Radiotherapy In Prostate Cancer Patients Research Articles

The IMPACT of 68GA-PSMA-PET in definitive radiotherapy planning for prostate cancer patients.

79 Background: The implementation of 68Ga-PSMA-PET-imaging for staging and the impact on stage adaption during treatment radiotherapy (RT) planning is not well studied yet. The present work is to evaluate the integration of 68Ga-PSMA-PET into standard RT planning and to determine the influence on staging and on changes in the initially planned treatment concept for definitive RT in prostate cancer patients. Methods: A total of 66 prostate cancer patients with PSMA-PET delivered before treatment were retrospectively analyzed. All patients had bone scintigraphy and magnetic resonance imaging (MRI) of abdomen (52 patients; 79%) or thoraco-abdominal computed tomography (CT) (14 patients; 21%). After PSMA-imaging, all information was reviewed and re-classification was performed with the additional information taken into account. Thereafter, patients were evaluated with the information obtained by PSMA-PET imaging led to a change in staging and subsequently resulted in a change of the RT concept and treatment fields. Results: Median age of patients was 66 years (range 46 – 84 years). Median pretreatment PSA level was 25.2 ng/mL (range 4.4 – 130.8 ng/mL). The initial stage was changed in 27 patients (41%); 8 patients (12%) under-staged, 11 patients (17%) over-staged and 8 patents (12%) had distant metastasis. RT fields changed in 9 patients (14%) and RT cancelled because of distant metastasis detected with PSMA-PET in 6 patients (9%). The mean pretreatment PSA values were significantly higher in over-staged patients or patient with distant metastasis compared to under-staged patients (55.0±38.8 ng/mL vs. 28.1±19.1 ng/mL; p = 0.02). Also upstaging was observed more frequently in patients with ≥ T3a disease compared to patients with < T3 disease (15 patients [56%] vs. 4 patients [15%]; p = 0.04). However, Gleason score and primary tumor SUV had no significant impact on stage change and particularly on RT decision and treatment plan changes. Conclusions: The performance of a PSMA-PET frequently leads to changes in the stage, altering the RT treatment regimen especially in patients with extensive stage disease and higher pretreatment PSA values.

Is it essential to use fiducial markers during cone-beam CT-based radiotherapy for prostate cancer patients?

To compare soft-tissue cone-beam computed tomography (CBCT-P) and fiducial marker (CBCT-FM)-based image guided radiotherapy in prostate cancer patients. Sixteen prostate cancer patients were treated with volumetric modulated arc therapy. Manual alignment using CBCT-P and CBCT-FM was performed for each patient. Couch shifts were calculated and compared between methods in the left-right (x), superior-inferior (y), and anterior-posterior (z) directions. CBCT-P and CBCT-FM alignments were compared using 252 scans from the 16 patients. Mean displacement from zero was 2.4±1.3, 1.7±1.2, and 1.8±1.1mm for CBCT-P and 2.3±1.3, 1.7±1.1 and 1.8±1.1mm for CBCT-FM in the x, y and z directions, respectively. There was no difference in median displacement between CBCT-P and CBCT-FM; however, there was a significant positive correlation between CBCT-P- and CBCT-FM-based displacements in the x (r=0.881; p<0.001), y (r=0.789; p<0.001) and z (r=0.856; p<0.001) directions by linear regression analysis. Systematic deviations within each group were <1mm; however, random and systematic errors were similar in the x and y directions but larger in the z direction. Our study demonstrated that CBCT-FM was not superior to CBCT-P for image-guided radiotherapy in prostate cancer patients.

