World Congress of Brachytherapy 10-12 May, 2012 - Estro-events.org

S82 World Congress of Brachytherapy 2012
: Permanent 125 I seed BT is a successful and established
treatment of earlystage prostate cancer. Although this sample
represents the learning curve of our institution the outcomes are
similar to the literature.
PO202
LONG TERM RESULTS WITH MULTIMODALITY RADIOTHERAPY (3D, IGRT,
LDRBT, HDRBT) IN PROSTATE ADENOCARCINOMA
S. Rodríguez Villalba 1 , M. Santos Ortega 1 , M. Deppiagio 1 , J. Pérez
Calatayud 1 , J. Richart 1 , F. Ballester 2
1
Clinica Benidorm, Radiation Oncology, Benidorm, Spain
2
Valencia University, Atomic Molecular and Nuclear Physicist,
Valencia, Spain
: A retrospective analysis is made evaluating the
toxicity and efficacy of different multimodality radiotherapy
approaches for organ confined prostate cancer in our Institution with
a minimum followup of 12 months.
: From September 2004 to December 2010 we
have treated in our Department with a radical treatment 262
patients. Our protocol has been based with uniformity on the risk
classification of prostate adenocarcinoma. It includes external
radiotherapy (extRT)(3D or IGRT) or LDRBT in low risk patients, IGRT
or combined treatment (3D over prostate and seminal vesicles+
LDRBT) in intermediate risk patients and IGRT or combined treatment
(IMRT over pelvis and HDRBT) in high risk patients. 48 p (18.3%) have
been treated with extRT3D, 58p(22%) with IGRT, 68p (26%) with
LDRBT, 59 p (22.5%) with combined 3D + LDRBT and 29p (11.1%) with
combined IMRT and HDRBT. Median age 71 years (4687 y). Median PSA
at diagnostic 9.74 ng/ml (2.5 500 ng/ml). Median Gleason 6 (29). 75
p (29%) were included in low risk (LR), 97 (37%) intermediate risk (IR)
and 90 (34%) in high risk (HR).
: The local control have been reach in 254 p (97%). All patients
treated with IGRT, 3D+ LDRBT and IMRT + HDRBT are under local
control. Two patients treated with 3D and 6 p (9%) treated with
LDRBT exclusively have local failure. The local failure have been
produced in 1 patient treated with 7200 cGy and 1p treated with 7560
cGy.
Biochemical failure have been reached in 8p (3%). 2p (0.8%) of LR, 4
(1.5%) IR and 2p (0.8%) of HR
We have evidenced lymph node failure in 6p (2%). One p (0.4%) of IR
and 5p (1.9%) of HR. 3p treated with extRT3D (1%), 2p IGRT (0.8%) and
1 p with 3D+ LDRBT (0.4%).
Distance failure in 13p (5%).5p (1.9%) of IR and 8 p (3.1%) of HR. 6 p
treated with extRT3D (3.3%), 4 with IGRT (1.6%), 1 with LDRBT (0.4%)
and 2 with 3D+ LDRBT (0.8%).
The toxicity evaluated is:
GENITOURINARY (GU) TOXICITY # TREATMENT
GRADE 3
Hematuria 4 p 3 p IGRT and 1p with 3D+
(1.5%) LDRBT
Cystitis 1p IGRT
(0.4%)
Urinary obstruction 3p 1p IGRT and 2p LDRBT
(1.1%)
Urethral stenosis 4p
(1.5%)
Increased of the urinary frequency 2p
(0.8%)
Urinary retention 2p
(0.8%)
GASTROINTESTINAL (GI) TOXICITY
GRADE 3
Diarrhea 1p
(0.4%)
Rectitis 23p
(8.8%)
2p IGRT and 2p 3D +
LDRBT
1p IGRT and 1p 3D +
LDRBT
IMRT and HDRBT
IGRT
IGRT
Median time for GU toxicity 3 months (148 months).
Median time for GI toxicity 10.5 months (040 months).
Only one patient treated with 3D+ LDRBT had rectitis grade 3. This
patient was treated previously of an embolism of an iliac aneurism
several years ago with changes in the vascular drainage).
At the end of the followup, December of 2010, 216 p (82%) are alive
without any evidence of disease, 4 p (1.5%) are alive with Biochemical
failure, 18 (7%) have died of an intercurrent disease, 4 (1.5%) have
loose of control, 13 p (5%) live with active prostate disease and 7 (3%)
have died of prostate tumor. The median followup is 35.5 months (5
88 months)
: Despite the good outcomes obtained with the different
radiotherapy approaches our results shows a better disease control
with more intensive radiotherapy doses. In our experience,
combination modalities with BT techniques achieve more intensity
treatments with lesser toxic events, mainly related to gastrointestinal
damage.
PO203
RECTUM PRESERVATION BY BOLUS HYALURONAN INJECTION INTO
PERI/PARA RECTAL SPACE DURING HDRBT OF PROSTATE CANCER
K. Kishi 1 , M. Sato 1 , Y. Noda 1 , T. Sonomura 1 , S. Shirai 1 , R. Yamada 2
1
Wakayama Medical University, Radiation Oncology, Wakayama City,
Japan
2
Kishiwada Tokushukai Hospital, Urology, Kishiwada City, Japan
: To evaluate feasibility and effectiveness of
nativetype hyaluronate gel injection (HGI) to reduce the rectal dose
during high dose rate interstitial brachytherapy (HDRBT) of prostate
cancer, by comparing HGI and control groups.
: From Jun 2006 to September 2008, 40
patients with T2aT3a prostate cancer were treated with a combined
schedule of 50Gy of external beam radiotherapy (EBRT) followed by
HDRBT. 17 patients underwent bolus HGI into anterior part of
perirectal space. The other 23 including 17 with matched prostate
size were randomly sampled for control from database in the same
period.
: The HGI procedure was easily performed and took approx.
ten minutes. There were no procedurerelated complications. By HGI,
the rectum was shrunken and shifted posteriorly. The minimum
rectoprostate distance was increased from 0.3±0.4 to 2.6±0.7cm
(mean ±sd) after gel injection, and shrunk the rectum volume behind
the prostate level decreases to 21.7±7.6% of the original size, and
further gas inflation of the rectum was blocked. 12.46Gy±2.14 bid was
prescribed in control group and 14.52Gy±2.0 in single fraction in HGI
group (p