Patterns of Bone Failure in Localized Prostate Cancer Previously Irradiated: The Preventive Role of External Radiotherapy on Pelvic Bone Metastases

Introduction: External beam radiation therapy (EBRT) can cure localized prostate cancer (PCa) by sterilizing cancer cells in the prostate gland and surrounding tissues at risk of microscopic dissemination. We hypothesized that pelvic EBRT for localized PCa might have an unexpected prophylactic impact on the occurrence of pelvic bone metastases.Material and Methods: We reviewed the data of 332 metastatic PCa patients. We examined associations between the number (≤5 vs. >5) and the location of bone metastases (in-field vs. out-of-field), which occurred at first relapse, and a previous history of EBRT for PCa (EBRT vs. No-EBRT).Results: One hundred and ten patients M0 at baseline were eligible. Fifty-six patients (51%) were in the No-EBRT group, and 54 patients (49%) in the EBRT group. The proportion of patients who developed >5 bone metastases in the bony pelvis was higher in the No-EBRT group vs. the EBRT group: 10 patients (18%) vs. 2 patients (4%), respectively (p = 0.02). By multivariate analysis EBRT was associated with a lesser occurrence of patients who had >5 bone metastases in the bony pelvis (OR = 0.17 [95%CI, 0.04–0.87], p = 0.03). Time to occurrence of bone metastases ≥5 years (OR = 0.10 [95%CI, 0.05–0.19], p < 0.01), prior curative prostate treatment (OR = 0.58 [95%CI, 0.36–0.91], p = 0.02), >5 bone metastases in bony pelvis (OR = 2.61 [95%CI, 1.28–5.31], p < 0.01), >5 bone metastases out of bony pelvis (OR = 1.73 [95%CI, 1.09–2.76], p = 0.02) were all predictive of overall survival.Conclusion: Previous pelvic EBRT for PCa is associated with a lower number of pelvic bone metastases, which is associated with better overall survival

Salvage extended field or involved field nodal irradiation in 18F-fluorocholine PET/CT oligorecurrent nodal failures from prostate cancer

International audienceThe concept of metastasis-directed therapy for nodal oligorecurrences with stereotactic body radiotherapy is increasingly accepted. Hence, the comparison between salvage extended field radiotherapy (s-EFRT) and salvage involved field radiotherapy (s-IFRT) in patients with 18F-fluorocholine (FCH) PET/CT+ nodal oligorecurrences from prostate cancer is worthy of investigation.METHODS:Patients with oligorecurrent nodes on FCH PET/CT treated with salvage radiotherapy between 2009 and 2017 in a single tertiary cancer centre were selected for this study. Patients treated with s-IFRT were compared with those treated with s-EFRT. Toxicities and times to failure (TTF) were compared between the two groups.RESULTS:The study included 62 patients with positive lymph nodes only who underwent FCH PET/CT for a rising PSA level after radical prostatectomy or radiotherapy. Of these patients, 35 had s-IFRT and 27 had s-EFRT. After a median follow-up of 41.8 months (range 5.9-108.1 months), no differences were observed in acute or late gastrointestinal and genitourinary toxicities of grade 2 or more between the two groups. The 3-year failure rates were 55.3% (95% CI 37.0-70.3%) in the s-IFRT group and 88.3% (95% CI 66.9-96.1%) in the s-EFRT group (p = 0.0094). In multivariate analysis of TTF, an interval of >5 years was significantly correlated with better outcomes (HR = 0.33, 95% CI 0.13-0.86, p = 0.023). There was a strong trend toward better outcomes with s-EFRT even after adjusting for concomitant androgen-deprivation therapy (HR = 0.38, 95% CI 0.12-1.27, p = 0.116).CONCLUSION:FCH PET-positive node-targeted s-EFRT is feasible with low rates of toxicity and longer TTF, suggesting that oligorecurrent nodal disease diagnosed on FCH PET is unlikely

Impact of rectal distension on prostate CBCT-based positioning assessed with 6 degrees-of-freedom couch