Modelling late stool frequency and rectal pain after radical radiotherapy in prostate cancer patients: Results from a large pooled population

AimTo investigate late gastrointestinal toxicity in a large pooled population of prostate cancer patients treated with radical radiotherapy. Normal tissue complication probability models were developed for late stool frequency and late rectal pain. Methods and materialsPopulation included 1336 patients, 3-year minimum follow-up, treated with 66–80Gy. Toxicity was scored with LENT-SOMA-scale. Two toxicity endpoints were considered: grade ⩾2 rectal pain and mean grade (average score during follow-up) in stool frequency >1.DVHs of anorectum were reduced to equivalent uniform dose (EUD). The best-value of the volume parameter n was determined through numerical optimization. Association between EUD/clinical factors and the endpoints was investigated by logistic analyses. Likelihood, Brier-score and calibration were used to evaluate models.External calibration was also carried out. Results4% of patients (45/1122) reported mean stool frequency grade >1; grade ⩾2 rectal pain was present in the TROG 03.04 RADAR population only (21/677, 3.1%): for this endpoint, the analysis was limited to this population.Analysis of DVHs highlighted the importance of mid-range doses (30–50Gy) for both endpoints.EUDs calculated with n=1 (OR=1.04) and n=0.35 (OR=1.06) were the most suitable dosimetric descriptors for stool frequency and rectal pain respectively.The final models included EUD and cardiovascular diseases (OR=1.78) for stool frequency and EUD and presence of acute gastrointestinal toxicity (OR=4.2) for rectal pain. ConclusionBest predictors of stool frequency and rectal pain are consistent with findings previously reported for late faecal incontinence, indicating an important role in optimization of mid-range dose region to minimize these symptoms highly impacting the quality-of-life of long surviving patients.

Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using (11)C-choline PET/CT.

To assess the prognostic value of the therapeutic response by (11)C-choline PET/CT in prostate cancer patients with biochemical recurrence in which (11)C-choline PET/CT indicated radio-guided radiotherapy. The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. (11)C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and (11)C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. (11)C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by (11)C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and (11)C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). (11)C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by (11)C-choline PET/CT has prognostic significance.

Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using 11C-choline PET/CT

ObjectiveTo assess the prognostic value of the therapeutic response by 11C-choline PET/CT in prostate cancer patients with biochemical recurrence in which 11C-choline PET/CT indicated radio-guided radiotherapy. MethodsThe study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. 11C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings.One year after treatment patients underwent PSA and 11C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. Results11C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimeter in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimeter and 10 (27.0%) only less than a centimeter in size.The response by 11C-choline PET/CT was categorized one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression.The response was concordant between the PSA result and 11C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%).New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). Conclusion11C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique.The evaluation of therapeutic response by 11C-choline PET/CT has prognostic significance.

Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients

Background and purposeCurative radiotherapy for prostate cancer may lead to anorectal side effects, including rectal bleeding, fecal incontinence, increased stool frequency and rectal pain. The main objective of this study was to develop multivariable NTCP models for these side effects. Material and methodsThe study sample was composed of 262 patients with localized or locally advanced prostate cancer (stage T1–3). Anorectal toxicity was prospectively assessed using a standardized follow-up program. Different anatomical subregions within and around the anorectum were delineated. A LASSO logistic regression analysis was used to analyze dose volume effects on toxicity. ResultsIn the univariable analysis, rectal bleeding, increase in stool frequency and fecal incontinence were significantly associated with a large number of dosimetric parameters. The collinearity between these predictors was high (VIF>5). In the multivariable model, rectal bleeding was associated with the anorectum (V70) and anticoagulant use, fecal incontinence was associated with the external sphincter (V15) and the iliococcygeal muscle (V55). Finally, increase in stool frequency was associated with the iliococcygeal muscle (V45) and the levator ani (V40). No significant associations were found for rectal pain. ConclusionsDifferent anorectal side effects are associated with different anatomical substructures within and around the anorectum. The dosimetric variables associated with these side effects can be used to optimize radiotherapy treatment planning aiming at prevention of specific side effects and to estimate the benefit of new radiation technologies.

