3D conformal radiotherapy for prostate carcinoma: focus on toxicity

Prostate carcinoma is the most common malignancy in men. Due to (un)controlled screening and patient awareness the incidence seems to be increasing with years. Many (treatment) options are available, that can be roughly divided in surgery ([laparoscopic] prostatectomy [including lymphadenectomy]), radiotherapy (brachytherapy [iodine125 seeds / palladium seeds / HDR Ir 192 afterloading] and / or external beam [+/- androgen ablation]) and for some patients even watchful waiting is advocated. The combination of prognostic factors like stage, Gleason score (differentiation grade), PSA and others e.g. the percentage of positive prostate biopsies, will give an indicate the chances for organ confined disease, seminal vesicle infiltration, lymph nodes metastases and ultimately for tumor control

Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

Purpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September 1995. 66 patients with primary, solitary muscle invasive bladder cancer were treated with TUR, EBRT, and IRT, aiming at bladder preservation. According to the protocol, in three patients low-dose EBRT was applied, whereas 63 patients received high-dose EBRT. Immediately prior to IRT, 42 patients underwent a lymphnode dissection, and in 16 cases a partial cystectomy was performed. For IRT, two to five catheters were used and IRT was started within 24 h after surgery. The majority of patients received 30 Gy of IRT, with a mean dose rate of .58 Gy/h. In three patients, additional EBRT was applied following IRT. Follow-up consisted of regular cystoscopies, mostly done during joint clinics of urologist and radiation oncologist, with urine cytology routinely performed. The median follow-up period was 26 months. The Kaplan-Meier method was used for the determination of survival rates. Results: In seven patients, a bladder relapse developed. The probability of remaining bladder relapse free at 5 years was 88%. The bladder was preserved in 98% of the surviving patients. Metastases developed in 16 patients, and the probability of remaining metastasis free at 5 years was 66%. The cumulative 5-year overall and bladder and distant relapse free survival were 48% and 69%, respectively. Acute toxicity was not serious in the majority of cases; surgical correction of a persisting vesicocutaneous fistula was necessary in two patients, whereas a wound toilet had to be performed in another patient. Serious late toxicity (bladder, RTOG Grade 31 was experienced by only one patient. Conclusions: Interstitial radiation preceded by TUR and EBRT, in a selected group of patients with muscle invasive bladder cancer, yields an excellent bladder tumor control rate with a high probability of bladder preservation. Survival was mainly dependent on the development of distant metastases. Serious acute and late toxicity was rare

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