scholarly journals Variations in Rectal Volumes and Dosimetry Values Including NTCP due to Interfractional Variability When Administering 2D-Based IG-IMRT for Prostate Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Takashi Hanada ◽  
Yutaka Shiraishi ◽  
Toshio Ohashi ◽  
Junichi Fukada ◽  
Tomoki Tanaka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Bleeding ◽  
Patient Population ◽  
Physiological Changes ◽  
Rectal Toxicity ◽  
Dosimetric Verification ◽  
Cbct Analysis ◽  
Initial Prediction

We estimated variations in rectal volumes and dosimetry values including NTCP with interfractional motion during prostate IG-IMRT. Rectal volumes, DVH parameters, and NTCPs of 20 patients were analyzed. For this patient population, the median (range) volume on the initial plan for the rectum was 45.6 cc (31.3–82.0), showing on-treatment spread around the initial prediction based on the initial plan. DVH parameters of on-treatment CBCT analyses showed systematic regularity shift from the prediction based on the initial plan. Using the Lyman-Kutcher-Burman model, NTCPs of predicted late rectal bleeding toxicity of rectal grade ≥ 2 (RTOG) and the QUANTEC update rectal toxicity for the prediction based on the initial plan were 0.09% (0.02–0.24) and 0.02% (0.00–0.07), respectively, with NTCPs from on-treatment CBCT analyses being 0.35% (0.01–6.16) and 0.12% (0.00–4.11), respectively. Using the relative seriality model, for grade ≥ 2 bleeding rectal toxicity, NTCP of the prediction based on the initial plan was 0.64% (0.15–1.22) versus 1.48% (0.18–7.66) for on-treatment CBCT analysis. Interfraction variations in rectal volumes occur in all patients due to physiological changes. Thus, rectal assessment during 2D-based IG-IMRT using NTCP models has the potential to provide useful and practical dosimetric verification.

Dose escalation with high-dose-3D-conformal/IMRT (HD-3D-CRT/IMRT) compared with low-dose 3D-conformal/IMRT plus HDR brachytherapy (LD-3D-CRT/IMRT+HDR-B) for intermediate- or high-risk prostate cancer: Disease control, survival, and toxicity.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 169-169
Author(s):  
Ines Guix ◽  
Jose Maria Bartrina ◽  
Jose Ignacio Tello ◽  
Ivan Garcia ◽  
Luis Quinzaños ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Rectal Bleeding ◽  
Late Effects ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Rectal Toxicity ◽  
Group 2 ◽  
Group 1 ◽  
3D Crt

169 Background: To report early and late toxicity and biochemical outcome in a prospective series of 1,465 patients with intermediate- or high-risk clinically localized prostate cancer treated with either HD-3D-CRT/IMRT or with LD-3D-CRT/IMRT+HDR-B. Methods: Between 12/1999 and 10/2011, 1,465 pts (pts) with PSA›10, Gleason score›6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT or IMRT to the prostate in 38 fractions (group 1; 733 pts) or 46 Gy LD-3D-CRT or IMRT followed by 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 732 pts), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. 94 pts of group 1 (12.8%) and 20 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 49 pts in group 1 (6.7%) and 10 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 102 months, the 10-year free-from-failure survival was 90.7% and 98.3% (p<0.002) in group 1 and 2 respectively; free-from-metastases survival 95.9% and 97.8% (p<0,006)for group 1 and 2 respectively; and cause-specific survival 97.1% and 98.2% (p<0.08). Conclusions: High-dose 3D-EBRT + HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiotherapy. Control rates were significantly better with in the HDR-boosted patients as expected by higher effective-dose.

Rectal toxicity results for patients treated with HDR brachytherapy as monotherapy versus dose-escalated external beam radiotherapy for localized prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 5-5
Author(s):  
Jacob Samuel Parzen ◽  
Hong Ye ◽  
Gary S. Gustafson ◽  
Alvaro Martinez ◽  
Evelyn Sebastian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Bleeding ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
External Beam ◽  
Hdr Brachytherapy ◽  
Rectal Toxicity ◽  
Rectal Pain

