ESTRO 36 Abstract Book

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S961 ESTRO 36 2017
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Patients treated with Iodine-125 BT with post-implant
dosimetry after at least 5 years of follow-up were
retrospectively assessed. Patients who received
combination therapy (EBRT and BT) and salvage BT were
excluded.
Results
From 616 patients treated between March 2001 and
November 2010, 406 of them were included in the study.
65.5% were low-risk; 30%, intermediate-risk; 4.5%, high-
risk. After a median follow-up of 87.5 months, 61 (15.0%)
patients developed biochemical recurrence. BFFS at 5
and 10 years was 90.6% and 82.2% respectively. There
were no significant differences in the BFFS among the
risk groups (p = 0.294). Nadir ≥ 1 ng/ml was associated
with higher risk of biochemical failure (HR = 5.81; CI 95%:
3.39 to 9.94; p ≤ 0.001). MFS at 5 and 10 years was 98.3%
and 94% respectively. Three patients (0.3%) died from
prostate cancer during follow-up. OS at 5 and 10 years
was 96.2% and 85.1% respectively. Acute and late grade ≥
2 and grade ≥ 3 gastrointestinal toxicity were observed in
5.6% and 0.5% and 4.6% and 0.5%, respectively. Acute
and late grade ≥ 2 and grade ≥ 3 genitourinary toxicity
were 57.3%, 3.6% and 28%, 3.1%, respectively.
Conclusion
Iodine-125 LDR-BT is a safety and efficient treatment for
well-selected prostate cancer patients.
EP-1772 HDR Brachytherapy in the treatment of
Prostate Cancer – the Vienna Experience
O. Komina1, C. Seitz-Kästner 1, J. Hofbauer1, M. Kuntner1,
J. Wimmer1, T. Knocke-Abulesz1, E. Nechvile 1
1 KH Hietzing mit Neurologischem Zentrum Rosenhügel,
Sonderabteilung für Strahlentherapie, Wien, Austria
Purpose or Objective
Radiation Therapy (RT) plays a crucial role in the
treatment of prostate cancer. The advantage of high dose
rate brachytherapy (HDR-BT) as monotherapy or boost to
deliver high radiation dose to the tumor and to spare
organs at risk (OAR) was recently shown in clinical studies.
Material and Methods
We summarized the overall patient data collected in our
institution since 2010 when we implemented the real time
planning system based on 3D ultrasound imaging. Between
2010 and 2015 a total of 256 patients were treated and
584 implants being performed. 47% of the patients with
local disease received HDR-BT alone (4 x 9 Gy on a weekly
basis [n= 22], after 2012 3 x 10,5 Gy every other week [n=
99]). 53% of the patients received combination therapy for
treatment of intermediate or high-risk prostate cancer.
These patients received one or two fractions of HDR-BT
with the doses of 9 or 10,5 Gy respectively combined with
local external beam RT of the prostate only or additional
pelvic lymph node irradiation. 17 patients were treated in
terms of salvage therapy after radical prostatectomy
(RPE), external beam or brachytherapy.
Results
Median age was 69,2 years (range 44,8 - 87,5). The
majority of patients (37%) had Gleason 6 histology, 29%
Gleason 7a, and 9% 7b. High risk patients receiving
exclusively combination therapy had Gleason 8 in 13%,
Gleason 9 in 11% and Gleason 10 in 1% of the cases. The
median V100 for the prostate was 93,7%. No acute grade
≥3 toxicity was observed in the whole cohort of the
patients. Late rectal toxicity was observed predominantly
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. Larrea1, E. López-Muñoz1, P. Antonini 1, V. Gonázlez1,
M.C. Baños2, J. Bea2, M.A. García2
1Clinica Virgen del Consuelo, Radiation Oncology,
Valencia, Spain
2Clinica 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