Bladder neck resection prior to I125 LDR brachytherapy improves post-implant urinary toxicity. A...
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OR71 Presentation Time: 3:10 PM Prospective analysis of long-term health-related quality-of-life after permanent brachytherapy for prostate cancer Pedram Derakhshani, M.D. 1,2 Gregor Spira, M.D. 1,3 Carsten Weise, M.D. 1,3 Stephan Neubauer, M.D. 1,2 1 West German Prostate Center, Klinik am Ring, Cologne, Germany; 2 Urology, Klinik am Ring, Cologne, Germany; 3 Radiooncology, Klinik am Ring, Cologne, Germany. Purpose: Important criteria for patients seeking non-surgical treatment options for localized prostate cancer are expected influences on their quality of life. The aim of our study was to evaluate long-term urinary, bowel and sexual function status prospectively after permanent brachytherapy (PB) with I-125 seeds using validated quality-of-life (QoL) questionnaires. Methods and Materials: 939 patients were treated in a single European institution with permanent seed implants between December 2000 and June 2006 using iodine stranded seeds. Out of those 506 consecutive patients (treated between July 2004 and June 2006) were separated and followed in terms of QoL, urinary function and sexual status. Validated questionnaires (IPSS, EORTC QLQ-C30, PR25-Prostate-Module, IIEF5) were administered to patients before and at 1, 3, 6, 12, 24, and 36 months after treatment. Results: Median followup of patients was 32.4 months (16 to 41 months). Urinary function (before PB mean IPSS 6.7) significantly worsened at 3 and 6 months after PB (mean IPSS 13.2/9.9) but returned to pre-treatment levels after 12 months (mean IPSS 8.2). Urinary bother score (UB) in PR25 was significantly worse at 3 and 6 months after PB and reached baseline at 12 months. 67.7% of patients had normal erectile function in IIEF5 before PB. In potent patients erectile dysfunction was noted at intervals 12, 24 and 36 months after PB in 35.3%, 31.8% and 33%. General health status (GHS) before PB was excellent (score 88.85) and remained stable at all intervals after PB (mean score 89.82). There was no change in bowel function (BF) throughout the study period (before PB score 3.06, after PB mean score 5.1). Conclusions: General health status of patients after permanent prostate implant is excellent throughout the treatment period. The rate of long- term erectile dysfunction remains low. The results of our study show that permanent brachytherapy leads to only minor deterioration in quality of life and transient urinary symptoms. OR72 Presentation Time: 3:20 PM Bladder neck resection prior to I 125 LDR brachytherapy improves post-implant urinary toxicity. A matched-pair analysis Stelios Voulgaris, MBBS 1 Sara J. Khaksar, MRCP, FRCR 2 Jenny P. Nobes, MRCP 2 Anita McGrogan 3 Robert W. Laing, MRCP, FRCR 2 Stephen E.M. Langley, MS, FRCS 1 1 Urology, St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom; 2 Clinical Oncology, St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom; 3 Pharmacoepidemiology, University of Surrey, Guildford, Surrey, United Kingdom. Purpose: To evaluate the effect of bladder neck resection (BNR) prior to brachytherapy (BXT) on patients’ International Prostate Symptom Score (IPSS) and urinary Quality of Life (QoL) score three and six months post- implant. Methods and Materials: A total of 30 patients underwent BNR for obstructive symptoms and/or obstructive uroflowmetry prior to BXT between August 2006 and October 2007 at a single institution. Twenty two (73.3%) received BXT as monotherapy, 4 (13.3%) neoadjuvant androgen deprivation (NAAD) plus BXT and 4 (13.3%) combination of NAAD, BXT and external beam radiotherapy (EBRT). Patients’ prostate volume and Qmax at baseline were documented. IPSS and QoL score were reported at baseline, post-BNR but prior to BXT and finally three and six months post-implant. Using our centre’s prospective database of over 1200 patients to date, a matched contemporaneous control group was identified for every treatment group (BXT, NAAD+BXT or NAAD+BXT+EBRT) using as inclusion criteria prostate size and Qmax prior to treatment. Changes