ESTRO 36 Abstract Book

978 / 1082

S962 ESTRO 36 2017
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1 CHU de Québec- L'Hôtel Dieu de Québec, Radiation
Oncology and Research Centre, Quebec, Canada
2 Odette Cancer Centre, Radiation Oncology, Toronto,
Canada
3 Canadian Cancer Trials Group, Queen 's University,
Kingston, Canada
4 Mc Gill Jewish General Hospital, Department of
Radiation Oncology, Montreal, Canada
5 Windsor Regional Hospital, Radiation Oncology,
Windsor, Canada
6 CHUM Hôpital Notre Dame, Radiation Oncology,
Montreal, Canada
7 University Health Network Princess Margaret Cancer
Centre, Radiation Oncology, Toronto, Canada
8 Lakeridge Hospital, Radiation Oncology, Oshawa,
Canada
9 Dr 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.
Conclusion
The pilot study demonstrated the feasibility of
randomization between treatment with IGRT alone vs
IGRT + HDR boost. Treatment compliance was good
including adherence quality assurance.
EP-1775 Acute toxicity in early cancer prostate
patients: low dose rate vs high dose rate monotherapy.
S. Rodríguez Villalba1, A. Otal Palacín1, J. Richart
Sanchez 1, J. Pérez-Calatayud2,3, M. Santos Ortega1
1 Clinica Benidorm, Radiotherapy Department, Benidorm,
Spain
2 Clinica Benidorm and Hospital La Fe, Radiotherapy
Department, Benidorm, Spain
3Hospital La Fe, Radiothetherapy Department, Valencia,
Spain
Purpose or Objective
Brachytherapy (BT) in their two modalities, Low dose rate
(LDR) and High Dose Rate (HDR) are used in prostate
cancer. At present, all available clinical data regarding
these two techniques suggests that they are equally
effective, providing high tumor control rates. We compare
our experience considering acute toxicity in patients with
low or intermediate stages treated with LDR BT or HDR BT
in monotherapy.
Material and Methods
Between January 2004 and June 2016 we have treated 113
patients with BT as an exclusively treatment, 85 patients
with permanent LDR with Iodine-125 seeds and 28 with
HDR Ir-192. Both modalities were performed using
ultrasound based intraoperative techniques.
Results
LDR BT PATIENTS: Median age 68 years (48-81 y), median
Gleason 5 (2-7), median value of PSA at diagnosis 7,3
ng/ml (2,5-16,3). 70 patients (82%) low risk (DÁmico
classification) and 15 (18%) intermediate risk. In 25 cases
(29%) the prescription dose was 145 Gy and in 60 (71%) 160
Gy. Thirty-three (39%) received hormonal treatment.
HDR BT PATIENTS: Median age 70,5 years (55-80 y),
median Gleason 6 (3-8), median value of PSA at diagnosis
9,08 ng/ml (3-19,75). 12 patients (42%) low risk (DÁmico
classification) and 16 (58%) intermediate risk. All patients
were treated with 2 applications of 13,5 Gy in
monotherapy. Twenty (71%) received hormonal
treatment.
We analyze the acute toxicity of both treatments
following criteria CTCEV.3 and the results are presented
on the table.
There are not Grade 3 o 4 acute toxicity.
GRADE 0
LDR/HDR
GRADE
1
LDR/HD
R
GRADE
2
LDR/HD
R
HAEMATURIA 100%/ 100% 0%/ 0% 0%/ 0%
CYSTITIS 35%/ 100% 3%/ 0% 21%/ 0%
INCONTINENCY
URYNARY
97%/ 87% 0%/ 8% 3%/ 4%
OBSTRUCCION
URYNARY 60%/ 100% 15%/ 0% 30%/0%
URINARY
FRECUENCY/URGEN
CY
41%/ 96% 9%/ 0% 47%/ 4%
URINARY RETENTION 94%/ 100% 3%/ 0% 3%/ 0%
DIARRHEA 94%/ 100% 3%/ 0% 3%/ 0%
RECTAL
INCONTINENCY 100%/ 100% 0%/ 0% 0%/ 0%
RECTITIS 94%/ 96% 6%/ 4% 0%/ 0%
Conclusion
In this analyses the acute genitourinary toxicity was higher
when the patient were treated with LDR BT including 2
patients (3%) who needed urinary catheter after the
implant. We did not find any differences in
gastrointestinal toxicity with and excellent tolerance in
both groups.
Electronic Poster: Brachytherapy: Gynaecolgy
EP-1776 Is a single CT plan for vaginal cylinder
brachytherapy adequate?
M. Zahra1, M. Doak1, W. Keough2
1Western General Hospital- Edinburgh Cancer Centre,