ESTRO 36 Abstract Book

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S140 ESTRO 36
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≤60cc; no use of androgen deprivation and no previous
prostate surgery.
The patients were monitored prospectively for toxicity
(CTCAE v. 3.0) and health-related quality of life
(Expanded Prostate Cancer Index Composite [EPIC]). A
clinically significant decrement was considered an EPIC
score decrease greater than one-half of the SD of the
baseline value for each domain. Patient satisfaction was
evaluated using a five-category predetermined Likert
scale question.
Results
The median age was 71 years (range 55-78), median initial
PSA 7.05 ng/ml (4.2-17.8) and median baseline IPSS was 5
(0-14). Forty-four percent of the patients were low-risk
and 56% intermediate-risk. The median prostate volume
was 34cc (17-60). Median CTV and OAR doses were: V100:
96.5% (95-99.4), V150 20.5% (13.7-35.1), V200 5.3% (3.1-
10.1), Urethral Dmax 106% (103-111) and rectum 2cc 53 %
(45-48)
After a median follow-up is 16 months (3-31), acute grade-
2 genitourinary and gastrointestinal toxicity occurred in 4
patients (9%) and 2 patients (2.3%), respectively. Two
patients presented late GU grade-2 toxicity (4.6%). No
grade-3 toxicity occurred.
In terms of QoL, there was a statistically significant
decline in EPIC urinary urgency domain between month 1
and month 6 (p=0.006), and returned to baseline by month
12. Mean EPIC urinary irritative-obstructive, bowel, sexual
and hormonal domains did not present significant changes.
Of patients potent at baseline evaluation, 60% remained
potent at last follow-up.
Patients rated their satisfaction at 6 months as “very-
satisfied” (23%) or “extremely-satisfied” (77%).
Conclusion
HDR brachytherapy monotherapy administered in a single
fraction of 19Gy, demonstrate excellent results in terms
of toxicity, tolerance, safety, patient satisfaction and
QoL. Longer follow-up is needed to confirm the efficacy of
this strategy.
OC-0271 The clinical outcome after high dose rate
brachytherapy as monotherapy in localized prostate
cancer
S. Kariya1, K. Kobayashi1, I. Yamasaki2, S. Ashida2, K.
Inoue2, T. Yamagami1
1 Kochi Medical School, Department of Radiology,
Nankoku, Japan
2 Kochi Medical School, Department of Urology, Nankoku,
Japan
Purpose or Objective
The aim of this study is to report the clinical outcome
after a single implant, high dose rate (HDR) brachytherapy
in localized prostate cancer.
Material and Methods
Eighty-three patients, 2 with low-risk (T stage < or = 2a,
PSA < or = 10 ng/ml, and Gleason score (GS) < or = 6), 28
with intermediate-risk (T stage = 2b or 2c, PSA > 10 and <
or = 20 ng/ml, GS = 7), and 53 with high-risk (T stage > or
= 3a, PSA > 20 ng/ml, GS > or = 8) prostate cancer who
underwent HDR brachytherapy as monotherapy (no
external beam radiotherapy) using 27 Gy/2 fractions in
one day from July 2011 to October 2014 were analyzed
prospectively. Patient age ranged 57 to 81 (median 72 ）
years old. Fifty-nine patients were received neoadjuvant
hormonal therapy, and 10 patients were also adjuvant
hormonal therapy. Acute and late toxicities were assessed
as per Common Terminology Criteria for Adverse Events
(CTCAE), Version 4.03. The dosimetric factors affecting
the acute or late grade 2 to 3 GU toxicity were analyzed
by univariate analysis. PSA failure was defined as the
Phoenix definition of nadir + 2 ng/mL. Biochemical
relapse-free survival was analyzed using the Kaplan Meir
method.
Results
The median follow-up period was 52 months (range 21 –
64). The 4-year biochemical relapse-free survival rate was
89.0%. Neither acute nor late grade 2 to 3 rectal toxicities
developed. Acute grade 2 genitourinary (GU) toxicity
occurred in 12.0% (grade 3 in 0.0%). The predictor of
acute grade 2 GU toxicity was urethra D90 (the dose that
covers 90% volume of the urethra) > 11.5 Gy (p-value <
0.01). Late grade 2 to 3 GU toxicity occurred in 20.5%
(grade 3 in 3.6%). However, any predictors of late grade 2
to 3 GU toxicity weren’t founded.
Conclusion
HDR brachytherapy as monotherapy in localized prostate
cancer is a highly effective treatment with minimal side
effects.
OC-0272 Long-term rectal toxicity following I-125
prostate brachytherapy in 1,260 patients
A. Yorozu1, S. Sutani1, R. Kota1, A. Sunaguchi1, K. Toya1,
S. Saito 2
1Tokyo Medical Centre- NHO, Department of Radiation
Oncology, Tokyo, Japan
2Tokyo Medical Centre- NHO, Department of Urology,
Tokyo, Japan
Purpose or Objective
To analyze factors associated with long-term rectal
toxicity in permanent prostate brachytherapy patients.
Material and Methods
This retrospective cohort study examined 1,260 patients
treated with I-125 brachytherapy without external beam
radiotherapy between 2003 and 2013. Neoadjuvant
androgen deprivation (NAD) was given to 39% of patients.
The patient, treatment, and dosimetry factors were
examined for an association with rectal toxicity. Toxicity
was graded according to the National Cancer Institute’s
Common Terminology Criteria for Adverse Events ver 4.0.
Rectal dosimetry was calculated through dose-volume
histogram of the rectum using day-1 and day-30 CT-based
dosimetry, and expressed as volume of rectum in cc
receiving 100% and 150% of the prescription dose (RV100
and RV150, respectively), and as dose to 5% and 30% of
rectum (RD5 and RD30 respectively). The Kaplan-Meier
method and Cox regression model were used for analysis.
Results
The median follow-up was 6.6 years. Median RV100 was
0.15 cc at day 1, and 0.56 cc at day 30. Any grade of
proctitis, rectal bleeding, fecal incontinence, diarrhea,
and anal pain was observed in 22.9%, 22.8%, 15.2%, 10.6%,
and 9.9% of patients, respectively. Toxicities were
categorized as grade 1 in 28.8% of patients and grade 2 in
1.7%. No Grade 3 toxicity was observed. Actuarial risk of
grade 2 rectal toxicity was 2.0%. The majority cases (82%)
of grade 2 toxicities were diagnosed by the third year.
Upon univariate analysis, the likelihood of G2 toxicity was
significantly associated with RV150, RV100, RD30, RD5 at
day 1, and NAD. Only RV100 at day 1 and NAD fit a Cox
regression model. Actuarial risk of grade 2 was 1.4%, 3.1%,
4.8%, and 6.7% for patients with RV100 <=0.2cc, 0.2-0.5cc,
0.5-1cc, >1cc at day 1, respectively (P=0.029). Actuarial
risk of grade 2 was 1.1 % for patients with NAD, and 2.2%
for patients without NAD (p=0.032).
Conclusion
I-125 prostate brachytherapy is well tolerated. Rectal
dosimetry at day 1 is relevant to long-term rectal toxicity.
RV100 and NAD are associated with rectal toxicity.
OC-0273 Prostate brachytherapy in African-Caribbean
patients: A retrospective analysis of 370 cases
V. Atallah1, N. Leduc2, M. Creoff 2, P. Escarmant2, V.
Vinh-Hung2
1universitary hospital, radiotherapy, Pointe-a-pitre,
Guadeloupe
2Universitary hospital Martinique, Radiotherapy, Fort-
de-france, Martinique