from baseline in IPSS and QoL score for patients were assessed at 3 and 6 months. A positive change is indicating worsening of symptoms. A Wilcoxon signed rank sum test was used. Results: Statistical analysis for the NAAD+BXT and NAAD+BXT+EBRT groups was not feasible due to insufficient number of cases. Analysis for the BXT as monotherapy group showed that patients who had a BNR experienced less deterioration in their IPSS than those in the control group at 3 and 6 months. Median IPSS change at 3 months was 5 and 8 for the BNR and control group, respectively (p 5 0.008). At 6 months the median IPSS change was 2.5 and 6.5, respectively (p 5 0.001). However, a significant improvement in QoL was only demonstrated at the 6 month interval. At 3 months median QoL score change was 1 and 2 for the BNR and control groups respectively (p 5 0.129). Median change of QoL score at six months was 0 and 2, respectively (p 5 0.015). Conclusions: BNR appears to improve early urinary toxicity in suitably selected patients undergoing BXT. Longer followup as well as further analysis of other parameters is planned. OR73 Presentation Time: 3:30 PM Patterns of death following permanent prostate brachytherapy Nathan Bittner, M.D. 2 Gregory S. Merrick, M.D. 1 Robert Galbreath, Ph.D. 4 Wayne M. Butler, Ph.D. 1 Kent E. Wallner, M.D. 3 Zachariah A. Allen, M.S. 1 Sarah G. Brammer, B.S. 1 1 Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV; 2 Radiation Oncology, University of Washington Medical Center, Seattle, WA; 3 Radiation Oncology, Department of Veterans Affairs, Seattle, WA; 4 Ohio University Eastern, St. Clairsville, OH. Purpose: To evaluate patterns of death in low-risk (LR), intermediate-risk (IR) and high-risk (HR) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. Methods and Materials: From April 1995 through November 2004, 1,354 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years prior to analysis. Androgen deprivation therapy was administered to 532 patients (39.3%). Of those patients, 361 received ADT for <6 months while 171 received O6 months of ADT. Seven hundred and three patients (51.9%) received supplemental XRT. The median and mean followup was 5.4 and 5.7 years, respectively. Multiple clinical, treatment and dosimetric parameters were evaluated as predictors of cause-specific (CSS), biochemical progression-free (bPFS) and overall survival (OS). Results: For the entire cohort, the 11-year CSS was 97.0% (99.7%, 99.0% and 90.1% for LR, IR and HR). OS was 74.8% (82.5%, 78.3% and 61.9% for LR, IR and HR). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3% and 19.8% for LR, IR and HR). The death rate from second malignancies (non-prostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0% and 10.8% for LR, IR and HR. High-risk patients were most likely to receive ADT, especially prolonged courses ( O 6 months). In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group while death due to cardiovascular, non-prostate cancer and all other causes were most closely related to patient age and tobacco. Conclusions: Death from prostate cancer represented approximately 10% of all deaths with cardiovascular mortality predominating. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients was primarily due to an excess of cardiovascular deaths. Changes in lifestyle to improve cardiovascular health including cessation of tobacco and minimization of ADT use may improve overall survival in patients with clinically localized prostate cancer. 117 Abstracts / Brachytherapy 7 (2008) 91e194
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Transcript of Bladder neck resection prior to I125 LDR brachytherapy improves post-implant urinary toxicity. A...
117Abstracts / Brachytherapy 7 (2008) 91e194
OR71 Presentation Time: 3:10 PM
Prospective analysis of long-term health-related quality-of-life
after permanent brachytherapy for prostate cancer
Pedram Derakhshani, M.D.1,2 Gregor Spira, M.D.1,3 Carsten Weise,
M.D.1,3 Stephan Neubauer, M.D.1,2 1West German Prostate Center, Klinik
am Ring, Cologne, Germany; 2Urology, Klinik am Ring, Cologne,
Germany; 3Radiooncology, Klinik am Ring, Cologne, Germany.
