy was 8100 cGy delivered to the prostate in 45 fractions. Pelvic lymph nodes were treated in 13% (458) of the cases. Results: At baseline, incontinence grading in our 3,602 men was G0 in 3,086 (86%), G1 in 479 (13%) and G2/3 in 37 (1%) and IPSS was 0-7 in 2092 (58%), 8 to 19 in 1,276 (35%) and 20 or more in 233 (6.5%). After IG-IMRT, 2,635 (85%) of baseline GO men remained continent, 408 (13%) developed G1 incontinence and 43 (1.1%) developed G2/3 incontinence. Of 479 baseline G1 incontinent men, 259 (54%) improved to G0. Of 37 baseline G2/G3 incontinent men, 21 (57%) improved to G0/1 incontinence. In 2,092 mildly symptomatic men by IPSS (average 3.5 at baseline), there was a rise to 5.4 but 1,619 (77%) remained mildly symptomatic. In the 1,276 moderately symptomatic men at baseline the average IPSS (12) decreased to 9.8 at last follow up (p<0.001). Similarly, in the 233 severely symptomatic men at baseline the average IPSS (24) dropped to 13 at last follow up (p<0.001). Conclusions: Urinary incontinence following high dose IG-IMRT for prostate cancer is rare. IG-IMRT seems to improve some men with baseline urinary incontinence and higher IPSS scores. High dose IG-IMRT remains a good treatment option for localized prostate cancer.

Incidence, predictors, and cost implications of gastrointestinal complications following intensity-modulated radiation therapy for prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 31-31
Author(s):  
Monica J. Wood ◽  
Gally Reznor ◽  
Quoc-Dien Trinh ◽  
Paul Linh Nguyen
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Cost Savings ◽  
Gastrointestinal Complications ◽  
Intensity Modulated ◽  
Coagulation Therapy ◽  
Gi Toxicity ◽  
Medicare Spending

31 Background: The objective of this study was to examine the incidence and predictors of gastrointestinal (GI) complications following intensity-modulated radiation therapy (IMRT) for prostate cancer and their impact on national healthcare expenditure. Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data, we identified 11,781 men diagnosed with non-metastatic prostate cancer from 2002 to 2006 who underwent definitive IMRT, had no pre-existing GI toxicity, and had at least 36 months of follow-up after IMRT initiation. Annual incremental spending was defined as the difference between the total Medicare payments in the year after the development of the first GI complication and the total Medicare payments in the year preceding prostate cancer diagnosis, excluding prostate cancer treatment-related costs. We used multivariate logistic regression to evaluate the odds ratio of developing IMRT-related GI toxicity, and quantile regression to compare the annual incremental costs between groups. All analyses were done using SAS 9.3. Results: Over the 36-month follow-up period, the incidence of post-IMRT GI complications was 26.5% (n=3,118). Patients on anti-coagulation therapy or receiving brachytherapy boost were more likely to develop IMRT-related GI toxicities (OR 1.11, 95% CI 1.01-1.22 (p=0.029) and OR 1.18, 95% CI 1.08-1.30 (p<0.001), respectively). The median Medicare annual incremental cost per patient associated with post-IMRT GI complications was $3,375 in 2014 dollars (95% CI $3,222-3,529, p<0.0001). Among patients with post-IMRT GI complications, the presence of diabetes was associated with an additional $610 (95% CI $206-1,014, p=0.003) per patient in Medicare spending. Conclusions: Medicare spending associated with post-IMRT GI complications is considerable, often in excess of 10% of IMRT cost. Quantifying these expenditures may better frame the potential for cost savings of emerging technologies that aim to reduce the incidence and severity of IMRT-related GI toxicities.

scholarly journals Moderately Hypofractionated Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost for Prostate Cancer: Five-Year Toxicity Results from a Prospective Phase I/II Trial

2020 ◽  
Author(s):  
Anthony Ricco ◽  
Nitai Mukhopadhyay ◽  
Xiaoyan Deng ◽  
Diane Holdford ◽  
Vicki Skinner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Phase I ◽  
Intensity Modulated Radiation Therapy ◽  
Prevalence Rates ◽  
Intensity Modulated ◽  
Integrated Boost ◽  
Grade 3 ◽  
Moderate Hypofractionation

Abstract Background In this phase I/II trial, five-year physician-assessed toxicity and patient reported quality of life data is reported for patients undergoing moderately hypofractionated intensity modulated radiation therapy (IMRT) for prostate cancer using a simultaneous integrated boost (SIB) and pelvic lymph node (LN) coverage. Materials and Methods Patients with T1-T2 localized prostate cancer were prospectively enrolled, receiving risk group based coverage of prostate +/- seminal vesicles (SVs) +/- pelvic lymph nodes (LNs). Low risk (LR) received 69.6 Gy/29 fractions to the prostate, while intermediate risk (IR) and high risk (HR) patients received 72Gy/30fx to the prostate and 54Gy/30fx to the SVs. If predicted risk of LN involvement > 15%, 50.4Gy/30fx was delivered to pelvic LNs. Androgen deprivation therapy was given to IR and HR patients. Results There were 55 patients enrolled and 49 patients evaluable at a median follow up of 60 months. Included were 11 (20%) LR, 23 (41.8%) IR, and 21 (38.2%) HR patients. Pelvic LN treatment was given in 25 patients (51%). Prevalence rates of late grade 2 GI toxicity at 1, 3, and 5 years was 5.8%, 3.9%, and 5.8% respectively, with no grade 3 events. Prevalence rates of late grade 2 GU toxicity at 1, 3, and 5 years rates were 15.4%, 7.7%, and 13.5% respectively, with three grade 3 events (5.8%). The biochemical relapse free survival at 5 years was 88.3%. There were no local, regional, or distant failures, with all patients still alive at last follow up. Conclusions Moderate hypofractionation of localized prostate cancer utilizing a SIB technique and LN coverage produces tolerable acute/late toxicity. Given equivalent efficacy between moderate hypofractionation schedules, the optimal regimen will be determined by long-term toxicity reported from both the physician and patient perspective.

Sign in / Sign up

Export Citation Format

Share Document