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Yamazaki H, Suzuki G, Masui K, Aibe N, Kimoto T, Yamada K, Okihara K, Hongo F, Okumi M, Shiraishi T, Fujihara A, Yoshida K, Nakamura S, Kato T, Hashimoto Y, Okabe H. The influence of Gleason score ≤ 6 histology on the outcome of high-risk localized prostate cancer after modern radiotherapy. Sci Rep 2024; 14:8011. [PMID: 38580670 PMCID: PMC10997615 DOI: 10.1038/s41598-024-55457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/23/2024] [Indexed: 04/07/2024] Open
Abstract
We aimed to retrospectively review outcomes in patients with high-risk prostate cancer and a Gleason score ≤ 6 following modern radiotherapy. We analyzed the outcomes of 1374 patients who had undergone modern radiotherapy, comprising a high-risk low grade [HRLG] group (Gleason score ≤ 6; n = 94) and a high-risk high grade [HRHG] group (Gleason score ≥ 7, n = 1125). We included 955 patients who received brachytherapy with or without external beam radio-therapy (EBRT) and 264 who received modern EBRT (intensity-modulated radiotherapy [IMRT] or stereotactic body radiotherapy [SBRT]). At a median follow-up of 60 (2-177) months, actuarial 5-year biochemical failure-free survival rates were 97.8 and 91.8% (p = 0.017), respectively. The frequency of clinical failure in the HRLG group was less than that in the HRHG group (0% vs 5.4%, p = 0.012). The HRLG group had a better 5-year distant metastasis-free survival than the HRHG group (100% vs 96.0%, p = 0.035). As the HRLG group exhibited no clinical failure and better outcomes than the HRHG group, the HRLG group might potentially be classified as a lower-risk group.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan.
| | - Gen Suzuki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Koji Masui
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Takuya Kimoto
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masayoshi Okumi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takumi Shiraishi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Yoshida
- Department of Department of Radiology, Kansai Medical University, Hirakata, 573-1010, Japan
| | - Satoaki Nakamura
- Department of Department of Radiology, Kansai Medical University, Hirakata, 573-1010, Japan
| | - Takashi Kato
- Department of Radiology, Ujitakeda Hospital, Uji-City, Kyoto, 611-0021, Japan
| | - Yasutoshi Hashimoto
- Department of Radiology, Ujitakeda Hospital, Uji-City, Kyoto, 611-0021, Japan
| | - Haruumi Okabe
- Department of Radiology, Ujitakeda Hospital, Uji-City, Kyoto, 611-0021, Japan
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Tanaka N. The oncologic and safety outcomes of low-dose-rate brachytherapy for the treatment of prostate cancer. Prostate Int 2023; 11:127-133. [PMID: 37745911 PMCID: PMC10513906 DOI: 10.1016/j.prnil.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Around 40 years have passed since a modern low-dose-rate (LDR) brachytherapy for prostate cancer was introduced. LDR brachytherapy has become one of the definitive treatment options besides radical prostatectomy (RP) and external beam radiation therapy (EBRT). LDR brachytherapy has several advantages over EBRT such as a higher prescribed dose to the prostate gland while avoiding unnecessary irradiation of organs at risk, a precipitous dose gradient, a brief treatment time, and a short hospital stay. Previous reports revealed that the long-term oncologic outcomes of LDR brachytherapy are superior to those of EBRT. The oncologic outcomes of low- to intermediate-risk patients are equivalent to those of RP using the recurrence definition of surgery of prostate specific antigen (PSA) >0.2 ng/mL, while the oncologic outcomes of LDR brachytherapy as tri-modality (combined EBRT and androgen deprivation therapy) for high-risk patients is superior to that of RP using the recurrence definition of surgery. In respect of toxicity, urinary disorders such as urgency and frequency are often observed after the acute phase of treatment, but these events usually resolve, while the quality of life of urinary continence is well preserved for a long time. Erectile function decreases yearly, but is relatively preserved compared to RP. In conclusion, the most noteworthy strength of LDR brachytherapy for low- to intermediate-risk patients is the "brief treatment time" that provides long recurrence-free survival, while that for high-risk patients who received LDR brachytherapy (tri-modality) is "excellent disease control."
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Affiliation(s)
- Nobumichi Tanaka
- Department of Prostate Brachytherapy, Nara Medical University, Japan
- Department of Urology, Nara Medical University, Japan
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Miyajima K, Suzuki H, Urabe F, Iwatani K, Imai Y, Yasue K, Yanagisawa T, Kimura S, Tashiro K, Tsuzuki S, Koike Y, Miki J, Yuen S, Sasaki T, Aoki M, Sato S, Takahashi H, Miki K, Kimura T. Clinical characteristics of secondary bladder cancer developing after low-/high-dose-rate brachytherapy to treat localized prostate cancer. Int J Clin Oncol 2023; 28:1200-1206. [PMID: 37432614 DOI: 10.1007/s10147-023-02383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND To explore correlations between the clinical attributes of secondary bladder cancer and brachytherapy, we retrospectively reviewed our institutional database on patients with localized prostate cancer who underwent low-dose-rate brachytherapy (LDR-BT) or high-dose-rate brachytherapy (HDR-BT) with or without external beam radiation therapy (EBRT) or radical prostatectomy (RP). METHODS From October 2003 to December 2014, 2551 patients with localized prostate cancer were treated at our institution. Of these, data on 2163 were available (LDR-BT alone: n = 953; LDR-TB with EBRT: n = 181; HDR-BT with EBRT: n = 283; RP without EBRT: n = 746). The times of secondary bladder cancer development subsequent to radical treatment, and their clinical characteristics, were studied. RESULTS Age-adjusted Cox's regression analyses indicated that brachytherapy did not significantly impact the incidence of secondary bladder cancer. However, the pathological characteristics of such cancer differed between patients treated via brachytherapy and RP without EBRT; invasive bladder cancer was more common in such patients. CONCLUSION The risk for secondary bladder cancer was not significantly increased after brachytherapy compared to non-irradiation therapy. However, brachytherapy patients exhibited a higher incidence of invasive bladder cancer. Therefore, meticulous follow-up is crucial for early detection and treatment of bladder cancer in such patients.
