Long-term Toxicity Outcomes Research Articles

Outcomes for Patients With Head and Neck Sarcoma Treated Curatively With Radiation Therapy and Surgery

Soft tissue sarcomas (STSs) of the head and neck (H&N) are rare malignancies that are challenging to manage. We sought to describe the outcomes of patients treated with curative intent using combined surgery and radiation therapy (RT) for H&N STS. We performed a single-institution retrospective review of patients with nonmetastatic STS of the H&N who were treated from 1968 to 2020. The Kaplan-Meier method was used to estimate disease-specific survival (DSS) and local control (LC). Multivariable analyses (MVAs) were conducted using Cox proportional hazards model. One hundred ninety-two patients had a median follow-up of 82 months. Tumors arose in the neck (n = 50, 26%), paranasal sinuses (n = 36, 19%), or face (n = 23, 12%). Most patients were treated with postoperative RT (n = 134, 70%). Postoperative RT doses were higher (median, 60 Gy; preoperative dose, 50 Gy; P < .001). Treatment sequence was not associated with LC (preoperative RT, 78% [63%-88%]; postoperative RT, 75% [66%-82%]; P = .48). On MVA, positive/uncertain margin was the only variable associated with LC (hazard ratio [HR], 2.54; 95% CI, 1.34-4.82; P = .004). LC was significant on MVA (HR, 4.48; 95% CI, 2.62-7.67; P < .001) for DSS. Patients who received postoperative RT were less likely to experience a major wound complication (7.5% vs 22.4%; HR, 0.28; 95% CI, 0.11-0.68; P = .005). There was no difference in the rate of late toxicities between patients who received preoperative or postoperative RT. H&N STS continues to have relatively poorer LC than STS of the trunk or extremities. We found LC to be associated with DSS. Timing of RT did not impact oncologic or long-term toxicity outcomes; however, preoperative RT did increase the chance of developing a major wound complication.

Analysis of LDR Outcomes in Clinically Localized Prostate Cancer Incorporating a Significant TURP Cohort: A Community Experience

To report the 5 year biochemical relapse free survival (BRFS), overall survival (OS) and long term toxicity outcomes of patients treated with 125Iodine (125I) brachytherapy as monotherapy for clinically localised, low to intermediate risk prostate cancer in the community setting with 3 radiation oncologists and 16 urologists. 371 patients (median age 67 years) with clinically localised prostate cancer were treated from 2004 to 2011 with 125I monotherapy. Median PSA at diagnosis was 5.6 (range 0.6-15.1). T stage was T1 (51%) and T2 (49%) Gleason score was ≤5 (1%); 6 (73%) and 7 (26%). Neoadjuvant hormonal therapy (median 4.5 month course) was used in 84 patients (23%). 102 patients (27%) underwent TURP prior to implant. Patients were evaluated for BRFS, OS and long-term toxicity outcomes. Biochemical relapse was defined by the Phoenix (nadir+2ng/ml) definition. Kaplan-Meier method was used to estimate BRFS and OS, with close-out (censoring) 5 years after implant. Median follow-up time for relapse was 5.2 years with 95% followed up for ≥4 years. 5 year BRFS for the entire cohort was 95%. BRFS by Gleason score classification cohort analysis was 96% and 91% for <6 and 7 respectively. Differences in BRFS between T1 and T2 stages, risk groups (low, low-intermediate, intermediate) and prostate volumes (<30, <40, <50, ≥50 cc) were not significant (p>0.1), probably because the number of relapses was so small. Overall survival was 96% at 5 years, with no deaths from prostate cancer, 7 deaths from other cancers and 7 deaths from other causes. Late grade 2 or 3 toxicities were reported in 10% and 5% of patients respectively with urinary retention in 12% and haematuria in 2%. Urinary incontinence requiring at least 1 pad per day occurred in 3 patients (<1%). Patients with a prior TURP had a greater incidence of late grade 2 or 3 urinary retention (p=0.0011). No patient developed urethral necrosis or recto-prostatic fistula. BRFS and OS results are comparable with published series, as is the incidence and severity of late toxicities. Our results indicate prior TURP is not a contraindication for LDR brachytherapy in cases where implant is technically feasible. However, the risk of subsequent urinary retention is increased.

Comparison of effect of rectal volume delineation methods on dose constraint endpoints in the treatment of prostate cancer with intensity-modulated radiation therapy

Identifying a reliable method of rectal volume delineation (RVD) for prostate cancer treatment planning using intensity-modulated radiation therapy (IMRT) is invaluable for clinical and investigational purposes. We analyzed rectal dose constraint outcomes utilizing commonly used RVD methods. Sixty-two prostate cancer patients treated with IMRT from August 2008 to March 2010 were reviewed. RVD either included the entire rectal volume (ERV) or limited the volume to a 3 mm rectal wall (3 MM). V50 ,the percentage of rectal volume receiving 50 Gy, V65, V70, and V75.6 were determined and analyzed for differences. We analyzed factors including definitive and postoperative treatment, rectal volume, and length. For definitive treatment, using ERV, the mean rectal V50, V65, V70, and V75.6 was 41.3, 21.6, 15.1, and 7.0 %, respectively. Using 3 MM, the mean V50, V65, V70, and V75.6 was 37.3, 23.4, 18.5, and 10.3 %, respectively. The V65, V70, and V75.6 were significantly lower in ERV than 3 MM (p < 0.01), while V50 was significantly higher (p < 0.01). Similar findings were noted with rectal volumes <100 cm3 and length <10 cm. There was no difference in V50 and V65 with rectal length ≥10 cm. For postoperative treatment, using ERV, the mean rectal V50, V65, and V70 was 30.2, 12.9, and 2.7 %, respectively. Using 3 MM, the mean V50, V65, and V70 was 30.6, 16.5, and 4.7 %, respectively. The V65 and V70 were lower in ERV than 3 MM (p < 0.01), but not V50. Similar findings were observed with volumes <100 cm3 and length ≥10 cm. We identified different rectal dose–volume endpoints when using common methods of RVD. The differences in dose–volume outcomes are dependent upon prescribed dose, rectal volume, and length. Further analysis, incorporating larger numbers and long-term toxicity outcomes, will contribute to the standardization of contouring and dose–volume analysis for treatment planning.

58: Long-Term Toxicity Outcomes After High Dose Conformal Radiotherapy for Clinically Localized Prostate Cancer

58: Long-Term Toxicity Outcomes After High Dose Conformal Radiotherapy for Clinically Localized Prostate Cancer