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Bladder and urethra subregions predicting urinary toxicity after prostate cancer radiotherapy

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HAL Id: hal-02177163

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Bladder and urethra subregions predicting urinary

toxicity after prostate cancer radiotherapy

E. Mylona, Oscar Acosta, T. Lizee, J. Castelli, C. Lafond, G. Crehange, N.

Magne, S. Chiavassa, S. Supiot, R. de Crevoisier

To cite this version:

E. Mylona, Oscar Acosta, T. Lizee, J. Castelli, C. Lafond, et al.. Bladder and urethra subregions

predicting urinary toxicity after prostate cancer radiotherapy. Radiotherapy and Oncology, Elsevier,

2019, 133, pp.S449-S449. �10.1016/S0167-8140(19)31273-3�. �hal-02177163�

(2)

S448

ESTRO 38

Italy ;8Fondazione IRCCS Istituto Nazionale dei Tumori,

Medical Physics, Milano, Italy ;9Cliniche

Gavazzeni-Humanitas, Radiotherapy, Bergamo, Italy ;10Cliniche

Gavazzeni-Humanitas, Medical Physics, Bergamo, Italy ;

11Ospedale degli Infermi, Radiotherapy, Biella, Italy ; 12Comprensorio Sanitario di Bolzano, Radiotherapy,

Bolzano, Italy ;13Azienda Ospedaliero Universitaria S.

Maria della Misericordia, Radiotherapy, Udine, Italy ;

14Azienda Ospedaliero Universitaria S. Maria della

Misericordia, Medical Physics, Udine, Italy ;15University

of Milan- Department of Oncology and Hemato-oncology - Fondazione IRCCS Istituto Nazionale dei Tumori-Prostate Cancer Program - Fondazione IRCCS Istituto Nazionale dei Tumori- Radiation Oncology 1, Radiotherapy, Milano, Italy ;16Fondazione Centro San

Raffaele, Radiotherapy, Milano, Italy ;17Programma

Prostata- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy, Milano, Italy ;18Fondazione

Centro San Raffaele, Medical Physics, Milano, Italy

Purpose or Objective

To determine the evolution of Quality of Life (QoL) within the 1st year after RT for prostate cancer (PC) and its relationship with RT-related urinary and bowel symptoms (symp).

Material and Methods

Patients (pts) in a multicenter observational study aimed at evaluation of symp and QoL after WPRT were included. Bowel toxicity was scored by means of the Inflammatory Bowel Disease Questionnaire (IBDQ), including QoL scales evaluating both social (SWB) and emotional (EWB) wellbeing. In IBDQ scales (range 1-7) lower scores indicate worse outcome. Moreover, QoL was also measured through the Hospital Anxiety and Depression Scale (HADS), which scores anxiety (ANX) and depression (DEP) separately (range 0-21 for both, greater values mean increased severity, score ≥8 indicating ANX/DEP mood). Urinary toxicity was scored through both the IPSS (range 0-35) (range 0-21), with greater scores indicating increased

symptom’s severity for both questionnaires.

Longitudinal evaluation of QoL in the 1st year after RT was analyzed by means of ANOVA for multiple measures. Associations between urinary/bowel symp and 1.worsening of SWB/EWB of at least 2 points compared to baseline and 2.presence of ANX/DEP mood at 1 year were evaluated by means of logistic regression (LR).

Results

304 pts were available for longitudinal evaluation, 38% treated with conventional RT and 62% with moderate hypofractionation with radical (28%), adjuvant (33%) or salvage (39%) intent. Median EQD2Gy (a/b=3Gy) to prostate/prostatic bed was 74Gy, that to pelvic nodes 50Gy.

Evolution of QoL over time was characterized by a quadratic trend for SWB & EWB (p>0.001), with significant worsening at RT end and subsequent recovery after RT completion. Conversely, ANX & DEP could be described by a linear decreasing trend (p=0.002/p=0.01), reaching the lowest average values at 1 yr (see Figures 1 and 2). At multivariate LR, SWB worsening (23 pts) was associated to urinary obstructive symp (OR=1.09 for 1-point IPSS increase, p=0.006), while EWB worsening (9 pts) was associated to bowel symp (OR=5 for 1-point IBDQ decrease, p=0.001) .

ANX mood (30 pts) was independently associated with both urinary obstructive symp (OR=1.12 for 1-point IPSS increase, p=0.001) and bowel symp (OR=3.2 for 1-point IBDQ decrease, p=0.0007). DEP mood (18 pts) was associated to urinary incontinence (OR=1.14 for 1-point ICIQ increase, p=0.001).

ANX/DEP at 1 year were highly negatively correlated with EWB (r=-0.79/-0.71, p<0.001).

Conclusion

SWB & EWB after WPRT for PC are both decreased shortly after RT completion but recover within 1 year, with a limited number of pts reporting worsening SWB/EWB scores at 1 year, mainly associated with persistent bowel and obstructive urinary symp.