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Affiliation(s)
- Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Suzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiji Yasue
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Steffi Yuen
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, China
| | - Takaya Sasaki
- Department of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Liang Z, Yuliang C, Zhu M, Zhou Y, Wu X, Li H, Fan B, Zhou Z, Yan W. The direct prognosis comparison of 125I low-dose-rate brachytherapy versus laparoscopic radical prostatectomy for patients with intermediate-risk prostate cancer. Eur J Med Res 2023; 28:181. [PMID: 37268989 DOI: 10.1186/s40001-023-01140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/14/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND This study aims to compare the clinical outcomes after performing radical prostatectomy (RP) or low-dose-rate brachytherapy (LDR) for patients with intermediate-risk prostate cancer (IRPC). METHODS We performed a retrospective analysis on 361 IRPC patients who underwent treatment in Peking Union Medical College Hospital from January 2014 to August 2021, of which 160 underwent RP and 201 underwent Iodine-125 LDR. Patients were followed in clinic monthly during the first three months and at three-month intervals thereafter. Univariate and multivariate regression analyses were conducted to predict biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), cancer-specific survival (CSS), and overall survival (OS). Biochemical recurrence was defined using the Phoenix definition for LDR and the surgical definition for RP. The log-rank test was applied to compare bRFS between the two modalities, and Cox regression analysis was performed to identify factors associated with bRFS. RESULTS Median follow-up was 54 months for RP and 69 months for LDR. According to log-rank test, the differences of 5-year bRFS (70.2% vs 83.2%, P = 0.003) and 8-year bRFS (63.1% vs 68.9%, P < 0.001) between RP and LDR groups were statistically significant. Our results also indicated that there was no significant difference in terms of cRFS, CSS, or OS between the two groups. With multivariate analysis of the entire cohort, prostate volume ≤ 30 ml (P < 0.001), positive margin (P < 0.001), and percentage positive biopsy cores > 50% (P < 0.001) were independent factors suggestive of worse bRFS. CONCLUSIONS LDR is a reasonable treatment option for IRPC patients, yielding improved bRFS and equivalent rates of cRFS, CSS and OS when compared with RP.
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Affiliation(s)
- Zhen Liang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Yuliang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Zhu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingcheng Wu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bu Fan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
- Department of Urology, Surgical Building of Peking, Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China.
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
- Department of Urology, Surgical Building of Peking, Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing, Dong Cheng District, Beijing, 100730, China.
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Imai Y, Urabe F, Iwatani K, Nakazono M, Tashiro K, Honda M, Aoki M, Sato S, Takahashi H, Miki K, Kimura T. Comparison of outcomes in high-risk prostate cancer patients treated with low-/high-dose-rate brachytherapy plus external beam radiotherapy. Int J Clin Oncol 2023; 28:698-706. [PMID: 36814038 DOI: 10.1007/s10147-023-02314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Although brachytherapy is a standard treatment option for patients with high-risk prostate cancer, only a few studies have compared low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT). We applied propensity score-based inverse probability treatment weighting (IPTW) to compare oncological outcomes for LDR-BT and HDR-BT. METHODS We retrospectively assessed prognosis in 392 patients with high-risk localized prostate cancer who had undergone brachytherapy plus external beam radiation. IPTW was applied to adjust the Kaplan-Meier survival analyses and Cox proportional hazards regression analyses, with the goal of minimizing bias from patient background. RESULTS The IPTW-adjusted Kaplan-Meier survival analyses showed no statistically significant differences for time to biochemical recurrence, clinical progression, castration-resistant prostate cancer, or death from any cause. The IPTW-adjusted Cox regression analyses also showed that the modality of brachytherapy was not an independent factor in these oncological outcomes. Notably, the two groups differed regarding complications; LDR-BT was associated with a higher rate of acute grade ≥ 2 GU toxicity, and late grade 3 toxicity was noted only in HDR-BT. CONCLUSION Our analysis of long-term outcomes in patients with high-risk localized prostate cancer shows no significant differences in oncological outcomes between LDR-BT and HDR-BT, but some differences in toxicity, and offers patients and clinicians useful information in deciding management strategies for high-risk localized prostate cancer.
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Affiliation(s)
- Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Honda
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Taniguchi T, Iinuma K, Nakano M, Kawase M, Takeuchi S, Kato D, Takai M, Nakane K, Ishihara T, Ito M, Kumano T, Matsuo M, Koie T. Chronological changes of lower urinary tract symptoms after low-dose-rate brachytherapy for prostate cancer using SpaceOAR® system. Prostate Int 2022; 10:207-212. [PMID: 36570644 PMCID: PMC9747576 DOI: 10.1016/j.prnil.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study is to investigate chronological changes of lower urinary tract symptoms (LUTS) in patients with prostate cancer who underwent low-dose-rate brachytherapy (LDR-BT) followed by the insertion of SpaceOAR® system (SpaceOAR). Methods In this retrospective study, 483 patients with localized prostate cancer underwent LDR-BT at the Gifu University Hospital between August 2004 and December 2020. SpaceOAR was inserted in 30 patients after LDR-BT (SpaceOAR group), and 453 patients received LDR-BT alone (non-SpaceOAR group). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), quality of life due to urinary symptoms (IPSS-QOL), and uroflowmetry (UFM), including maximum flow rate (Qmax), voided volume, and post-voided residual urine (PVR), were evaluated before LDR-BT, and at 1, 3, 6, 9, and 12 months after LDR-BT. The outcomes were chronological changes in IPSS, OABSS, and IPSS-QOL compared to pretreatment values and those of covariates in relation to UFM. Results The IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with either group. According to the PVR interaction effect, the insertion of SpaceOAR was significantly affected by chronological changes in PVR (P = 0.001). Three months after LDR-BT, PVR in the SpaceOAR group was significantly higher than that in the non-SpaceOAR group (49.8 mL vs. 30.5 mL; P = 0.002). Conclusion SpaceOAR use may temporally increase PVR; however, IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with LUTS before and after LDR-BT. The combination of LDR-BT and SpaceOAR may be acceptable for treating patients with prostate cancer regarding the chronological changes in LUTS after brachytherapy.