International audienceIntroduction: Prostate requires a daily correction of its 3-dimensional position in relation with rectal distension. In this study, we sought to determine whether rectal distension with respect to the rectal behavior might have an impact on prostate translations and/or rotations during prostate image guided radiation therapy using a 6 degrees-of-freedom (DOF) couch.Methods and materials: We reviewed the data from 39 patients with localized prostate cancer treated with protracted external radiation therapy using a 6 DOF couch. Before each fraction, a kilovoltage cone beam computed tomography (kV-CBCT) scan was performed. The automatic fusion algorithm was set to fuse on soft tissue and allowed correction for translations in 3 dimensions and rotations in the longitudinal axis ("roll") and lateral axis ("pitch"). After contouring the rectum on each kV-CBCT, we determined the cross-sectional area (CSA) and relative CSA (CSArel) by dividing with the CSA of planning CT. The standard deviation of CSArel per patient was used to classify the patients in 2 groups: patients with a stable rectum and patients with an unstable rectum. The CSArel was compared between these 2 groups with a linear mixed model with group as fixed effect and patient as random effect.Results: A total of 616 kV-CBCT were analyzed, and 2 subgroups of patients could be defined a posteriori: 19 patients had a stable rectum, mean CSArel (1.06 +/- 0.08); the other 20 patients had an unstable rectum, mean CSArel (1.43 +/- 0.08). The average pitch in the group with a stable rectum was 0.36 degrees (+/- 0.21) versus 0.40 degrees (+/- 0.20) (P = .898). The pitch was not correlated with the CSArel (P = -.065, r = 0.119). The average roll in the group with a stable rectum was 0.27 degrees (+/- 0.16) versus 0.05 degrees (+/- 0.16) (P = .137). The roll was not correlated with the CSA (P=.094, r = 0.068). The average CSArel was higher (P = .0013) and more variable (P = .035) in the unstable group.Conclusion: Rectal distension had no impact on the pitch or on the roll, which suggest that a 6 DOF couch has little interest in daily practice for prostate image guided radiation therapy. (C) 2018 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved

Focal or whole-gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for postradiotherapy local failure: How best to spare the rectum?

International audiencePURPOSE: Salvage prostate permanent implant (sPPI) for postradiation local failure provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum is still unknown. METHODS AND MATERIALS: We reviewed the postimplant CT-based dosimetry of 18 selected patients who underwent sPPI with I-125 seeds for isolated biopsy-proven local failure several years after external beam radiation therapy. Ten patients had whole-prostate sPPI, and 8 patients had multiparametric MRI-based focal sPPI. In 8 patients, hyaluronic acid (HA) gel was injected into the prostate rectum space. RESULTS: The median cumulative biological effective dose after EBRT sPPI for the prostate and the rectum was higher in patients treated with whole-gland sPPI than in patients treated with focal sPPI (313.5 Gy(2) vs. 174.4 Gy(2); p = 0.06 and 258.1 Gy(3) vs. 172.6 (Gy3); p < 0.01, respectively). The median Dolcc for the rectum was significantly lower in patients who had HA gel: 63.3 Gy (29.0-78.3) vs. 83.9 Gy (34.9-180.0) (p = 0.04). CONCLUSIONS: Cumulative prostate and rectum biological effective doses were lower with focal sPPI. Duce delivered to the rectum was significantly lower with HA gel, while there was no difference between focal or whole-gland plans. (C) 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved

Impact of waiting time on nodal staging in head and neck squamous-cell carcinoma treated with radical intensity modulated radiotherapy

Background and purpose: To evaluate the influence of delays for radiotherapy on survival, recurrence and upstaging for head and neck squamous-cell carcinoma (HNSCC) with no nodal involvement treated with intensity modulated radiotherapy (IMRT). Material and methods: This retrospective study included 63 consecutive patients with HNSCC located in the pharynx and larynx and treated with exclusive IMRT with or without chemotherapy. Survival, loco-regional or distant failure and upstaging were analyzed according to the waiting time. Results: Mean waiting time for treatment was 62.5 days for the hypopharynx subgroup (range = 37–102), 63 days for the larynx subgroup (range = 19–128) and 58.5 days for the oropharynx subgroup (range = 29–99) (p = 0.725). Nine patients (14%) experienced upstaging. Loco-regional or distant failure occurred in 18 patients. Beyond a delay of 50 days, 19% of patients had local failure, 17% nodal recurrence and 11% distant failure. Within a delay of 50 days, no nodal or distant failure was observed and only 1 patient experienced local recurrence. Upstaging and overall survival were not significantly affected by an increased waiting time. Conclusion: For N0 patients treated with IMRT for HNSCC, waiting time around 50 days after the diagnosis was not significantly associated with an excessive risk of upstaging or recurrence