PO-1013: Adaptive radiotherapy in prostate cancer patients: concepts for Individualized Radiotherapy (iRT)

PO-1013: Adaptive radiotherapy in prostate cancer patients: concepts for Individualized Radiotherapy (iRT)

EP-1341: Single-nucleotide polymorphisms associated with toxicity to radiotherapy in prostate cancer patients

EP-1341: Single-nucleotide polymorphisms associated with toxicity to radiotherapy in prostate cancer patients

Quality of Life and Sexual Activity after Stereotactic Hypofractionated Radiotherapy of Prostate Cancer Patients

Background: Quality of life (QoL) is an important factor for the cancer patients after treatment. The study aimed to investigate QoL and sexual activity in patients who had undergone stereotactic hypofractionated radiotherapy (HRT). Methods: The analysis included 82 prostate cancer patients: 40 patients treated by HRT (33.5 Gy in 5 fractions) and 42 patients treated by standard three-dimensional conformal radiation treatment 3DCRT (70-82 Gy in 35-41 fractions); and 50 healthy men without any type of cancer. The subjects filled out the questionnaires: EORTC QLQC30 (version 3.0.) and the prostate cancer-specific EORTC QLQ-PR25. The median follow-up was 21 months for HRT patients and 28 months for 3DCRT patients. Results: The tolerance for stereotactic HRT was shown to be good. The QoL and the general health status of HRT patients were higher than of 3DCRT patients and even of healthy men. Most patients treated by HRT felt that they had lost their masculinity. However, they were still interested in having sex; one third of them were sexually active, most reported satisfaction with their sex life. Conclusions: HRT for prostate cancer patients was an attractive treatment in relation to patients' QoL assessment in the short term analysis.

Secondary Cancers After Radiation Therapy for Primary Prostate or Rectal Cancer.

Literature about the risk of secondary cancer after radiation therapy (RT) of prostate and rectal cancer reveals contradictory results. We conducted a meta-analysis to examine whether the RT induces secondary rectal or prostate cancer in patients, respectively, with prostate or rectal cancer. All studies published in Medline or Pubmed up to March 3, 2015, containing RT of primary rectal or prostate cancer, and providing risk estimates of secondary prostate or rectal cancer were considered as eligible. Relative risk (RR) and standardized incidence ratios (SIR) were calculated using the random-effects model. Twenty studies met the inclusion criteria. 12 of them were from the Surveillance, Epidemiology, and End Results (SEER) database. For prostate cancer patients, pooled adjusted RRs or SIRs did not show an effect on the risk of secondary rectal cancer. However, notwithstanding the limitations of SEER-based studies, the subgroup of prostate cancer patients receiving external beam radiation therapy (EBRT) showed an increased risk of rectal cancer. For rectal cancer patients, pooled adjusted RR of prostate cancer was 1.12 (95 % CI, 0.44-2.8) and SIR was 0.40 (95 % CI, 0.29-0.55). All studies included in the SIR analysis of rectal cancer were derived from the SEER data source. Based on current evidence, RT for prostate cancer patients had no effect on rectal cancer incidence, except for patients who received EBRT therapy. However, compared with the general population, RT for rectal cancer is associated with a decreased prostate cancer risk as found in SEER-based studies.

Adjuvant Radiotherapy in Prostate Cancer Patients Treated with Surgery: The Impact of Age and Tumor Characteristics