5 Background: We present a large retrospective analysis comparing rectal toxicity following high dose rate (HDR) brachytherapy as monotherapy relative to dose-escalated external beam radiotherapy (EBRT) for patients with localized prostate cancer. Methods: 2683 patients treated with HDR or EBRT between 1994 and 2017 were included. 545 (20.3%) received HDR and 2138 (79.7%) EBRT. HDR fractionation was 38 Gy/4 fractions (n=321), 24 Gy/2 (n=96), or 27 Gy/2 (n=128). EBRT patients received a median dose of 75.6 Gy in 1.8 Gy fractions [range 70.2-82.8 Gy], using either 3D conformal or intensity modulated radiotherapy (IMRT). All EBRT patients underwent 3D image guidance via an off-line adaptive process. Treatment was directed to prostate only (n=780) or prostate and seminal vesicles (n=1351). No nodal therapy was given. Target volume for HDR patients included the prostate with no expansion. Acute and chronic gastrointestinal (GI) toxicity was defined as occurring ≤ 6 and > 6 months, respectively, after radiotherapy and was graded per CTCAE version 3.0. Toxicity variables were analyzed with χ2 test. Results: Median follow-up was 7.5 years (7.4 years for EBRT and 7.9 years for HDR). 69.1% of EBRT patients received IMRT with the remainder treated using 3D conformal technique. Compared to EBRT, HDR was associated with decreased rates of acute grade ≥ 2 diarrhea (0.7% vs. 4.5%, p < 0.001), rectal pain/tenesmus (0.6% vs. 7.9%, p < 0.001), and rectal bleeding (0% vs. 1.6%, p=0.001). Rates of chronic grade ≥ 2 rectal bleeding (1.3% vs. 8.7%, p < 0.001) and radiation proctitis (0.9% vs. 3.3%, p=0.001) favored HDR over EBRT. Rates of any chronic rectal toxicity grade ≥ 2 were 2.4% vs. 10.5% (p < 0.001) for HDR vs. EBRT, respectively. For the 1478 EBRT patients treated with IMRT, acute and chronic rates of any grade ≥ 2GI toxicity were 4.2% and 5.6%, respectively, compared to 1.5% (p=0.002) and 2.4% (p=0.002), respectively, for HDR patients. Conclusions: In appropriately selected patients with localized prostate cancer undergoing definitive radiation therapy, HDR brachytherapy as monotherapy is an effective strategy for reducing acute and chronic rectal toxicity.

Proton therapy for prostate cancer: An analysis of rectal toxicity outcomes at University of Florida Proton Therapy Institute (UFPTI).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 161-161
Author(s):  
Rovel J. Colaco ◽  
Bradford S. Hoppe ◽  
Randal H. Henderson ◽  
Romaine Charles Nichols ◽  
Christopher G. Morris ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Dose ◽  
Proton Therapy ◽  
Rectal Bleeding ◽  
Treatment Technique ◽  
Rectal Toxicity ◽  
University Of Florida ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Grade 3

161 Background: We aimed to characterize gastrointestinal effects of proton therapy (PT) in patients treated for prostate cancer, identify factors associated with rectal bleeding (RB), and compare RB between patients on investigational protocols (IP) versus outcome tracking protocols (OTP). Methods: 1,290 patients treated consecutively with PT between August 2006 and June 2010 were studied. Pre-existing potential risk factors for RB (hemorrhoids, diabetes, aspirin, other anticoagulants) were recorded. Common terminology criteria for adverse events (CTCAE version 4.0) were used to grade toxicity. Median follow up was 3.5 years. Results: The majority (94.6%) of Grade 2 or higher gastrointestinal toxicity (GR2+) events after PT were rectal bleeding. GR1 RB occurred in 390 (30.2%) of patients, including those requiring no prescription intervention (82.6%) and those placed on a vitamin A regimen (16.3%). GR2 RB occurred in 14.7% of patients, including patients requiring prescription rectal suppositories (9.5%), cautery (4.9%), or hyperbaric oxygen (0.3%). Grade 3 (GR3) occurred in 0.8% of patients, including those requiring transfusion (0.6%) or colostomy (0.1%). Multivariate analyses showed that pretreatment daily aspirin (p=0.03), other anticoagulation (p=0.001), and the volume of rectum exposed to radiation dose levels (V70) (<.0001) were associated with an increased risk of Gr2+RB. Patients treated on investigational protocols (IP) had similar toxicity rates as those treated on an outcomes tracking protocol (OTP). Reduced rectal toxicity was noted in latter years of the study, which correlated with changes in treatment technique, pretreatment evaluation, and post-treatment supportive care regimens. Conclusions: PT was associated with low rates of GI toxicity, the most common toxicity being transient RB. GR2+RB is strongly associated with patient use of aspirin, other anti-coagulation and radiation dose volume parameters.