Purpose: Important criteria for patients seeking non-surgical treatmentoptions for localized prostate cancer are expected influences on theirquality of life. The aim of our study was to evaluate long-term urinary,bowel and sexual function status prospectively after permanentbrachytherapy (PB) with I-125 seeds using validated quality-of-life (QoL)questionnaires.Methods and Materials: 939 patients were treated in a single Europeaninstitution with permanent seed implants between December 2000 andJune 2006 using iodine stranded seeds. Out of those 506 consecutivepatients (treated between July 2004 and June 2006) were separated andfollowed in terms of QoL, urinary function and sexual status. Validatedquestionnaires (IPSS, EORTC QLQ-C30, PR25-Prostate-Module, IIEF5)were administered to patients before and at 1, 3, 6, 12, 24, and 36 monthsafter treatment.Results: Median followup of patients was 32.4 months (16 to 41 months).Urinary function (before PB mean IPSS 6.7) significantly worsened at 3and 6 months after PB (mean IPSS 13.2/9.9) but returned to pre-treatmentlevels after 12 months (mean IPSS 8.2). Urinary bother score (UB) inPR25 was significantly worse at 3 and 6 months after PB and reachedbaseline at 12 months. 67.7% of patients had normal erectile function inIIEF5 before PB. In potent patients erectile dysfunction was noted atintervals 12, 24 and 36 months after PB in 35.3%, 31.8% and 33%.General health status (GHS) before PB was excellent (score 88.85) andremained stable at all intervals after PB (mean score 89.82). There was nochange in bowel function (BF) throughout the study period (before PBscore 3.06, after PB mean score 5.1).Conclusions: General health status of patients after permanent prostateimplant is excellent throughout the treatment period. The rate of long-term erectile dysfunction remains low. The results of our study show thatpermanent brachytherapy leads to only minor deterioration in quality oflife and transient urinary symptoms.
OR72 Presentation Time: 3:20 PM
Bladder neck resection prior to I125 LDR brachytherapy improves
post-implant urinary toxicity. A matched-pair analysis
Stelios Voulgaris, MBBS1 Sara J. Khaksar, MRCP, FRCR2 Jenny P. Nobes,
MRCP2 Anita McGrogan3 Robert W. Laing, MRCP, FRCR2 Stephen E.M.
Langley, MS, FRCS1 1Urology, St Luke’s Cancer Centre, Royal Surrey
County Hospital, Guildford, Surrey, United Kingdom; 2Clinical Oncology,
St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey,
United Kingdom; 3Pharmacoepidemiology, University of Surrey,
Guildford, Surrey, United Kingdom.
Purpose: To evaluate the effect of bladder neck resection (BNR) prior tobrachytherapy (BXT) on patients’ International Prostate Symptom Score(IPSS) and urinary Quality of Life (QoL) score three and six months post-implant.Methods and Materials: A total of 30 patients underwent BNR forobstructive symptoms and/or obstructive uroflowmetry prior to BXTbetween August 2006 and October 2007 at a single institution. Twentytwo (73.3%) received BXT as monotherapy, 4 (13.3%) neoadjuvantandrogen deprivation (NAAD) plus BXT and 4 (13.3%) combination ofNAAD, BXT and external beam radiotherapy (EBRT). Patients’ prostatevolume and Qmax at baseline were documented. IPSS and QoL scorewere reported at baseline, post-BNR but prior to BXT and finally threeand six months post-implant. Using our centre’s prospective database ofover 1200 patients to date, a matched contemporaneous control group
was identified for every treatment group (BXT, NAAD+BXT orNAAD+BXT+EBRT) using as inclusion criteria prostate size and Qmaxprior to treatment. Changes from baseline in IPSS and QoL score forpatients were assessed at 3 and 6 months. A positive change isindicating worsening of symptoms. A Wilcoxon signed rank sum testwas used.Results: Statistical analysis for the NAAD+BXT and NAAD+BXT+EBRTgroups was not feasible due to insufficient number of cases. Analysis forthe BXT as monotherapy group showed that patients who had a BNRexperienced less deterioration in their IPSS than those in the controlgroup at 3 and 6 months. Median IPSS change at 3 months was 5 and 8 forthe BNR and control group, respectively (p 5 0.008). At 6 months themedian IPSS change was 2.5 and 6.5, respectively (p 5 0.001). However,a significant improvement in QoL was only demonstrated at the 6 monthinterval. At 3 months median QoL score change was 1 and 2 for the BNRand control groups respectively (p 5 0.129). Median change of QoL scoreat six months was 0 and 2, respectively (p 5 0.015).Conclusions: BNR appears to improve early urinary toxicity in suitablyselected patients undergoing BXT. Longer followup as well as furtheranalysis of other parameters is planned.