BackgroundThe overall mortality (OM) and cancer-specific mortality (CSM) benefits of adjuvant radiotherapy (aRT) in treating prostate cancer (PCa) patients with adverse pathologic characteristics at radical prostatectomy (RP) are unclear. ObjectiveTo test the impact of aRT on survival in PCa patients treated with RP according to adverse pathologic characteristics (Gleason score [GS] 8–10; pT3b/4, lymph node invasion [LNI]) and age categories (<70 vs ≥70 yr). Design, setting, and participantsA total of 7616 patients with pT3/4 pN0/1 PCa treated with RP between 1995 and 2009 within the Surveillance Epidemiology and End Results–Medicare linked database were included. Outcome measurements and statistical analysisCox regression analysis was used to test the relationship between aRT and CSM, as well as OM in the entire cohort. Stratification was performed according to tumor characteristics and age categories. Results and limitationsIn patients with fewer than two adverse pathologic characteristics, aRT did not improve CSM or OM. Conversely, in patients with two or more adverse pathologic characteristics, the 10-yr CSM-free rate was 92% in patients treated with aRT versus 82% in patients treated without aRT (p<0.001). This survival improvement was confirmed in patients aged <70 yr (p=0.01) but not in those ≥70 yr (p=0.1). In multivariable analyses, aRT was an independent predictor of lower CSM risk (hazard ratio: 0.45; p=0.02) only among patients aged <70 yr with two or more adverse pathologic characteristics. Similar trends were observed when OM was examined as an end point. ConclusionsAge and tumor characteristics should be considered in the selection of optimal aRT candidates after surgery. Only patients aged <70 yr with two or more adverse pathologic characteristics (GS 8–10, pT3b/4, LNI) appear to benefit from aRT. Patient summaryThe usefulness of adjuvant radiotherapy after surgery for prostate cancer greatly depends on tumor characteristics and patient age. Only patients with advanced local tumor characteristics aged <70 yr seem to benefit from this treatment modality.

Follow-Up Analysis of Combined HDR-Brachytherapy and External Beam Radiotherapy for Prostate Cancer Patients

Follow-Up Analysis of Combined HDR-Brachytherapy and External Beam Radiotherapy for Prostate Cancer Patients

PO-1040: Follow-up analysis of combined HDR-brachytherapy and external beam radiotherapy for prostate cancer patients

PO-1040: Follow-up analysis of combined HDR-brachytherapy and external beam radiotherapy for prostate cancer patients

1011 Adjuvant radiotherapy in prostate cancer patients treated with surgery: The impact of age and tumour characteristics

Background: The overall mortality (OM) and cancer-specific mortality (CSM) benefits of adjuvant radiotherapy (aRT) in treating prostate cancer (PCa) patients with adverse pathologic characteristics at radical prostatectomy (RP) are unclear. Objective: To test the impact of aRT on survival in PCa patients treated with RP according to adverse pathologic characteristics (Gleason score [GS] 8–10; pT3b/4, lymph node invasion [LNI]) and age categories (<70 vs 70 yr). Design, setting, and participants: A total of 7616 patients with pT3/4 pN0/1 PCa treated with RP between 1995 and 2009 within the Surveillance Epidemiology and End Results– Medicare linked database were included. Outcome measurements and statistical analysis: Cox regression analysis was used to test the relationship between aRT and CSM, as well as OM in the entire cohort. Stratification was performed according to tumor characteristics and age categories. Results and limitations: In patients with fewer than two adverse pathologic characteristics, aRT did not improve CSM or OM. Conversely, in patients with two or more adverse pathologic characteristics, the 10-yr CSM-free rate was 92% in patients treated with aRT versus 82% in patients treated without aRT (p < 0.001). This survival improvement was confirmed in patients aged <70 yr (p = 0.01) but not in those 70 yr (p = 0.1). In multivariable analyses, aRT was an independent predictor of lower CSM risk (hazard ratio: 0.45; p = 0.02) only among patients aged <70 yr with two or more adverse pathologic characteristics. Similar trends were observed when OM was examined as an end point. Conclusions: Age and tumor characteristics should be considered in the selection of optimal aRT candidates after surgery. Only patients aged <70 yr with two or more adverse pathologic characteristics (GS 8–10, pT3b/4, LNI) appear to benefit from aRT. Patient summary: The usefulness of adjuvant radiotherapy after surgery for prostate cancer greatly depends on tumor characteristics and patient age. Only patients with advanced local tumor characteristics aged <70 yr seem to benefit from this treatment modality. soc # 2015 European As

Radiotherapy in Prostate Cancer Patients With Pelvic Lymphocele After Surgery: Clinical and Dosimetric Data of 30 Patients