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Affiliation(s)
- Tomoki Taniguchi
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan,Corresponding author. Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu, Gifu 500-8717, Japan
| | - Makoto Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Shinichi Takeuchi
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Daiki Kato
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Manabu Takai
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Masaya Ito
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Tomoyasu Kumano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Takuya Koie
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
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Oare C, Sun S, Dusenbery K, Reynolds M, Koozekanani D, Gerbi B, Ferreira C. Analysis of dose to the macula, optic disc, and lens in relation to vision toxicities - A retrospective study using COMS eye plaques. Phys Med 2022; 101:71-78. [PMID: 35981450 DOI: 10.1016/j.ejmp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/08/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to relate common toxicity endpoints with dose to the macula, optic disc, and lens for uveal melanoma patients treated with Iodine-125 Collaborative Ocular Melanoma Study (COMS) eye plaque brachytherapy. METHODS A cohort of 52 patients treated at a single institution between 2005 and 2019 were retrospectively reviewed. Demographics, dosimetry, and clinical outcomes were recorded. Univariate, relative risk, and Kaplan-Meier analyses were performed to relate dose to toxicity endpoints including retinopathy, vision decline, and cataracts. RESULTS By the end of follow up (Median = 3.6 years, Range = 0.4 - 13.5 years), 65 % of eyes sustained radiation retinopathy, 40 % demonstrated moderate vision decline (>5 Snellen lines lost), and 56 % developed cataracts. Significant (p < 0.05) risk estimates exist for retinopathy and VA decline for doses >52 Gy to the macula and >42 Gy to the optic disc. Moreover, dose to the lens > 16 Gy showed a significant risk for cataract formation. Kaplan-Meier analysis demonstrated significantly different incidence of radiation retinopathy for > 52 Gy to the macula and > 42 Gy to the optic disc. In addition, the Kaplan-Meier analysis showed significantly different incidence of cataract formation for patients with lens dose > 16 Gy. CONCLUSIONS Dose-effect relationships exist for the macula and optic disc with respect to the loss of visual acuity and the development of retinopathy. To better preserve vision after treatment, further research is needed to reduce macula, optic disc, and lens doses while maintaining tumor control.
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Affiliation(s)
- Courtney Oare
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States.
| | - Susan Sun
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Kathryn Dusenbery
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Margaret Reynolds
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Dara Koozekanani
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Bruce Gerbi
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Clara Ferreira
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
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Salerno KE, Turkbey B, Lindenberg L, Mena E, Schott EE, Brennan AK, Roy S, Shankavaram U, Patel K, Cooley-Zgela T, McKinney Y, Wood BJ, Pinto PA, Choyke P, Citrin DE. Detection of failure patterns using advanced imaging in patients with biochemical recurrence following low-dose-rate brachytherapy for prostate cancer. Brachytherapy 2022; 21:442-450. [PMID: 35523680 DOI: 10.1016/j.brachy.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE/OBJECTIVE(S) This study describes the pattern of failure in patients with biochemical (BCR) recurrence after low-dose-rate (LDR) brachytherapy as a component of definitive treatment for prostate cancer. METHODS Patients with BCR after LDR brachytherapy ± external beam radiation therapy (EBRT) were enrolled on prospective IRB approved advanced imaging protocols. Patients underwent 3T multiparametric MRI (mpMRI); a subset underwent prostate specific membrane antigen (PSMA)-based PET/CT. Pathologic confirmation was obtained unless contraindicated. RESULTS Between January 2011 and April 2021, 51 patients with BCR after brachytherapy (n = 36) or brachytherapy + EBRT (n = 15) underwent mpMRI and were included in this analysis. Of 38 patients with available dosimetry, only two had D90<90%. The prostate and seminal vesicles were a site of failure in 66.7% (n = 34) and 39.2% (n = 20), respectively. PET/CT (n = 32 patients) more often identified lesions pelvic lymph nodes (50%; n = 16) and distant metastases (18.8%; n = 6), than mpMRI. Isolated nodal disease (9.8%; n = 5) and distant metastases (n = 1) without local recurrence were uncommon. Recurrence within the prostate was located in the transition zone in 48.5%, central or midline in 45.5%, and anterior in 36.4% of patients. CONCLUSION In this cohort of patients with BCR after LDR brachytherapy ± EBRT, the predominant recurrence pattern was local (prostate ± seminal vesicles) with frequent occurrence in the anterior prostate and transition zone. mpMRI and PSMA PET/CT provided complementary information to localize sites of recurrence, with PSMA PET/CT often confirming mpMRI findings and identifying occult nodal or distant metastases.
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Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Esther Mena
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Erica E Schott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alexandra K Brennan
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Soumyajit Roy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Krishnan Patel
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Yolanda McKinney
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter Choyke
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Matsuoka Y, Uehara S, Toda K, Fukushima H, Tanaka H, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Focal brachytherapy for localized prostate cancer: 5.7-year clinical outcomes and a pair-matched study with radical prostatectomy. Urol Oncol 2021; 40:161.e15-161.e23. [PMID: 34895818 DOI: 10.1016/j.urolonc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/09/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To report experience with focal brachytherapy (FB) and compare its clinical outcomes with those of radical prostatectomy (RP) in localized prostate cancer. METHODS Fifty-one patients with low- to intermediate-risk prostate cancer underwent low-dose-rate FB. Survival rates free from biochemical failure (BF), additional treatment (AT) including re-FB, and whole-gland or systemic salvage therapy (ST) were calculated and oncological risk factors were investigated. Patient-reported outcomes on genitourinary function were also assessed. Using propensity scoring, 51 pair-matched RP patients were selected. Oncological control, urinary continence, and ejaculation status after FB and RP were compared. RESULTS During a median 5.7-year follow-up, BF, AT, and ST occurred in 12 (24%), 10 (20%), and 4 FB patients (8%), respectively. 6 of 10 AT patients were managed with re-FB alone. In the RP cohort, 3 patients (6%) underwent ST. 5-year BF-free survival rate after FB was 79%. Compared to 5-year ST-free survival rate of 94% after RP, ST-free and AT-free survival rates after FB were 93% (P = 0.813) and 87% (P = 0.049), respectively. Multivariate analyses of FB-treated patients showed that time to PSA nadir was negatively associated with BF and AT (hazard ratio 0.84 and 0.83, respectively, P <0.001 for each). The difference in oncological outcomes between low- and intermediate-risk categories was not significant. At 2 years after FB and RP, pad-free continence rates were 100% and 81%, respectively (P = 0.001). Ejaculation was preserved in 67% and 0% of patients who had been capable of ejaculation at baseline, respectively (P <0.001). CONCLUSION In low- to intermediate-risk prostate cancer, FB-treated patients achieved superior genitourinary function compared to pair-matched RP patients. The need for ST was not substantially different between the 2 treatment cohorts. Over half of patients requiring AT could be managed by re-focal treatment rather than whole-gland ST. Early PSA nadir may predict poor oncological control after FB.