Multiparametric MRI-based Dosimetric Parameters Best Predict Short-term Time Course of PSA After Iodine 125 Permanent Prostate Implantation for Localized Prostate Cancer

International audienceD90% and V150% of the entire prostate are recognized as the best dosimetric predictors of outcome after 125 I permanent prostate implantation (PPI). The purpose of this study was 2-fold: 1) to determine the relationship between dose-volume parameters of the Dominant Intraprostatic Lesion (DIL) when compared to the prostate and early biochemical outcome after PPI; 2) to define if dose-volume parameters of the central gland (CG), the peripheral zone (PZ) and the DIL could best predict PSA bounce occurrence. The time course of PSA and mechanisms of bounces still remain unclear after PPI. Patients who had a higher dose in the DIL had a worse PSA level at 1 year which is in keeping with previous reports with a longer follow-up suggesting that patients who will achieve a very low PSA are more likely to require a protracted time after PPI. A strong relationship was found between V150% in the CG and PSA bounce. These pioneering results require further investigations

Inferring postimplant dose distribution of salvage permanent prostate implant (PPI) after primary PPI on CT images

International audiencePURPOSE:To evaluate the dose distribution of additional radioactive seeds implanted during salvage permanent prostate implant (sPPI) after a primary permanent prostate implant (pPPI).METHODS AND MATERIALS:Patients with localized prostate cancer were primarily implanted with iodine-125 seeds and had a dosimetric assessment based on day 30 postimplant CT (CT1). After an average of 6 years, these patients underwent sPPI followed by the same CT-based evaluation of dosimetry (CT2). Radioactive seeds on each CT were detected. The detected primary seeds on CT1 and CT2 were registered and then removed from CT2 referred as a modified CT2 (mCT2). Dosimetry evaluations (D90 and V100) of sPPI were performed with dedicated planning software on CT2 and mCT2. Indeed, prostate volume, D90, and V100 differences between CT2 and either CT1 or mCT2 were calculated, and values were expressed as mean (standard deviation).RESULTS:The mean prostate volume difference between sPPI and pPPI over the 6 patients was 9.85 (7.32) cm3. The average D90 and V100 assessed on CT2 were 486.5 Gy (58.9) and 100.0% (0.0), respectively, whereas it was 161.3 Gy (47.5) and 77.3% (25.2) on mCT2 (p = 0.031 each time). The average D90 the day of sPPI [145.4 Gy (11.2)] was not significantly different from that observed on mCT2 (p = 0.56).CONCLUSION:Postimplant D90 and V100 of sPPI after pPPI can be estimated on CT images after removing the primary seeds.Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved

Randomized Trial Assessing the Impact of Routine Assessment of Health-Related Quality of Life in Patients with Head and Neck Cancer

The impact of routine assessment of health-related quality of life (HRQoL) on satisfaction with care and the HRQoL of patients with head and neck cancer (HNC) treated with radiotherapy was assessed. Patients with HNC were randomly assigned to two arms, with stratification on sex, cancer localization, and stage of the disease. In the intervention arm, the patients completed the EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires first before randomization, then before each medical appointment during radiotherapy (7 weeks), and then every 3 months until 1 year and at 2 years thereafter. In the control arm, the EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires were completed before randomization and at 1 year and 2 years thereafter. The primary endpoint was mean change in HRQoL at score at 2 years from baseline assessed by EQ VAS from the EuroQol questionnaire. The secondary endpoint was mean change in satisfaction with care at 2 years from baseline assessed by QLQ-SAT32. Two hundred patients with head and neck cancers were involved in this study (mean age, 58.83 years (range, 36.56–87.89)), of whom 100 were assigned to the intervention arm and 100 to the control arm. Patients in the intervention arm were reported to have a statistically significant increase in EQ VAS at 2 years (p &lt; 0.0001) and exceeded the minimal clinically important difference (mean change at 2 years from baseline = 10.46). In the two arms, mean differences between arms were not statistically significant, but minimal clinically important differences in favor of the intervention arm were found for EQ VAS (mean change difference (MD) = 5.84), satisfaction with care, in particular waiting times (MD = 10.85) and satisfaction with accessibility (MD = 6.52). Routine assessment of HRQoL improves HRQoL and satisfaction with care for patients with HNC treated with radiotherapy