Intensity-modulated radiotherapy causes fewer side effects than three-dimensional conformal radiotherapy when used in combination with brachytherapy for the treatment of prostate cancer.
ABSTRACT To measure the benefits of intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3D-CRT) when used in combination with brachytherapy for the treatment of prostate cancer.
We conducted a retrospective review of all patients with localized prostate cancer who received external-beam radiotherapy (EBRT) in combination with brachytherapy with at least 1 year follow-up (n = 812). Combination therapy consisted of (103)Pd or (125)I implant, followed by a course of EBRT. From 1993 to March 2003 521 patients were treated with 3D-CRT, and from April 2003 to March 2009 291 patients were treated with IMRT. Urinary symptoms were prospectively measured with the International Prostate Symptom Score questionnaire with a single quality of life (QOL) question; rectal bleeding was assessed per the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. The Pearson χ(2) test was used to compare toxicities experienced by patients who were treated with either IMRT or 3D-CRT. Logistic regression analyses were also performed to rule out possible confounding factors.
Within the first 3 months after treatment, patients treated with 3D-CRT scored their urinary symptoms as follows: 19% mild, 44% moderate, and 37% severe; patients treated with IMRT scored their urinary symptoms as follows: 36% mild, 47% moderate, and 17% severe (p < 0.001). The 3D-CRT patients rated their QOL as follows: 35% positive, 20% neutral, and 45% negative; IMRT patients rated their QOL as follows: 51% positive, 18% neutral, and 31% negative (p < 0.001). After 1 year of follow-up there was no longer any difference in urinary morbidity between the two groups. Logistic regression confirmed the differences in International Prostate Symptom Score and QOL in the acute setting (p < 0.001 for both). Grade ≥ 2 rectal bleeding was reported by 11% of 3D-CRT patients and 7% of IMRT patients (p = 0.046); logistic regression analysis also confirmed this observation (p = 0.040).
When used in combination with brachytherapy, IMRT offers less Grade ≥ 2 rectal bleeding, less acute urinary toxicities, and is associated with a higher QOL compared with 3D-CRT.
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ABSTRACT: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥grade 2 proctitis. A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Actuarial risk of ≥grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following BT.International journal of radiation oncology, biology, physics 08/2013; 86(5):842-847. · 4.59 Impact Factor
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ABSTRACT: Die Häufigkeit, ein fortgeschrittenes Prostatakarzinom zu diagnostizieren, ist seit Einführung der PSA-Diagnostik drastisch gesunken. Die Therapie dieser Patientengruppe ist jedoch aufgrund der schlechten Prognose eine Herausforderung, welche seit Jahren kontrovers diskutiert wird. Neben der Frage der Radiatio der Lymphabflusswege wird die aktuelle Datenlage zur kombinierten Strahlentherapie mit hormonablativer Therapie dargestellt. Das Risiko von PSA-Rezidiven nimmt zu, seit radikale Prostatektomien von Patienten mit hohen Risikofaktoren oder fortgeschrittenen Tumoren häufiger durchgeführt werden. Hier hat entweder die adjuvante oder die Salvage-Radiatio einen festen Platz im Therapiealgorithmus des Prostatakarzinoms. Die LDR- und die HDR-Brachytherapie sind primäre Therapieoptionen bei Patienten mit niedrigen bzw. hohen Risikofaktoren und lokalisierter Erkrankung. Ein gutes Nebenwirkungsmanagement ist notwendig, um auftretende therapieassoziierte Symptome anhaltend zu lindern. Dieser Artikel vermittelt die möglichen Nebenwirkungen einer Strahlentherapie und die Behandlungskonzepte. Radiogene Zweittumoren stellen eine schwerwiegende Folge nach Strahlentherapie dar; auch hierzu wird eine Einschätzung der vorhandenen Daten dargelegt.Der Urologe 12/2012; 51(12). · 0.44 Impact Factor
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ABSTRACT: BACKGROUND AND PURPOSE: To determine the dose constraints for rectal bleeding in brachytherapy (BRT) combined with external beam radiotherapy (EBRT). MATERIALS AND METHODS: Post-BRT, pelvic computed tomography images were used for subsequent EBRT planning and BRT postplans in 37 patients. The physical doses for each plan were converted to biologically effective doses, and corresponding voxel doses were integrated to plot the summed dose-volume histogram (sum-DVH). Between 5 patients with (bled-pts) and 32 without (spared-pts) grade 2 or 3 rectal bleeding, the differences in the mean minimal dose (rDn) covering the rectal volume of 0.5-10.0cc and the rectal volume (rVn) receiving the calculated dose of 20-150Gy were compared. RESULTS: The differences in the summed-rDn were determined by BRT exposure, while those of the summed-rVn were determined in the low-dose range and superimposed in the high-dose range by EBRT exposure. Of the 13 patients with rV150 of >1.2cc, 4 were bled-pts (30.8%). Of the 24 patients with rV150 of ≦1.2cc, 1 was a bled-pts (4.2%) (p=0.024; odds ratio, 10.2; CI (95%), 1.0-104.3). CONCLUSIONS: The mono-scale DVH analysis is a promising method for exploring the threshold for rectal bleeding in combined radiotherapy.Radiotherapy and Oncology 03/2013; · 4.86 Impact Factor