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Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy

Abstract

Purpose: Recurrence of prostatic carcinoma within the prostate gland remains a significant problem for patients who present with locally advanced disease. In an attempt to improve the local control of such tumors, an iridium-192 transperineal, template-guided prostatic implant was combined wit radiofrequency-induced hyperthermia after external beam irradiation of the pelvic lymph nodes and prostate gland. This study evaluates the influence of pre-treatment patient characteristics and treatment parameters upon outcome. Materials and Methods: Between July 1987 and April 1992 33 patients with adenocarcinoma of the prostate were selected for treatment: 28 of these patients had extensive local disease on clinical examination (AJCC-4 stages T2b or c: 9 patients; T3: 19 patients); two patients with T2a tumors had Gleason grade 5 + 4 disease or disproportionately high prostate specific antigen (PSA) values and a mass encroaching upon the bladder on computerized tomographic scan. Three patients with more clinically limited T2a or T2b involvement elected implantation in lieu of an external beam irradiation boost. The mean pre-treatment serum PSA value was 25.6 ng/ml (Hybritech scale), with values of above 19 ng/ml for 17 of the patients. Treatment consisted of 50 Gy of external beam irradiation to the prostate and pelvic lymph nodes followed  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOLOGICAL INDICATORS; CARCINOMAS; EXTERNAL IRRADIATION; HEAT TREATMENTS; HYPERTHERMIA; IRIDIUM 192; LYMPH NODES; PELVIS; PROSTATE; RADIATION SOURCE IMPLANTS; RF SYSTEMS; SIDE EFFECTS
OSTI ID:
20420736
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1977005141
Submitting Site:
INIS
Size:
page(s) 253
Announcement Date:

Citation Formats

Hancock, Steven L, Kapp, Daniel S, Goffinet, Don R, Prionas, Stavros, Cox, Richard S, and Bagshaw, Malcolm A. Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97885-5.
Hancock, Steven L, Kapp, Daniel S, Goffinet, Don R, Prionas, Stavros, Cox, Richard S, & Bagshaw, Malcolm A. Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy. United States. doi:10.1016/0360-3016(95)97885-5.
Hancock, Steven L, Kapp, Daniel S, Goffinet, Don R, Prionas, Stavros, Cox, Richard S, and Bagshaw, Malcolm A. 1995. "Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy." United States. doi:10.1016/0360-3016(95)97885-5. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97885-5.
@misc{etde_20420736,
title = {Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy}
author = {Hancock, Steven L, Kapp, Daniel S, Goffinet, Don R, Prionas, Stavros, Cox, Richard S, and Bagshaw, Malcolm A}
abstractNote = {Purpose: Recurrence of prostatic carcinoma within the prostate gland remains a significant problem for patients who present with locally advanced disease. In an attempt to improve the local control of such tumors, an iridium-192 transperineal, template-guided prostatic implant was combined wit radiofrequency-induced hyperthermia after external beam irradiation of the pelvic lymph nodes and prostate gland. This study evaluates the influence of pre-treatment patient characteristics and treatment parameters upon outcome. Materials and Methods: Between July 1987 and April 1992 33 patients with adenocarcinoma of the prostate were selected for treatment: 28 of these patients had extensive local disease on clinical examination (AJCC-4 stages T2b or c: 9 patients; T3: 19 patients); two patients with T2a tumors had Gleason grade 5 + 4 disease or disproportionately high prostate specific antigen (PSA) values and a mass encroaching upon the bladder on computerized tomographic scan. Three patients with more clinically limited T2a or T2b involvement elected implantation in lieu of an external beam irradiation boost. The mean pre-treatment serum PSA value was 25.6 ng/ml (Hybritech scale), with values of above 19 ng/ml for 17 of the patients. Treatment consisted of 50 Gy of external beam irradiation to the prostate and pelvic lymph nodes followed by a transperineal needle implant of the prostate gland. Thirty-two patients had no evidence of pelvic nodal involvement during exploration at laparotomy performed after external irradiation, and 25 of these had lymph node samplings that were histologically negative for metastasis. Perineal template oriented needles were placed by inspection and palpation at laparotomy; 2 were performed closed under ultrasound guidance. Needles were afterloaded with {sup 192}Ir to provide a dose of 30 Gy to the periphery of the prostate gland. Interstitial radiofrequency-induced hyperthermia treatments were given in conjunction with the implant, one just prior to source loading and a second just after removal of the irridium sources. Temperatures were characterized by the T90, the temperature that was exceeded by 90% of the temperatures measured within the prostate. Although the objective was to achieve a temperature of 43 deg. C for 45 minutes, the mean T90 achieved was 39.9{+-}0.3 deg. C (range: 37.2 to 41.3 deg. C). Patients were followed with clinical examination and measurement of the serum PSA every 3 to 4 months during the first two years after therapy and every 6 months, thereafter. Follow-up ranges from 0.8 to 6.5 years (median 3.5 years). PSA values for each patient were fitted to determine rates of decline in PSA after therapy and rates of rise in PSA among those recurring after therapy. Results: PSA levels declined in all patients at a more rapid rate than generally observed after external beam radiation, alone. PSA levels have subsequently risen in 19 patients and are indeterminate in 3 others. Twelve of these 22 patients have experienced clinical relapse: 8 had distant metastasis only, 2 recurred within the prostate alone, and 2 had both local and distant relapse. One patient died of prostate cancer 3 years after treatment; 2 died of intercurrent diseases 1.3 and 5.3 years after treatment with rising PSA trends. Control varied by primary stage: with T3 disease, 14 of 19 patients (79%) have rising or indeterminate PSA trends and 7 clinically relapsed (5 distant, 1 local, and 1 local and distant); with T2 disease, 7 of 14 (50%) have rising PSA trends and 4 have relapsed clinically (2 distant, 1 local, 1 local and distant). Among 17 patients with initial PSA values above 19, 4 have no PSA rise from 3.2 to 4.2 years after treatment, 13 (76%) have rising PSA patterns and 8 have relapsed clinically (6 distant, 1 local, 1 local and distant). Among 16 patients with initial PSA values below 19, 9 (56%) remain clinically and biochemically disease free. Only 46% of temperatures measured in tumor exceeded 42 deg. C. T90 did not correlate significantly with either the rate of de cline in PSA or PSA trend. Side effects included penile dysesthesia or anesthesia in 5 patients, subsequent transurethral resections for prostatic necrosis, bladder ulceration, or stricture in 3 patients, lymphedema in 2 patients, and minor urinary incontinence in 5 patients. Most patients reported erectile impotence after treatment. Conclusions: Adequate hyperthermia remains difficult to achieve within the prostate gland. The limited experience in this series does not support a thermal dose-response. Although only 4 patients have experienced recurrence within the prostate gland, the frequency of distant recurrence among these patients with locally advanced disease obscures evaluation of this endpoint. This treatment regimen approaches local tissue tolerance and its results suggests that there will be limited overall gains from dose-escalation strategies for advanced prostatic cancer.}
doi = {10.1016/0360-3016(95)97885-5}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}