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Affiliation(s)
- Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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10
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Li Y, Chan Kong Ngai T, Zhou S, Yap Haw Hwong J, Pang Pei Ping E, Ong Li Kuan A, Wang Lian Chek M, Chua Lee Kiang M, Looi WS, Nei WL, Chua ET, On WLK, Tan Wee Kiat T, Yuen Shyi Peng J, Tuan Kit Loong J. A comparative analysis between low-dose-rate brachytherapy and external beam radiation therapy for low- and intermediate-risk prostate cancer in Asian men. Acta Oncol 2021; 60:1291-1295. [PMID: 34259123 DOI: 10.1080/0284186x.2021.1950921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the long-term clinical outcomes of low-risk (LR) and intermediate-risk (IR) prostate cancer patients treated with low-dose-rate brachytherapy (LDR-BT) and external beam radiation therapy (EBRT). PATIENTS AND METHODS Men with biopsy-proven low- and intermediate-risk prostate cancer received EBRT and LDR-BT in an Asian academic center from 2000 to 2019 were reviewed. Kaplan-Meier survival analysis was performed to compare biochemical failure-free survival (bFFS) and overall survival (OS) between LDR and EBRT in the low- and intermediate-risk cohorts. RESULTS 642 patients (521 EBRT and 121 LDR-BT) with low- and intermediate-risk prostate cancer were included for analysis. In the intermediate-risk group, 5- and 10-year bFFS was 96%, 89% and 86%, 61% for LDR-BT and EBRT, respectively. LDR-BT was associated with a statistically significant improvement of bFFS in the intermediate-risk cohort (HR 2.7, p = 0.02). In the low-risk cohort, no difference of bFFS was found between LDR-BT and EBRT (HR 1.9, p = 0.08). Hormone therapy was more common in EBRT than LDR-BT for intermediate-risk group (71% versus 44%, p < 0.05). Prostate cancer-specific mortality was low in both EBRT (1%) and LDR-BT (2%) cohorts. No significant difference in OS was found between LDR-BT and EBRT in low- and intermediate-risk group (HR 2.1, p = 0.2 and HR = 1.7, p = 0.3). CONCLUSION In our retrospective study, LDR-BT is associated with superior bFFS compared with EBRT in Asian men with intermediate-risk prostate cancer.
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Affiliation(s)
- Youquan Li
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | | | - Siqin Zhou
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jerome Yap Haw Hwong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eric Pang Pei Ping
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ashley Ong Li Kuan
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Michael Wang Lian Chek
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Melvin Chua Lee Kiang
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wen Shen Looi
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wen Long Nei
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Eu Tiong Chua
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Weber Lau Kam On
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Urology Centre, Singapore General Hospital, Singapore, Singapore
| | - Terence Tan Wee Kiat
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - John Yuen Shyi Peng
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Urology Centre, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey Tuan Kit Loong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
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11
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Aleef TA, Spadinger IT, Peacock MD, Salcudean SE, Mahdavi SS. Centre-specific autonomous treatment plans for prostate brachytherapy using cGANs. Int J Comput Assist Radiol Surg 2021; 16:1161-70. [PMID: 34050909 DOI: 10.1007/s11548-021-02405-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In low-dose-rate prostate brachytherapy (LDR-PB), treatment planning is the process of determining the arrangement of implantable radioactive sources that radiates the prostate while sparing healthy surrounding tissues. Currently, these plans are prepared manually by experts incorporating the centre's planning style and guidelines. In this article, we develop a novel framework that can learn a centre's planning strategy and automatically reproduce rapid clinically acceptable plans. METHODS The proposed framework is based on conditional generative adversarial networks that learn our centre's planning style using a pool of 931 historical LDR-PB planning data. Two additional losses that help constrain prohibited needle patterns and produce similar-looking plans are also proposed. Once trained, this model generates an initial distribution of needles which is passed to a planner. The planner then initializes the sources based on the predicted needles and uses a simulated annealing algorithm to optimize their locations further. RESULTS Quantitative analysis was carried out on 170 cases which showed the generated plans having similar dosimetry to that of the manual plans but with significantly lower planning durations. Indeed, on the test cases, the clinical target volumes achieving [Formula: see text] of the prescribed dose for the generated plans was on average [Formula: see text] ([Formula: see text] for manual plans) with an average planning time of [Formula: see text] min ([Formula: see text] min for manual plans). Further qualitative analysis was conducted by an expert planner who accepted [Formula: see text] of the plans with some changes ([Formula: see text] requiring minor changes & [Formula: see text] requiring major changes). CONCLUSION The proposed framework demonstrated the ability to rapidly generate quality treatment plans that not only fulfil the dosimetric requirements but also takes into account the centre's planning style. Adoption of such a framework would save significant amount of time and resources spent on every patient; boosting the overall operational efficiency of this treatment.
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12
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Saito K, Matsuoka Y, Toda K, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer. Brachytherapy 2021; 20:842-848. [PMID: 33883093 DOI: 10.1016/j.brachy.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. METHODS We recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2-3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. RESULTS Median follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. CONCLUSIONS Hemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.
