Erectile Dysfunction after External Beam Radiotherapy for Prostate Cancer: can it be prevented?

Around 8000 men are diagnosed with prostate cancer in the Netherlands every year (1). With the exception of skin cancer, it is the most common type of cancer in men. There are several ways to treat prostate cancer: hormonal therapy, radical prostatectomy, brachytherapy and external beam radiotherapy or a combination of these. A large part of the patients is treated with external beam radiotherapy. Three-dimensional conformal radiotherapy has been the standard technique for more than a decade. In three-dimensional conformal radiotherapy a computed tomography (CT) scan, called a planning CT scan, is performed in order to image the prostate and the surrounding organs. The physician delineates the prostate and anatomical structures that may cause radiation-induced toxicity, the organs at risk. Using this planning CT scan a treatment plan is made with the goal to distribute a high radiation dose in the prostate and a minimal dose in organs at risk, like the rectum. To achieve this goal radiation beams incident from various directions are created conform to the contour of prostate, avoiding the organs at risk. However, there are several uncertainties regarding delineation of the planning CT scan, deformation and movement of the prostate and patient (2). Therefore a margin of commonly 1 cm around the prostate is added to account for these uncertainties. The actual radiotherapy treatment is then delivered during 7 or 8 weeks in up to 39 fractions of 2 Gray (Gy) in our institute. All forms of treatment for prostate cancer, radiotherapy, prostatectomy and hormonal therapy, have an impact on sexual functioning and especially on erectile function (3-5). Because there is no clear evidence showing a survival benefit for one treatment above anothe

Quality of life and tumor control after short split-course chemoradiation for anal canal carcinoma

<p>Abstract</p> <p>Purpose</p> <p>To evaluate quality of life (QOL) and outcome of patients with anal carcinoma treated with short split-course chemoradiation (CRT).</p> <p>Methods</p> <p>From 1991 to 2005, 58 patients with anal cancer were curatively treated with CRT. External beam radiotherapy (52 Gy/26 fractions) with elective groin irradiation (24 Gy) was applied in 2 series divided by a median gap of 12 days. Chemotherapy including fluorouracil and Mitomycin-C was delivered in two sequences. Long-term QOL was assessed using the site-specific EORTC QLQ-CR29 and the global QLQ-C30 questionnaires.</p> <p>Results</p> <p>Five-year local control, colostomy-free survival, and overall survival were 78%, 94% and 80%, respectively. The global QOL score according to the QLQ-C30 was good with 70 out of 100. The QLQ-CR29 questionnaire revealed that 77% of patients were mostly satisfied with their body image. Significant anal pain or fecal incontinence was infrequently reported. Skin toxicity grade 3 or 4 was present in 76% of patients and erectile dysfunction was reported in 100% of male patients.</p> <p>Conclusions</p> <p>Short split-course CRT for anal carcinoma seems to be associated with good local control, survival and long-term global QOL. However, it is also associated with severe acute skin toxicity and sexual dysfunction. Implementation of modern techniques such as intensity-modulated radiation therapy (IMRT) might be considered to reduce toxicity.</p

Dose-volume parameters of the corpora cavernosa do not correlate with erectile dysfunction after external beam radiotherapy for prostate cancer: Results from a dose-escalation trial

Purpose: To analyze the correlation between dose-volume parameters of the corpora cavernosa and erectile dysfunction (ED) after external beam radiotherapy (EBRT) for prostate cancer. Methods and Materials: Between June 1997 and February 2003, a randomized dose-escalation trial comparing 68 Gy and 78 Gy was conducted. Patients at our institute were asked to participate in an additional part of the trial evaluating sexual function. After exclusion of patients with less than 2 years of follow-up, ED at baseline, or treatment with hormonal therapy, 96 patients were eligible. The proximal corpora cavernosa (crura), the superiormost 1-cm segment of the crura, and the penile bulb were contoured on the planning computed tomography scan and dose-volume parameters were calculated. Results: Two years after EBRT, 35 of the 96 patients had developed ED. No statistically significant correlations between ED 2 years after EBRT and dose-volume parameters of the crura, the superiormost 1-cm segment of the crura, or the penile bulb were found. The few patients using potency aids typically indicated to have ED. Conclusion: No correlation was found between ED after EBRT for prostate cancer and radiation dose to the crura or penile bulb. The present study is the largest study evaluating the correlation between ED and radiation dose to the corpora cavernosa after EBRT for prostate cancer. Until there is clear evidence that sparing the penile bulb or crura will reduce ED after EBRT, we advise to be careful in sparing these structures, especially when this involves reducing treatment margins. (c) 2008 Elsevier Inc