ANX/DEP decrease over time, suggesting their being more related to emotional upset following PC diagnosis rather than to treatment and side effects. Residual presence of ANX/DEP mood is significantly associated to both bowel and urinary symp.

PO-0852 Stereotactic Body Radiation Therapy for Unfavorable Prostate Cancer: Large institutional experience.

N. Aghdam1, S. Katarian1, M. Danner1, M. Ayoob1, T. Yung1, S. Lei1, D. Kumar2, B.T. Collins1, J. Lischalk1, A. Dritschilo1, S. Suy1, J. Lynch3, S.P. Collins1

1Georgetown University Hospital, Department of

Radiation Medicine, Washington DC, USA ;2North

Carolina Central University, Julius L. Chambers Biomedical/Biotechnology Research Institute BBRI, Raleigh, USA ;3Georgetown University Hospital,

Department of Urology, Washington DC, USA

Purpose or Objective

External beam radiation therapy plus brachytherapy boost is a highly effective treatment for unfavorable prostate cancer. However, utilization of brachytherapy in the United States is declining and not all patients are ideal candidates for this treatment approach due to technical reasons. Stereotactic body radiotherapy (SBRT) has emerged as a standard high dose option for low and favorable intermediate risk prostate cancer patients. In this report, we present the biochemical disease free survival for unfavorable prostate cancer treated with SBRT in a large single institution cohort.

Material and Methods

All patients with unfavorable intermediate risk (more than one intermediate risk factor, GS 4+3, or greater than 50% positive biopsy cores) and high risk prostate cancer treated with SBRT at a single institution were eligible for this study. Treatment was delivered using the robotic SBRT with doses of 35-36.25 Gy in five fractions or 19.5 Gy

in three fractions followed by fiducial-guided

supplemental IMRT (45–50.4 Gy). In general, patients with high grade, non-organ confined disease received

supplemental IMRT. Patient’s characteristics were

S449

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PO-0853 Bladder and urethra subregions predicting urinary toxicity after prostate cancer radiotherapy

E. Mylona1, O. Acosta1, T. Lizee1, J. Castelli2, C. Lafond2, G. Crehange3, N. Magne4, S. Chiavassa5, S. Supiot5, R. De Crevoisier1,2

1INSERM U1099 - University of Rennes, Laboratoire

Traitement du Signal et de l'Image, Rennes, France ;

2Centre Eugène Marquis, Radiotherapy department,

Rennes, France ; 3Centre Georges François Leclerc,

Radiotherapy department, Dijon, France ; 4Lucien

Neuwirth Cancer Institute, Radiotherapy department, St Priest en Jarez, France ; 5Institut de Cancérologie de

l'Ouest, Medical Physics Department, Nantes, France

Purpose or Objective

To apply a voxel-based analysis on the planning 3D dose distribution in order to identify symptom-related subregions (SRSs) of the bladder/urethra associated with acute and late urinary toxicity in prostate cancer radiation therapy (RT).

Material and Methods

Overall, 272 prostate cancer patients treated with IMRT/IGRT from two multicentric prospective phase III trials were analyzed. Each patient’s organ contours (bladder, urethra and prostate) were spatially normalized to a common coordinate system (CCS) via non-rigid registration. The obtained 3D deformation fields were used to propagate the planning dose distributions from the native space of each patient to the CCS. A voxel-based statistical analysis was applied to generate 3D dose-volume maps for different urinary symptoms and identify corresponding SRSs with statistically significant dose differences between patients with/without toxicity. All the identified SRSs were propagated from the CCS back to the native space of each individual and DVHs for the SRSs and the whole bladder were computed. Dose bins of significant dose difference between patients with/without urinary toxicity were identified. Logistic regression was used to estimate the DVH prediction capability (1Gy bin-wise) of the SRSs compared to the whole bladder.

Results

A local dose-effect relationship was found in the bladder and the urethra. SRSs of significant dose differences (p-value<0.01) were identified for four endpoints: acute and late incontinence in the urethra and the trigone, late retention and dysuria in the posterior part of the bladder, with average dose differences ranging from 1.26 to 9.28 Gy. Figure 2 shows these SRSs onthe template. The DVHs of the SRSs were significantly predictive of toxicity with maximum areas under the ROC curve (AUC): 71% for acute incontinence, 80% for late incontinence, 68% for late retention and 79% for late dysuria. The DVH of the bladder was predictive only for late incontinence and late dysuria (AUC=70%). Table 1 shows the prediction capability of the

DVH for the SRSs and the whole bladder in the native space.

Conclusion

The dose delivered to the urethra, the trigone and the posterior region of the bladder was predictive of acute and late incontinence, late retention and late dysuria. These SRSs appear more predictive than the whole bladder, suggesting that identification of radiosensitive subregions can improve the prediction capabilities for urinary toxicity and may be spared in order to decrease urinary symptoms. Additionally, this study provides the first evidence that explicitly correlate the true 3D dose to the urethra with urinary toxicity following EBRT.

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