OR73 Presentation Time: 3:30 PM
Patterns of death following permanent prostate brachytherapy
Nathan Bittner, M.D.2 Gregory S. Merrick, M.D.1 Robert Galbreath, Ph.D.4
Wayne M. Butler, Ph.D.1 Kent E. Wallner, M.D.3 Zachariah A. Allen, M.S.1
Sarah G. Brammer, B.S.1 1Schiffler Cancer Center, Wheeling Hospital,
Wheeling, WV; 2Radiation Oncology, University of Washington Medical
Center, Seattle, WA; 3Radiation Oncology, Department of Veterans Affairs,
Seattle, WA; 4Ohio University Eastern, St. Clairsville, OH.
Purpose: To evaluate patterns of death in low-risk (LR), intermediate-risk(IR) and high-risk (HR) patients undergoing permanent prostatebrachytherapy with or without supplemental therapies.Methods and Materials: From April 1995 through November 2004, 1,354consecutive patients underwent brachytherapy for clinical stage T1b-T3a(2002 AJCC) prostate cancer. All patients underwent brachytherapy morethan 3 years prior to analysis. Androgen deprivation therapy wasadministered to 532 patients (39.3%). Of those patients, 361 receivedADT for <6 months while 171 received O6 months of ADT. Sevenhundred and three patients (51.9%) received supplemental XRT. Themedian and mean followup was 5.4 and 5.7 years, respectively. Multipleclinical, treatment and dosimetric parameters were evaluated as predictorsof cause-specific (CSS), biochemical progression-free (bPFS) and overallsurvival (OS).Results: For the entire cohort, the 11-year CSS was 97.0% (99.7%, 99.0%and 90.1% for LR, IR and HR). OS was 74.8% (82.5%, 78.3% and 61.9%for LR, IR and HR). The cumulative death rate for cardiovascular diseasewas 11.5% (8.7%, 9.3% and 19.8% for LR, IR and HR). The death ratefrom second malignancies (non-prostate cancer) was 7.2% and was notsubstantially different when stratified by risk group. Death from allother causes was 6.5% for the entire cohort but 1.3%, 5.0% and 10.8%for LR, IR and HR. High-risk patients were most likely to receiveADT, especially prolonged courses (O6 months). In multivariateanalysis, death from prostate cancer was best predicted by Gleasonscore and risk group while death due to cardiovascular, non-prostatecancer and all other causes were most closely related to patient age andtobacco.Conclusions: Death from prostate cancer represented approximately 10%of all deaths with cardiovascular mortality predominating. In particular,overall survival was poorest in the high-risk group. Although high-riskpatients were most likely to die of prostate cancer, the divergence inoverall survival between high-risk and lower-risk patients was primarilydue to an excess of cardiovascular deaths. Changes in lifestyle to improvecardiovascular health including cessation of tobacco and minimization ofADT use may improve overall survival in patients with clinicallylocalized prostate cancer.
