Patient-reported health-related quality of life outcomes after HDR brachytherapy between small (&lt;60 cc) and large (≥60 cc) prostate glands

Press, Robert H.; Morgan, Tiffany; Cutrell, Patrick K.; Zhang, Chao; Rahnema, Sara; Sanda, Martin G.; Pattaras, John; Patel, Pretesh; Jani, Ashesh B.; Rossi, Peter J.

doi:10.1016/j.brachy.2018.08.009

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…Large prostate size (>60 cm 3 ) results in a greater probability of encountering pubic arch interference, and some consider this a relative contraindication to prostate brachytherapy [55]. Prostate size is associated with increased acute and late genitourinary toxicity for LDR brachytherapy [56e59], although the association between prostate volume and toxicity is not as consistent for HDR brachytherapy [60,61]. For SBRT, one study has reported outcomes of prostate SBRT (35e36.25 Gy in five fractions) specifically in 57 patients with prostate volumes 50 cm 3 [62].…”

Section: Discussionmentioning

confidence: 99%

Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?

Corkum

Achard²,

Morton

et al. 2022

Clinical Oncology

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Section: Discussionmentioning

confidence: 99%

Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?

Corkum

Achard²,

Morton

et al. 2022

Clinical Oncology

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“…Nonetheless, this therapy takes months, and can result in significant side effects for the patient. Press et al concluded that hormonal therapy caused worsening of several scores, including quality of life, incontinence, and sexual function, with a tendency to lower vitality [7], whilst Lee et al stated that ADT may lead to an increased acute urinary morbidity [21]. Other approaches can overcome minimal PAI, such as manipulating rigid implant needles and the ultrasound probe, while extending the lithotomy position can overcome more excessive PAI.…”

Section: Discussionmentioning

confidence: 99%

“…The American Brachytherapy Society (ABS) guidelines state that a prostate volume (V p ) of > 60 cc is technically more challenging as PAI is more prevalent with enlarged prostates, and such a V p is a relative contraindication for BT [3]. Earlier studies reported that 9% to 38% of patients had a V p ≥ 60 cc [4][5][6][7]. However, the relation between V p and the occurrence of PAI is not strong, and large prostates have been successfully implanted with good results for both dosimetry and biochemical control without excessive toxicity [2,5,7].…”

Section: Purposementioning

confidence: 99%

“…Earlier studies reported that 9% to 38% of patients had a V p ≥ 60 cc [4][5][6][7]. However, the relation between V p and the occurrence of PAI is not strong, and large prostates have been successfully implanted with good results for both dosimetry and biochemical control without excessive toxicity [2,5,7]. Therefore, the Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP), have recently adapted their guidelines related to gland size, which now state that a prostate volume of > 50-60 cc is no longer a contraindication for BT if there is minimal PAI [2].…”

Section: Purposementioning

confidence: 99%

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Overcoming pubic arch interference in prostate brachytherapy using steerable needles

Vries¹,

Wilby²,

Palmer³

et al. 2022

jcb

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Purpose: A proportion of patients are not directly eligible for prostate brachytherapy (BT) due to pubic arch interference (PAI). Constraints in positioning sources behind the pubic arch due to linear, horizontal needle paths, may hamper effective irradiation of the target volume. This work evaluated the effect of prostate volume (V p ) and patient posture change on the amount of PAI, and demonstrated that steerable needles may broaden the inclusion criteria for patients with enlarged prostates and observed PAI.Material and methods: Twenty-seven patients (V p > 60 cc) were included in this study. Access obstruction to the prostate was evaluated using diagnostic magnetic resonance imaging (MRI) scans, after six upward rotations of the pelvis and the prostate in 5 degree steps, to indicate the effect of patient posture change from supine to lithotomy position. For patients with PAI, we evaluated if the steerable needle could access the obstructed volume of the prostate.Results: The data showed no clear relation between V p and PAI. In 23 of the 27 patients, in which PAI was observed, 14 showed obstruction of the prostate of ≥ 10 mm in the supine position (mean PAI ± standard deviation: 15.2 ±3.8 mm). Anatomical rotation reduced PAI by 4.8 mm after every 10 degrees of upward rotation, still resulting in obstructions of 8.1 ±2.4 mm in 10 of the 14 cases after 15 degree rotation. The steerable needle enabled access to all the required coordinates of the prostate.Conclusions: The ability to steer along curved paths enables prostate BT in patients with enlarged prostates and PAI, and reduces the change of needing to abandon treatment.

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“…Prostate gland size (commonly defined as .60 cm 3 ) remains a relative contraindication to brachytherapy according to the ABS. While several studies have called this recommendation into question [34,[42][43][44][45], achieving an adequate dose distribution for larger prostate glands remains a challenge, particularly for less experienced brachytherapists. Furthermore, patients with larger prostate glands are more likely to be symptomatic often making them unsuitable candidates for PB.…”

Section: Discussionmentioning

confidence: 99%

Simulation of an HDR “Boost” with Stereotactic Proton versus Photon Therapy in Prostate Cancer: A Dosimetric Feasibility Study

Remick

Sabouri

Zhu

et al. 2021

International Journal of Particle Therapy

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Purpose/Objectives To compare the dose escalation potential of stereotactic body proton therapy (SBPT) versus stereotactic body photon therapy (SBXT) using high-dose rate prostate brachytherapy (HDR-B) dose-prescription metrics. Patients and Methods Twenty-five patients previously treated with radiation for prostate cancer were identified and stratified by prostate size (≤ 50cc; n = 13, > 50cc; n = 12). Initial CT simulation scans were re-planned using SBXT and SBPT modalities using a prescription dose of 19Gy in 2 fractions. Target coverage goals were designed to mimic the dose distributions of HDR-B and maximized to the upper limit constraint for the rectum and urethra. Dosimetric parameters between SBPT and SBXT were compared using the signed-rank test and again after stratification for prostate size (≤ 50cm3 and >50cm3) using the Wilcoxon rank test. Results Prostate volume receiving 100% of the dose (V100) was significantly greater for SBXT (99%) versus SBPT (96%) (P ≤ 0.01), whereas the median V125 (82% vs. 73%, P < 0.01) and V200 (12% vs. 2%, P < 0.01) was significantly greater for SBPT compared to SBXT. Median V150 was 49% for both cohorts (P = 0.92). V125 and V200 were significantly correlated with prostate size. For prostates > 50cm3, V200 was significantly greater with SBPT compared to SBXT (14.5% vs. 1%, P = 0.005), but not for prostates 50cm3 (9% vs 4%, P = 0.11). Median dose to 2cm3 of the bladder neck was significantly lower with SBPT versus SBXT (9.6 Gy vs. 14 Gy, P < 0.01). Conclusion SBPT and SBXT can be used to simulate an HDR-B boost for locally advanced prostate cancer. SBPT demonstrated greater dose escalation potential than SBXT. These results are relevant for future trial design, particularly in patients with high risk prostate cancer who are not amenable to brachytherapy.

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Patient-reported health-related quality of life outcomes after HDR brachytherapy between small (<60 cc) and large (≥60 cc) prostate glands

Cited by 8 publications

References 23 publications

Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?

Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?

Overcoming pubic arch interference in prostate brachytherapy using steerable needles

Simulation of an HDR “Boost” with Stereotactic Proton versus Photon Therapy in Prostate Cancer: A Dosimetric Feasibility Study

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