IntroductionThe purpose of the study was to evaluate the feasibility of irradiation after prostatectomy in the presence of asymptomatic pelvic lymphocele. Patients and MethodsThe inclusion criteria for this study were: (1) patients referred for postoperative (adjuvant or salvage) intensity modulated radiotherapy (IMRT; 66-69 Gy in 30 fractions); (2) detection of postoperative pelvic lymphocele at the simulation computed tomography [CT] scan; (3) no clinical symptoms; and (4) written informed consent. Radiotherapy toxicity and occurrence of symptoms or complications of lymphocele were analyzed. Dosimetric data (IMRT plans) and the modification of lymphocele volume during radiotherapy (cone beam CT [CBCT] scan) were evaluated. ResultsBetween January 2011 and July 2013, in 30 of 308 patients (10%) treated with radiotherapy after prostatectomy, pelvic lymphocele was detected on the simulation CT. The median lymphocele volume was 47 cm3 (range, 6-467.3 cm3). Lymphocele was not included in planning target volume (PTV) in 8 cases (27%). Maximum dose to lymphocele was 57 Gy (range, 5.7-73.3 Gy). Radiotherapy was well tolerated. In all but 2 patients, lymphoceles remained asymptomatic. Lymphocele drainage—because of symptom occurrence—had to be performed in 2 patients during IMRT and in one patient, 7 weeks after IMRT. CBCT at the end of IMRT showed reduction in lymphocele volume and position compared with the initial data (median reduction of 37%), more pronounced in lymphoceles included in PTV. ConclusionRadiotherapy after prostatectomy in the presence of pelvic asymptomatic lymphocele is feasible with acceptable acute and late toxicity. The volume of lymphoceles decreased during radiotherapy and this phenomenon might require intermediate radiotherapy plan evaluation.

Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis.

With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment.

Quality of life after stereotactic hypofractionated radiotherapy for prostate cancer patients.

e16089 Background: The standard treatment for early stage of prostate cancer is operation or radiotherapy. The objective of the study was to investigate safety of stereotactic hypofractionated radi...

PCN195 - NADIA® Psa Slope Impacts Urologists’ Recommendations for Adjuvant Radiotherapy for Prostate Cancer Patients with High-Risk Pathology Following Radical Prostatectomy

PCN195 - NADIA® Psa Slope Impacts Urologists’ Recommendations for Adjuvant Radiotherapy for Prostate Cancer Patients with High-Risk Pathology Following Radical Prostatectomy

Stereotaktyczna hypofrakcjonowana radioterapia chorych na raka gruczołu krokowego — doniesienie wstępne

Background . Prostate cancer is the second most frequent malignancy in men in Poland. The standard treatment for early stage prostate cancer is operation and radiotherapy. The objective of the study was to investigate the effectiveness and safety of stereotactic radiotherapy for localized prostate cancer. Material and methods . This is a prospective single-center clinical study. It was performed on prostate cancer patients with localized low- and intermediate-risk (according to NCCN) adenocarcinoma of the prostate T2-T3N0M0. Patients were prepared for treatment and immobilized according to a special protocol. For treatment planning CT and MRI scans were performed. IMRT plans were made. The PTV received 33.5 Gy in 5 fractions twice a week, which is equivalent to conventional 78 Gy in 39 fractions a 2 Gy (a/b for prostate cancer 1.4 Gy). Results . in the analysis 32 patients were included. The tolerance of treatment was good and no Grade 3 or higher acute toxicity was reported (according to RTOG/EORTC). PSA levels systematically decreased (from a mean PSA level 10.46 before treatment to 0.37 ng/ml 12 months after the end of treatment. Conclusions . Stereotactic hypofractionated radiotherapy for prostate cancer patients with X-rays from accelerator, with an IMRT technicque and very accurate patient positioning is an effective and safe treatment in the short-term analysis.

EP-1302: The effect of hormonotherapy duration on survival after conformal radiotherapy for prostate cancer patients

EP-1302: The effect of hormonotherapy duration on survival after conformal radiotherapy for prostate cancer patients