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Affiliation(s)
- Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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13
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Sakurai T, Takamatsu S, Shibata S, Taka M, Ishiyama M, Yamazaki M, Kojima H, Mizokami A, Kumano T, Gabata T. Incidence and dosimetric predictive factors of late rectal toxicity after low-dose-rate brachytherapy combined with volumetric modulated arc therapy in high-risk prostate cancer at a single institution: Retrospective study. Brachytherapy 2021; 20:584-94. [PMID: 33485811 DOI: 10.1016/j.brachy.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the incidence of rectal toxicity and to identify the associated dosimetric predictive parameters after I-125 seed low-dose-rate brachytherapy (LDR-BT) combined with volumetric modulated arc therapy (VMAT) and dose constraints. METHODS AND MATERIALS In total, 110 patients with high-risk prostate cancer received 110 Gy LDR-BT, followed by 45 Gy VMAT. Rectal toxicity was recorded according to Common Terminology Criteria for Adverse Events v.4.03. The dosimetric factors associated with LDR-BT and VMAT were analyzed to determine their relationship with rectal toxicity. Receiver operating characteristic (ROC) curve analysis was performed for ≥ grade 2 (G2) rectal toxicity prediction. RESULTS The follow-up duration was 10.1-115.2 months (median 60.5 months). Seven patients had G2 rectal hemorrhage, and none of the patients had grade 3 rectal hemorrhage. In the univariate analysis, the rectal volume receiving 100% of the prescribed dose (rV100) (p < 0.001), the dose covering 2 cc of the rectum (rD2cc) during LDR-BT (p = 0.002), and the combined rD2cc during LDR-BT and VMAT (p = 0.001) were identified as predictors of G2 rectal hemorrhage. In the ROC curve analysis, the cutoff value was 0.46 cc for rV100, 74.0 Gy for rD2cc, and 86.8 GyEQD2 for combined rD2cc. CONCLUSION Predictors of late ≥ G2 rectal hemorrhage are rV100, rD2cc, and combined rD2cc. The incidence of rectal toxicity is low and acceptable in this setting and is highly dependent on the rectal dose of LDR-BT. The use of higher-quality LDR-BT and VMAT dose constraints may further reduce the rate of rectal hemorrhage.
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14
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Van Bos E, Dekuyper P, Gabriel C, Waterloos M, Van Baelen A, Huybrechts S, Ameye F, Lambrecht A, Vulsteke C, Soenens C. Small cell carcinoma of the prostate after low-dose-rate brachytherapy: a case report. J Med Case Rep 2020; 14:203. [PMID: 33109264 PMCID: PMC7592557 DOI: 10.1186/s13256-020-02523-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Small cell carcinoma of the prostate is a rare condition with important differences from prostatic adenocarcinoma in terms of clinical and prognostic characteristics. A low prostate-specific antigen and a symptomatic patient, including paraneoplastic symptoms, characterize small cell carcinoma of the prostate. Diagnosis is made on the basis of prostate biopsy, and fluorodeoxyglucose positron emission tomography/computed tomography is often used for staging because up to 60% of patients present with de novo metastatic disease. Patients with metastatic disease are usually treated with platinum-based cytotoxic chemotherapy regimens similar to those used for small cell carcinoma of the lung. However, prognosis remains poor, with a median overall survival of 9 to 17 months despite therapy. Case presentation This report describes a case of an 80-year-old Caucasian patient with lymph node and bone metastatic small cell carcinoma of the prostate following low-dose-rate brachytherapy for a low-risk prostate carcinoma and treated with chemotherapy and immunotherapy. Conclusion Low-dose-rate brachytherapy might be an etiology of small cell prostate cancer.
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Affiliation(s)
- Eva Van Bos
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Peter Dekuyper
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | | | - Marjan Waterloos
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Anthony Van Baelen
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Stefan Huybrechts
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | | | - Christof Vulsteke
- Department of Oncology, AZ Maria Middelares, Ghent, Belgium.,Department of Molecular Imaging, Pathology, Radiotherapy and Oncology (MIPRO), Center for Oncological Research (CORE), Antwerp University, Antwerp, Belgium
| | - Charlotte Soenens
- Department of Urology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
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15
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Smith WH, Cesaretti J, Chin CP, Terk M, Stock RG. Salvage low dose rate brachytherapy for prostate cancer recurrence following definitive external beam radiation therapy. Radiother Oncol 2021; 155:42-7. [PMID: 33075391 DOI: 10.1016/j.radonc.2020.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We sought to describe the safety and efficacy of salvage low dose rate (LDR) brachytherapy for local prostate cancer recurrence following definitive RT. MATERIALS AND METHODS We included patients from two prospectively maintained institutional databases who underwent salvage LDR brachytherapy for biopsy confirmed intra-prostatic recurrence following primary RT. All patients were without evidence of metastatic disease. Freedom from biochemical failure (FFbF), prostate cancer specific survival (PCaSS), and overall survival (OS) were determined using the Kaplan-Meier estimates. Cox proportional hazard models were used to identify factors predictive of FFbF. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS 108 patients were included. Median follow-up was 6.3 years. The 5- and 10-year actuarial survival outcomes were as follows: FFbF, 63.1% and 52.0%; PCaSS, 90.5% and 77.8%; OS, 80.9% and 56.7%. On multivariate modeling, increasing grade group (HR 1.41, 95% CI 1.02-1.95, p = 0.036) and initial PSA at diagnosis (HR 1.02, 95% CI 1.004-1.05, p = 0.022) were associated with worse FFbF. Grade 3 toxicity occurred in 16.7% of patients; including genitourinary events in 15.7% and gastrointestinal events in 2.8% of patients. IPSS scores increased following implant, peaking at 2 months (median IPSS 20, p = 0.002) and thereafter remaining elevated throughout follow-up. CONCLUSIONS Salvage LDR brachytherapy is safe and efficacious, with acceptable grade 3+ toxicity and good biochemical control on long-term follow-up. Patients with higher grade group and higher PSA at initial diagnosis may be at increased risk for biochemical failure.
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16
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Licciardello T, Feliciani G, Mazzotti G, Mostacci D, Sarnelli A, Menghi E. Radiation protection and dosimetry issues for patients with prostate cancer after I-125 low-dose-rate brachytherapy permanent implant. Brachytherapy 2020; 20:272-278. [PMID: 33041230 DOI: 10.1016/j.brachy.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this work was to analyze the exposure rates measured in the proximity of patients who underwent prostate low-dose-rate brachytherapy with I-125 implant. Effective doses to relatives and to population were computed to estimate the time to reach radioprotection dose constraints. METHODS AND MATERIALS Measurements were obtained from 180 patients, whereas the body mass index was calculated and reported for 77 patients. The day after the implant, K˙ measurements were conducted at various skin distances and positions and converted to effective doses. A theoretical model was developed to estimate effective doses from total implanted activity. The latter was approximated with a 10-mL vial inside the patient. RESULTS The K˙ measurements showed a low correlation with the total implanted activity, albeit an increasing trend of K˙ was observed on increasing the activity. A stronger correlation was found between body mass index and K˙ measurements. The effective dose to population is in general lower than dose constraints as well as the effective doses to relatives, with the exception of children and pregnant women, who command special precautions. We report differences between the experimental model- and theoretical model-based dose evaluation together with their comparison with previous studies found in literature. CONCLUSIONS Based on the K˙ measurements and the results of the present analysis, it is possible to provide the patient with radiation safety instructions specifically tailored to his relatives' habits and working environment.
