A Contemporary Report of Low-Dose-Rate Brachytherapy for Prostate Cancer Using MRI for Risk Stratification: Disease Outcomes and Patient-Reported Quality of Life

Purpose: We examined a prospective consecutive cohort of low dose rate (LDR) brachytherapy for prostate cancer to evaluate the efficacy of monotherapy for unfavorable-intermediate risk (UIR) disease, and explore factors associated with toxicity and quality of life (QOL). Methods: 149 men with prostate cancer, including 114 staged with MRI, received Iodine-125 brachytherapy alone (144–145 Gy) or following external beam radiation therapy (110 Gy; EBRT). Patient-reported QOL was assessed by the Expanded Prostate Index Composite (EPIC) survey, and genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively recorded (CTC v4.0). Global QOL scores were assessed for decline greater than the minimum clinically important difference (MCID). Univariate analysis (UVA) was performed, with 30-day post-implant dosimetry covariates stratified into quartiles. Median follow-up was 63 mo. Results: Men with NCCN low (n = 42) or favorable-intermediate risk (n = 37) disease were treated with brachytherapy alone, while most with high-risk disease had combined EBRT (n = 17 of 18). Men with UIR disease (n = 52) were selected for monotherapy (n = 42) based on clinical factors and MRI findings. Freedom from biochemical failure-7 yr was 98%. Of 37 men with MRI treated with monotherapy for UIR disease, all 36 men without extraprostatic extension were controlled. Late Grade 2+/3+ toxicity occurred in 55/3% for GU and 8/2% for GI, respectively. Fifty men were sexually active at baseline and had 2 yr sexual data; 37 (74%) remained active at 2 yr. Global scores for urinary incontinence (UC), urinary irritation/obstruction (UIO), bowel function, and sexual function (SF) showed decreases greater than the MCID (p 5 yr. Analysis did not reveal any significant associations with any examined rectal or urethral dosimetry for late toxicity or QOL. Conclusion: Disease outcomes and patient-reported QOL support LDR brachytherapy, including monotherapy for UIR disease

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia:results of a survey

Aims To survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required. Materials and methods Selected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA. Results Fourteen responded. Only the diagnosis and follow-up of Crohn’s disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. The majority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification). Conclusion Views were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required