ESTRO 36 Abstract Book

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S975 ESTRO 36
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in the patients receiving additional external beam
therapy.
Conclusion
The feasibility of HDR-BT as a treatment option in low,
intermediate and high grade prostate carcinoma was
confirmed.
As previously expected, HDR-BT patients treated in a
monotherapy setting showed a more favorable profile of
detected side effects.
In our experience HDR-BT can be implemented within a
radiooncological department of a community hospital.
EP-1773 Clinical outcomes in localized prostate
cancer treated with HDR Brachytherapy as single
fraction
L. Larrea 1, E. López-Muñoz1, P. Antonini1, V. Gonázlez1,
M.C. Baños2, J. Bea 2, M.A. García2
1 Clinica Virgen del Consuelo, Radiation Oncology,
Valencia, Spain
2 Clinica Virgen del Consuelo, Radiophysics Department,
Valencia, Spain
Purpose or Objective
To describe the technique and analyze early outcomes in
patients with low and intermediate risk prostate cancer
treated with high dose rate brachytherapy (HDR) as
monotherapy.
Material and Methods
From January to December 2015, 8 low and 8 intermediate
prostate cancer patients were treated with 20 Gy HDR (Ir
192) as monotherapy, in one fractionation. At diagnosis,
mean PSA was 7,42 ng/mL (range 6-16) and mean Gleason
score was 6 (range 4-7). Any patient received androgen
deprivation therapy. Mean prostate volume was 49 cc
(range 21-67,3).
Under rachianesthesia the patient is placed in a dorsal
lithotomy position. A balloon catheter is placed into the
bladder to correctly visualization of the urethra in
transrectal ultrasonography (TRUS). Using a template,
plastic needles are placed into the prostate through the
perineal skin to the inside of the bladder. The template
has needles holes at 5 mm intervals. Mean number of
needles inserted was 13 (range 12-15). After implantation
of needles TRUS 2 mm spaced axial images are taken for
3D treatment planning. Prostate delination was done as
clinical target volume (CTV) and to evaluate dose
constraints. PTV includes the whole prostate gland with a
2 mm posterior wall rectal margin and 5 mm all margins.
Urethra was always defined. Dose constraints were:
urethra total dose less than 120% and rectal dose less than
70% of the prescription dose. Prescription dose to prostate
was 20 Gy. The minimal dose achieved to the 95% of the
volume (D95) was 21-23 Gy (105-110%). All the procedure
expends about 1-2 hours. Patients stay in hospital for 12
hours with urethral catheter. Genitourinary and
gastrointestinal toxicity was evaluated in agreement with
Common Terminology Criteria for Adverse Events (CTCAE
v4.03). For sexual function the International Index of
Erectil Function Questionnaire was used. The global cost
is a forfait for all the procedure.
Results
With a median follow-up of 15,1 months (range 10-21) all
patient survive without progression. Mean PSA after
treatment was 1,4 ng/mL (range 0,21-3,37). Three
patients presented acute disuria and one patient urinary
urgency (grade 1) that were resolved in less that 3 weeks.
Erectil function preservation was 87,5%. No
gastrointestinal toxicity was observed. One patient was
diagnosed of lung cancer two months after brachytherapy
treatment. The overall cost treatment was among €-
10.000 per patient (€-9.000-14.000).
Conclusion
In our experience, HDR brachytherapy using extreme
hypofractionation is a safe and well tolerated alternative
to permanent-seed implants with a high local control
disease and low toxicity rates. Some advantages as “in
vivo” prescription, short surgical time and no radioactive
procedure were confirmed. However, long-term follow-up
is needed to confirm our initial results.
EP-1774 Randomized phase II trial of IGRT with or
without HDR boost in intermediate-risk prostate cancer
E. Vigneault1, G. Morton2, W. Perulekar3, T. Niazi 4, G.
Springer5, M. Barkati6, P. Chung7, W. Koll8, A. Kamran9, M.
Montreal3, K. Ding3, A. Loblaw 2
1CHU de Québec- L'Hôtel Dieu de Québec, Radiation
Oncology and Research Centre, Quebec, Canada
2Odette Cancer Centre, Radiation Oncology, Toronto,
Canada
3Canadian Cancer Trials Group, Queen 's University,
Kingston, Canada
4Mc Gill Jewish General Hospital, Department of
Radiation Oncology, Montreal, Canada
5Windsor Regional Hospital, Radiation Oncology,
Windsor, Canada
6CHUM Hôpital Notre Dame, Radiation Oncology,
Montreal, Canada
7University Health Network Princess Margaret Cancer
Centre, Radiation Oncology, Toronto, Canada
8Lakeridge Hospital, Radiation Oncology, Oshawa,
Canada
9Dr H Bliss Murphy Cancer Centre, Radiation Oncology,
St-John's, Canada
Purpose or Objective
The purpose of this phase II randomized feasibility study
was to assess the ability of Canadian investigators from
multiple institutions to randomize patients to IGRT (Image
Guided Radiotherapy) or IGRT with HDR (High Dose Rate)
brachytherapy boost and to deliver the treatment
according to the highest radiation oncology quality
assurance benchmarks and standards.
Material and Methods
The primary endpoint was to determine the ability to
randomize 60 patients over an 18 months period. Arm 1
(IGRT) patients received 78 Gy in 39 fractions or 60 Gy in
20 fractions (physician’s preference) while Arm 2 (IGRT +
HDR) received 37.5 Gy in 15 fractions with HDR boost of
15Gy. IGRT options were daily imaging with prostate
fiducial markers, cone/fan beam CT images, or ultrasound
localization system. The secondary endpoints included:
acute genitourinary (GU) and gastrointestinal (GI) toxicity,
using NCI Common Terminology Criteria for Adverse Events
(CTCAE V 3.0) at 3 months, validation of a prospectively
defined radiation oncology quality assurance process
including real time peer review and treatment
compliance. All analyses were descriptive; no formal
comparisons between treatment arms were performed.
Results
Between April 2014 and September 2015, 57 NCCN defined
intermediate risk prostate cancer patients were
randomized between IGRT alone (Arm 1) N=29, vs. IGRT
plus HDR brachytherapy boost (Arm 2) N= 28. Overall,
93.0% received the treatment as randomized. There were
4 patients (1 on IGRT arm 1 and 3 patients on the
IGRT+HDR arm 2) who were treated differently from
randomization assignment. For the 29 patients receiving
IGRT (arm 1), there were 14 cases reported with minor
deviations and 3 with major deviations. For patients on
IGRT+HDR (arm 2), there were 18 cases reported with
minor deviations and 2 with major deviations. At 3 months
in the IGRT group (Arm 1), one patient reported grade 3
diarrhea while in the IGRT+HDR group (Arm 2), two
patients reported grade 3 hematuria. No other GI and GU
toxicities were reported.