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Affiliation(s)
- Tiziana Licciardello
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | - Giacomo Feliciani
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy.
| | - Giorgio Mazzotti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | | | - Anna Sarnelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | - Enrico Menghi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
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Miyake M, Tanaka N, Asakawa I, Yamaki K, Inoue T, Suzuki S, Hori S, Nakai Y, Anai S, Torimoto K, Toritsuka M, Nakagawa H, Tsukamoto S, Fujii T, Ohbayashi C, Hasegawa M, Kasahara M, Fujimoto K. A prospective study of oral 5-aminolevulinic acid to prevent adverse events in patients with localized prostate cancer undergoing low-dose-rate brachytherapy: Protocol of the AMBER study. Contemp Clin Trials Commun 2020; 19:100593. [PMID: 32637724 DOI: 10.1016/j.conctc.2020.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background Radiotherapy is one of the most frequently selected treatment options for patients with prostate cancer. However, adverse effects related to the irradiated surrounding normal organs are significant clinical concerns. Specifically, genitourinary and gastrointestinal toxicities can lead to a dramatically reduced quality of life. The aim of this clinical trial is to determine the efficacy of oral 5-aminolevulinic acid (ALA) phosphate with sodium ferrous citrate (SFC) in patients treated with low-dose-rate brachytherapy (LDR-BT) using an iodine-125 seed source. Methods The AMBER study is a prospective, single-center trial in patients with localized prostate cancer undergoing LDR-BT. Patients who undergo supplementary extra-beam radiotherapy are excluded, whereas those who undergo pre-implantation short-term (4–6 months) androgen deprivation therapy to decrease the prostate volume and/or improve oncological outcomes are included. After the screening and registration, the patients will be instructed to take capsules of ALA-SFC twice a day (200 mg and 229.42 mg per day) for 6 months from the day of seed implantation (prescribed radiation dose of 160 Gy). Patient data will be collected before the implantation; during oral ALA-SFC treatment; and 1, 3, 6, 9, and 12 month(s) after seed implantation. The primary endpoint of this trial is the urinary frequency 3 months after seed implantation. At each visit, the 24-h urinary frequency, total voided volume, and mean voided volume on a frequency volume chart and other patient-reported outcomes are recorded. The data of the trial cases will be compared with those of historical controls, who are consecutive patients undergoing LDR-BT without supplementary extra-beam radiotherapy between January 2016 and January 2019. The number of subjects has been set to be 50 for trial cases and 150 for the historical control cases. Pre- and post-treatment clinicopathologic factors are compared between two groups. Discussion The goal of this trial is to determine the potential benefit of ALA-SFC in patients who undergo LDR-BT. To the best of our knowledge, this is the first study investigating the potential clinical benefit of oral ALA-SFC after radiotherapy. More evidence from a further randomized controlled trial is needed to change the standard of care and lead to better post-radiotherapy management. Trial registration This clinical trial was prospectively registered with the Japan Registry of Clinical Trials on 5 December 2019. The reference number is jRCTs051190077, nara0013 (Certified Review Board of Nara Medical University).
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Key Words
- 5-Aminolevulinic acid
- ALA, 5-aminolevulinic acid
- Adverse event
- CTCAE, Common Toxicity Criteria for Adverse Events
- EBRT, extra-beam radiotherapy
- EPIC, Expanded Prostate Cancer Index Composite
- GI, gastrointestinal
- GU, genitourinary
- I-125, iodine-125
- IPSS, International Prostate Symptom Score
- J-POPS, Japanese nationwide prospective cohort study
- LDR-BT, low-dose-rate brachytherapy
- Low-dose-rate brachytherapy
- OABSS, overactive bladder symptom score
- PCa, prostate cancer
- PRO, patient reported outcome
- PSA, prostate-specific antigen
- Prostate cancer
- QOL, quality of life
- Radioprotection
- Radiotherapy
- SFC, sodium ferrous citrate
- SHIM, Sexual Health Inventory for Men
- Urinary frequency
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Bathala TK, Venkatesan AM, Ma J, Bhosale P, Wei W, Kudchadker RJ, Wang J, Anscher MS, Tang C, Bruno TL, Frank SJ, Szklaruk J. Quality comparison between three-dimensional T2-weighted SPACE and two-dimensional T2-weighted turbo spin echo magnetic resonance images for the brachytherapy planning evaluation of prostate and periprostatic anatomy. Brachytherapy 2020; 19:484-490. [PMID: 32402544 DOI: 10.1016/j.brachy.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/16/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare an isotropic three-dimensional (3D) T2-weighted sequence sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with an axial two-dimensional T2-weighted turbo spin echo (TSE) sequence with regard to overall image quality and the delineation of normal prostate and periprostatic anatomy for low-dose-rate prostate cancer brachytherapy planning evaluation. METHODS AND MATERIALS Patients (n = 69) with prostate cancer who had pelvic magnetic resonance imaging (MRI) for low-dose-rate brachytherapy treatment planning were included. Three radiologists independently assessed the visibility of nine anatomic structures on each sequence by using a 5-point scale and overall image quality by using a 4-point scale. The significance of the differences in diagnostic performance was tested with a Wilcoxon signed rank test. RESULTS No significant intersequence differences were found for most (7/9) anatomical structures and overall image quality. The mean scores for visibility of anatomical structures on the 3D SPACE and 2D TSE sequences, respectively, were as follows: the zonal anatomy (3.7; 3.9, p = 0.05), prostate capsule (3.9; 4.0, p = 0.08), neurovascular bundle (2.9; 2.9, p = 0.9), rectoprostatic angle (3.8; 3.8, p = 0.35), rectum (4.2; 4.3, p = 0.26), urethra (3.8; 3.9, p = 0.12), urinary bladder (4.6; 4.6, p = 0.61), and overall image quality (2.9; 2.9, p = 0.33). 3D SPACE was superior for delineation of the genitourinary diaphragm (3.8; 3.6, p = 0.003), whereas 2D TSE was superior for delineation of the seminal vesicles (3.5; 4.0, p < 0.0001). CONCLUSIONS Anatomic delineation of the prostatic and periprostatic anatomy provided by the 3D SPACE sequence is as robust in quality as that provided by a conventional 2D TSE sequence with superior delineation of the genitourinary diaphragm. For MRI-based brachytherapy treatment planning, the 3D SPACE sequence with subcentimeter isotropic resolution can replace the 2D TSE sequence and be incorporated into standard MRI protocols.