P024 Late rectal toxicity after RT for prostate cancer: Case of patients with moderate/severe basal symptoms

2014 ◽  
Vol 13 (5) ◽  
pp. 117
Author(s):  
G. Fellin ◽  
T. Rancati ◽  
V. Vavassori ◽  
C. Fiorino ◽  
R. Valdagni
Keyword(s):  
Prostate Cancer ◽  
Cancer Case ◽  
Prostate Cancer Case ◽  
Rectal Toxicity ◽  
Late Rectal Toxicity

scholarly journals Results and DVH analysis of late rectal bleeding in patients treated with 3D-CRT or IMRT for localized prostate cancer

2014 ◽  
Vol 56 (1) ◽  
pp. 122-127 ◽  
Author(s):  
M. Someya ◽  
M. Hori ◽  
K. Tateoka ◽  
K. Nakata ◽  
M. Takagi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Bleeding ◽  
Localized Prostate Cancer ◽  
3D Crt

Relationships between DVHs and late rectal bleeding after radiotherapy for prostate cancer: analysis of a large group of patients pooled from three institutions

2002 ◽  
Vol 64 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Claudio Fiorino ◽  
Cesare Cozzarini ◽  
Vittorio Vavassori ◽  
Giuseppe Sanguineti ◽  
Carla Bianchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Bleeding ◽  
Large Group

scholarly journals New sparse implantation technique of I-125 low-dose-rate brachytherapy using concomitant short-term hormonal treatment for low and intermediate-risk prostate cancer: An initial study of therapeutic feasibility

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Young Dong Yu ◽  
Jong Jin Oh ◽  
Hyun Soo Shin ◽  
Dong Soo Park
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Low Dose ◽  
Implantation Dose ◽  
Implantation Technique ◽  
Intermediate Risk ◽  
Rectal Toxicity ◽  
Oncological Outcomes ◽  
Low Dose Rate ◽  
Post Implantation

AbstractThis study aimed to evaluate the oncological outcomes and post-implantation complications of the concurrent androgen deprivation therapy (ADT) with I-125 low-dose-rate (LDR)-prostate brachytherapy (sparse implantation technique: SIT) in comparison with the conventional non-ADT using whole gland brachytherapy (CWT). 302 localized prostate cancer (PCa) patients were treated with CWT (implantation dose: 145 Gy) and 215 patients were treated with SIT, which applied reduced implantation dose of 123.5 Gy. SIT group had ADT consisting of bicalutamide 50 mg/day plus 3-month depot (11.25 mg) of leuprolide acetate subcutaneously on the post-implantation day-0. Post-implantation complications and biochemical-recurrence-free-survival (BCRS) were compared between the two groups. After ADT, SIT group had 40.9% patients (40.9%) with prostate volume reduction between 20–30%. At 3-months post-implantation, SIT group presented significantly better IPSS than CWT group (p = 0.038). Both groups showed decrease in IIEF-5 score at 3-months post-implantation, but ST group showed significantly better mean IIEF-5 scores (13.5) than the CWT group (11.1) (p = 0.045). For 3-months post-implantation dosimetry, both groups showed no significant differences regarding D90 (CWT 156 Gy vs. SIT 152 Gy). CWT group had 3 patients with rectal toxicity ≥radiation therapy oncology group (RTOG) grade 2 and 1 patient with urinary toxicity ≥RTOG grade 2 whereas SIT group had no patient with urinary or rectal toxicity ≥RTOG grade 2. Kaplan-Meier analyses showed no significant differences regarding PCSS were observed between the two groups (p = 0.350). The SIT group showed compatible oncological outcomes to the CWT and relatively smaller number of post-implantation complications within low- and intermediate-risk PCa patients.

Age and Comorbid Illness Are Associated With Late Rectal Toxicity Following Dose-Escalated Radiation Therapy for Prostate Cancer

2013 ◽  
Vol 85 (5) ◽  
pp. 1246-1253 ◽  
Author(s):  
Daniel A. Hamstra ◽  
Matt H. Stenmark ◽  
Tim Ritter ◽  
Dale Litzenberg ◽  
William Jackson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Comorbid Illness ◽  
Rectal Toxicity ◽  
Late Rectal Toxicity
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