DOSE ESCALATION AND QUALITY OF LIFE IN PATIENTS WITH LOCALIZED PROSTATE CANCER TREATED WITH RADIOTHERAPY: LONG-TERM RESULTS OF THE DUTCH RANDOMIZED DOSE-ESCALATION TRIAL (CKTO 96-10 TRIAL)

Purpose: To assess the impact of dose escalation of radiotherapy on quality of life (QoL) in prostate cancer patients. Patients and Methods: Three hundred prostate cancer patients participating in the Dutch randomized trial (CKTO 69-10) comparing 68 Gy with 78 Gy were the subject of this analysis. These patients filled out the SF-36 QoL questionnaire before radiotherapy (baseline) and 6, 12, 24, and 36 months thereafter. Changes in QoL over time of >= 10 points were considered clinically relevant. Repeated-measures regression analyses were applied to estimate and test the QoL changes over time, the differences between the two arms, and for association with a number of covariates. Results: At 3-year follow-up, the summary score physical health was 73.2 for the 68-Gy arm vs. 71.6 for the 78-Gy arm (p = 0.81), and the summary score mental health was 76.7 for the 68-Gy arm vs. 76.1 for the 78-Gy arm (p = 0.97). Statistically significant (p 10 points) was seen for only two scales. None of the tested covariates were significantly correlated with QoL scores. Conclusion: Dose escalation did not result in significant deterioration of QoL in prostate cancer patients. In both randomization arms, statistically significant decreases in QoL scores over time were seen in six scales. The deterioration of QoL was more pronounced in the physical than in the mental health domain and in some scales more in the high- than in the low-dose arm, but the differences between arms were not statistically significant. (C) 2011 Elsevier Inc

MARGIN EVALUATION IN THE PRESENCE OF DEFORMATION, ROTATION, AND TRANSLATION IN PROSTATE AND ENTIRE SEMINAL VESICLE IRRADIATION WITH DAILY MARKER-BASED SETUP CORRECTIONS

Purpose: To develop a method for margin evaluation accounting for all measured displacements during treatment of prostate cancer. Methods and Materials: For 21 patients treated with stereographic targeting marker-based online translation corrections, dose distributions with varying margins and gradients were created. Sets of possible cumulative delivered dose distributions were simulated by moving voxels and accumulating dose per voxel. Voxel motion was simulated consistent with measured distributions of systematic and random displacements due to stereographic targeting inaccuracies, deformation, rotation, and intrafraction motion. The method of simulation maintained measured correlation of voxel motions due to organ deformation. Results: For the clinical target volume including prostate and seminal vesicles (SV), the probability that some part receives <95% of the prescribed dose, the changes in minimum dose, and volume receiving 95% of prescription dose compared with planning were 80.5% +/- 19.2%, 9.0 +/- 6.8 Gy, and 3.0% +/- 3.7%, respectively, for the smallest studied margins (3 mm prostate, 5 mm SV) and steepest dose gradients. Corresponding values for largest margins (5 mm prostate, 8 mm SV) with a clinical intensity-modulated radiotherapy dose distribution were 46.5% +/- 34.7%, 6.7 +/- 5.8 Gy, and 1.6% +/- 2.3%. For prostate-only clinical target volume, the values were 51.8% +/- 17.7%, 3.3 +/- 1.6 Gy, and 0.6% +/- 0.5% with the smallest margins and 5.2% +/- 7.4%, 1.8 +/- 0.9 Gy, and 0.1% +/- 0.1% for the largest margins. Addition of three-dimensional rotation corrections only improved these values slightly. All rectal planning constraints were met in the actual reconstructed doses for all studied margins. Conclusion: We developed a system for margin validation in the presence of deformations. In our population, a 5-mm margin provided sufficient dosimetric coverage for the prostate. In contrast, an 8-mm SV margin was still insufficient owing to deformations. Addition of three-dimensional rotation corrections was of minor influence. (C) 2011 Elsevier Inc