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Affiliation(s)
- Tharakeswara K Bathala
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priyadarshini Bhosale
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Wei
- Cancer Biostatistics Section, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mitchell S Anscher
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Janio Szklaruk
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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Gocho T, Hori M, Fukushima Y, Someya M, Kitagawa M, Hasegawa T, Tsuchiya T, Hareyama M, Takagi M, Hashimoto K, Masumori N, Sakata KI. Evaluation of the urethral α/β ratio and tissue repair half-time for iodine-125 prostate brachytherapy with or without supplemental external beam radiotherapy. Brachytherapy 2020; 19:290-297. [PMID: 32249179 DOI: 10.1016/j.brachy.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the correlation between postimplant dosimetric quantifiers and the genitourinary (GU) toxicity of low-dose rate brachytherapy for prostate cancer. METHODS AND MATERIALS The minimum urethral dose (UD10, 30, and 90) and the percent volume of the urethra receiving the prescription dose (V100, V150) were calculated from the postimplant dose-volume histograms of 182 patients. We then calculated various urethral biologically equivalent doses (uBEDs) using different values of the α/β ratio and tissue repair half-time (t1/2) and examined the correlations with GU toxicity. RESULTS Common dosimetric quantifiers, such as UD90 (brachytherapy) + UD50 (external beam radiotherapy), showed no correlation with Grade ≥ 2 GU toxicity. There was a significant correlation between Grade ≥2 GU toxicity and uBED when the α/β value was 0.5 or 1 Gy and t1/2 was 0.5-2.5 h. An uBED (α/β = 1.0, t1/2 = 0.5) had the largest hazard ratio for GU toxicity, and it was also significantly correlated with Grade ≥ 2 GU toxicity according to multivariate analysis. CONCLUSIONS We observed a significant correlation of uBED with GU toxicity when α/β was 0.5 or 1.0 Gy and t1/2 was 0.5-2.5 h. As the simple formula we used has not been verified in basic experiments, more data are needed to validate our results.
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Affiliation(s)
- Toshio Gocho
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Masakazu Hori
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Yuuki Fukushima
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Masanori Someya
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Masato Hareyama
- Department of Radiology, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Masaru Takagi
- Department of Radiology, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University, Sapporo, Hokkaido, Japan.
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Vuolukka K, Auvinen P, Palmgren JE, Voutilainen T, Aaltomaa S, Kataja V. Long-term efficacy and urological toxicity of low-dose-rate brachytherapy (LDR-BT) as monotherapy in localized prostate cancer. Brachytherapy 2019; 18:583-588. [PMID: 31227400 DOI: 10.1016/j.brachy.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/16/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the incidence of late severe (≥Grade 3) urinary toxicity and the long-term efficacy after low-dose-rate brachytherapy (LDR-BT) in patients with localized prostate cancer (PCa). METHODS AND MATERIALS During the years 1999-2008, 241 patients with PCa who underwent LDR-BT with I125 and were followed up in Kuopio University Hospital were included to this analysis. The incidence of late severe (Grade 3) urinary toxicity and the long-term efficacy results were analyzed. RESULTS All D'Amico risk groups were represented, as 58.9%, 35.3%, and 5.8% of the patients were classified as low-, intermediate-, and high-risk patients, respectively. With a median followup of 11.4 years after implantation, the incidence of severe urinary toxicity increased throughout the followup period. The risk of Grade 3 urinary toxicity was highest among patients with higher Gleason scores (p = 0.016) and higher initial urine residual volumes (p = 0.017) and the cumulative incidence of severe urinary toxicity was 10.0%. The crude rate for transurethral prostatic resection was 5.8%. The relapse-free survival, the cause-specific survival, and the overall survival were 79.3%, 95.0%, and 66.4%, respectively. CONCLUSIONS The treatment was well tolerated as 90% of patients avoided any Grade 3 urinary toxicity. LDR-BT for localized PCa achieved high and durable efficacy. These results support the role of LDR-BT monotherapy as one of the valid primary treatment options for low-risk and favorable intermediate-risk patients.
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Affiliation(s)
- Kristiina Vuolukka
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland.
| | - Päivi Auvinen
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Kuopio, Finland
| | - Jan-Erik Palmgren
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- University of Eastern Finland, Kuopio, Finland; Central Finland Central Hospital, Jyväskylä, Finland
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Taggar AS, Charas T, Cohen GN, Boonyawan K, Kollmeier M, McBride S, Mathur N, Damato AL, Zelefsky MJ. Placement of an absorbable rectal hydrogel spacer in patients undergoing low-dose-rate brachytherapy with palladium-103. Brachytherapy 2018; 17:251-8. [PMID: 29241706 DOI: 10.1016/j.brachy.2017.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Rates of rectal toxicity after low-dose-rate (LDR) brachytherapy for prostate cancer are dependent on rectal dose, which is associated with rectal distance from prostate and implanted seeds. Placement of a hydrogel spacer between the prostate and rectum has proven to reduce the volume of the rectum exposed to higher radiation dose levels in the setting of external beam radiotherapy. We present our findings with placing a rectal hydrogel spacer in patients following LDR brachytherapy, and we further assess the impact of this placement on dosimetry and acute rectal toxicity. METHODS AND MATERIALS Between January 2016 and April 2017, 74 patients had placement of a hydrogel spacer, immediately following a Pd-103 seed-implant procedure. Brachytherapy was delivered as follows: as a monotherapy to 26 (35%) patients; as part of planned combination therapy with external beam radiotherapy to 40 (54%) patients; or as a salvage monotherapy to eight (11%) patients. Postoperative MRI was used to assess separation achieved with rectal spacer. Acute toxicity was assessed retrospectively using Radiation Oncology Therapy Group radiation toxicity grading system. Rectal dosimetry was compared with a consecutive cohort of 136 patients treated with seed implantation at our institution without a spacer, using a 2-tailed paired Student's t test (p < 0.05 for statistical significance). RESULTS On average, 11.2-mm (SD 3.3) separation was achieved between the prostate and the rectum. The resultant mean rectal volume receiving 100% of prescribed dose (V100%), dose to 1 cc of rectum (D1cc), and dose to 2 cc of rectum (D2cc) were 0 (SD 0.05 cc), 25.3% (SD 12.7), and 20.5% (SD 9.9), respectively. All rectal dosimetric parameters improved significantly for the cohort with spacer placement as compared with the nonspacer cohort. Mean prostate volume, prostate V100 and dose to 90% of gland (D90) were 29.3 cc (SD 12.4), 94.0% (SD 3.81), and 112.4% (SD 12.0), respectively. Urethral D20, D5cc, and D1cc were 122.0% (SD 17.27), 133.8% (SD 22.8), and 144.0% (SD 25.4), respectively. After completing all treatments, at the time of first the followup, 7 patients reported acute rectal toxicity-6 experiencing Grade 1 rectal discomfort and 1 (with preexisting hemorrhoids) experiencing Grade 1 bleeding. CONCLUSIONS Injection of rectal spacer is feasible in the post-LDR brachytherapy setting and reduces dose to the rectum with minimal toxicity. Prostate and urethral dosimetries do not appear to be affected by the placement of a spacer. Further studies with long-term followup are warranted to assess the impact on reduction of late rectal toxicity.
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Mahdavi SS, Spadinger IT, Chng NT, Morris WJ. Robustness to source displacement in dual air kerma strength planning for focal low-dose-rate brachytherapy of prostate cancer. Brachytherapy 2016; 15:642-9. [PMID: 27263060 DOI: 10.1016/j.brachy.2016.04.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the use of dual source strength implants for focal low-dose-rate brachytherapy. METHODS AND MATERIALS An interneedle dual source strength planning strategy is described for focal low-dose-rate brachytherapy of the prostate. The implanted treatment plans were designed using peripheral (except near the rectum) needles loaded with high strength (0.9 U) sources and central needles loaded with low strength (0.4 U) sources ("interneedle" dual strength planning). This approach has been applied for focally treating 3 patients. In this article, we compare the characteristics and robustness to source motion of interneedle dual strength planning with four alternative planning strategies (single strength high, low, and intermediate, and intraneedle dual strength) on 50 simulated cases. RESULTS Interneedle dual source strength planning results in greater robustness to source motion and overall lower seed and needle density compared to the standard low source strength planning currently used in our centre. This planning approach is also significantly superior to single strength high, single strength intermediate and intraneedle dual strength planning strategies in terms of high dose to the urethral avoidance structure. CONCLUSIONS The use of interneedle dual source strength treatment plans for focal low-dose-rate brachytherapy is possibly the practical solution for limiting the density of sources required to deliver the prescribed dose while limiting proximity of high strength sources to organs at risk.
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Affiliation(s)
- S Sara Mahdavi
- Department of Radiation Oncology, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Ingrid T Spadinger
- Department of Medical Physics, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Nicholas T Chng
- Department of Medical Physics, Centre for the North, British Columbia Cancer Agency, Prince George, BC, Canada
| | - W James Morris
- Department of Radiation Oncology, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC, Canada
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Nakamura S, Murakami N, Inaba K, Wakita A, Kobayashi K, Takahashi K, Okamoto H, Umezawa R, Morota M, Sumi M, Igaki H, Ito Y, Itami J. After low and high dose-rate interstitial brachytherapy followed by IMRT radiotherapy for intermediate and high risk prostate cancer. BMC Cancer 2016; 16:296. [PMID: 27142069 DOI: 10.1186/s12885-016-2329-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
Abstract
Background The study aimed to compare urinary symptoms in patients with clinically localized prostate cancer after a combination of either low-dose-rate or high-dose-rate interstitial brachytherapy along with intensity-modulated radiation therapy (LDR-ISBT + IMRT or HDR-ISBT + IMRT). Methods From June 2009 to April 2014, 16 and 22 patients were treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT, respectively. No patient from these groups was excluded from this study. The prescribed dose of LDR-ISBT, HDR-ISBT, and IMRT was 115 Gy, 20 Gy in 2 fractions, and 46 Gy in 23 fractions, respectively. Obstructive and irritative urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) examined before and after treatments. After ISBT, IPSS was evaluated in the 1st and 4th weeks, then every 2–3 months for the 1st year, and every 6 months thereafter. Results The median follow-up of the patients treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT was 1070.5 days and 1048.5 days, respectively (p = 0.321). The IPSS-increment in the LDR-ISBT + IMRT group was greater than that in the HDR-ISBT + IMRT between 91 and 180 days after ISBT (p = 0.015). In the LDR-ISBT + IMRT group, the IPSS took longer time to return to the initial level than in the HDR-ISBT + IMRT group (in LDR-ISBT + IMRT group, the recovery time was 90 days later). The dose to urethra showed a statistically significant association with the IPSS-increment in the irritative urinary symptoms (p = 0.011). Clinical outcomes were comparable between both the groups. Conclusions Both therapeutic modalities are safe and well suited for patients with clinically localized prostate cancer; however, it took patients longer to recover from LDR-ISBT + IMRT than from HDR-ISBT + IMRT. It is possible that fast dose delivery induced early symptoms and early recovery, while gradual dose delivery induced late symptoms and late recovery. Urethral dose reductions were associated with small increments in IPSS.
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Kishan AU, Kupelian PA. Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects. Brachytherapy 2015; 14:148-59. [PMID: 25516492 DOI: 10.1016/j.brachy.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022]
Abstract
As clinical outcomes for patients with clinically localized prostate cancer continue to improve, patients and physicians are increasing making treatment decisions based on concerns regarding long-term morbidity. A primary concern is late radiation proctitis, a clinical entity embodied by various signs and symptoms, ranging from diarrhea to rectal fistulas. Here, we present a comprehensive literature review examining the clinical manifestations and pathophysiology of late radiation proctitis after low-dose-rate brachytherapy (BT), as well as its incidence and predictors. The long-term risks of rectal bleeding after BT are on the order of 5-7%, whereas the risks of severe ulceration or fistula are on the order of 0.6%. The most robust predictor appears to be the volume of rectum receiving the prescription dose. In certain situations (e.g., salvage setting, for patients with increased radiosensitivity, and following aggressive biopsy after BT), the risk of these severe toxicities may be increased by up to 10-fold. A variety of excellent management options exist for rectal bleeding, with endoscopic methods being the most commonly used.
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