User login
Bladder Toxicity After Volumetric Arc Radiation Therapy (VMAT) Treatment for Prostate Cancer Following Prostatectomy
Methods: We did a retrospective review of 55 patients with prostate cancer treated using external beam radiation therapy VMAT between 2013 through 2017.
Results: Sixteen were adjuvant/salvage therapy to the prostate fossa (PF) after a prostatectomy while 39 had primary radiation therapy for intact prostate cancer. The dose volume histogram (DVH) institutional bladder constraints were v65 200 cc, 55% when > 150 cc and there were no incidences of hematuria when the PTV was < 150 cc.
Conclusions: (1) Overall incidence of hematuria with VMAT treatment to the prostate was 10/55(18%); (2) Higher bladder DVH v65 volumes correlated with higher incidence of hematuria; (3) Higher PTV in PF group correlated with higher incidence of hematuria with the greatest risk occurring when the PTV was greater than 200 cc. This is due to more bladder in the treatment field; (4) Careful patient selection should be made for surgery to avoid post-surgery radiation therapy; (5) When treating PF keep the PTV volume under 150 cc; and (6) This finding should be studied with larger number of patients.
Methods: We did a retrospective review of 55 patients with prostate cancer treated using external beam radiation therapy VMAT between 2013 through 2017.
Results: Sixteen were adjuvant/salvage therapy to the prostate fossa (PF) after a prostatectomy while 39 had primary radiation therapy for intact prostate cancer. The dose volume histogram (DVH) institutional bladder constraints were v65 200 cc, 55% when > 150 cc and there were no incidences of hematuria when the PTV was < 150 cc.
Conclusions: (1) Overall incidence of hematuria with VMAT treatment to the prostate was 10/55(18%); (2) Higher bladder DVH v65 volumes correlated with higher incidence of hematuria; (3) Higher PTV in PF group correlated with higher incidence of hematuria with the greatest risk occurring when the PTV was greater than 200 cc. This is due to more bladder in the treatment field; (4) Careful patient selection should be made for surgery to avoid post-surgery radiation therapy; (5) When treating PF keep the PTV volume under 150 cc; and (6) This finding should be studied with larger number of patients.
Methods: We did a retrospective review of 55 patients with prostate cancer treated using external beam radiation therapy VMAT between 2013 through 2017.
Results: Sixteen were adjuvant/salvage therapy to the prostate fossa (PF) after a prostatectomy while 39 had primary radiation therapy for intact prostate cancer. The dose volume histogram (DVH) institutional bladder constraints were v65 200 cc, 55% when > 150 cc and there were no incidences of hematuria when the PTV was < 150 cc.
Conclusions: (1) Overall incidence of hematuria with VMAT treatment to the prostate was 10/55(18%); (2) Higher bladder DVH v65 volumes correlated with higher incidence of hematuria; (3) Higher PTV in PF group correlated with higher incidence of hematuria with the greatest risk occurring when the PTV was greater than 200 cc. This is due to more bladder in the treatment field; (4) Careful patient selection should be made for surgery to avoid post-surgery radiation therapy; (5) When treating PF keep the PTV volume under 150 cc; and (6) This finding should be studied with larger number of patients.
Comparison of PFT Before and After Radiation Therapy for Lung Cancer
Background: Radiation therapy (RT) for lung cancer is a standard of care. Radiation exposure to normal lung tissue can cause loss of function due to pneumonitis and fibrosis. We evaluated subjectively and objectively with pulmonary function tests (PFT) for toxicity following RT.
Objective: The purpose of our retrospective study was to correlate post radiation PFT changes and symptoms.
Methods: We studied retrospectively 18 patients with lung cancer treated at the Jackson VAMC between 2014 and 2016. All patients had pretreatment and posttreatment PFTs. Symptoms of dyspnea were graded using the Common Terminology Criteria for Adverse Events (CTCAE).
Results: Sixteen received SBRT; (15 with 50 Gy in 5 fractions; one 48 Gy in 4 fractions); one 60 Gy in 6 weeks and one 45 Gy in 30 bid fractions. Sites of treatment included 13 (72%) upper lobe, 2 (11%) right middle lobe and 3 (17%) lower lobe. The median drop in FEV1 posttreatment was 0.15. While 8 (44%) patients had grade I/II dyspnea prior to treatment, 14 (78%) patients had the same after treatment. Only 1 patient who received both SBRT to LUL and Conventional XRT to the mediastinum developed grade II dyspnea. His FEV1 dropped 37% or 0.37 from baseline. Symptomatically 11 (61%) had no increased dyspnea with a median FEV1 drop of 3% or 0.06 from baseline; while 7 (39%) patients had worsening of dyspnea after treatment with a median drop of 0.23 (11%) from baseline in FEV1. Patients treated in the middle and lower lobes had a median FEV1 drop of 0.43 from baseline There was no significant median change (+0.04) when treating the upper lobe. 38% of patients who had an upper lobe treated complained of worsening dyspnea, while 66% of patients with lower lobe treated reported worsening dyspnea.
Conclusions: After definitive XRT, 39% of patients had worsening in symptoms with a median drop of 11% in the FEV1, compared to only a 3% drop in FEV1 in patients who did not report a worsening of symptoms. Patients with lower lobe tumors had greater PFT changes with worsening dyspnea.
Background: Radiation therapy (RT) for lung cancer is a standard of care. Radiation exposure to normal lung tissue can cause loss of function due to pneumonitis and fibrosis. We evaluated subjectively and objectively with pulmonary function tests (PFT) for toxicity following RT.
Objective: The purpose of our retrospective study was to correlate post radiation PFT changes and symptoms.
Methods: We studied retrospectively 18 patients with lung cancer treated at the Jackson VAMC between 2014 and 2016. All patients had pretreatment and posttreatment PFTs. Symptoms of dyspnea were graded using the Common Terminology Criteria for Adverse Events (CTCAE).
Results: Sixteen received SBRT; (15 with 50 Gy in 5 fractions; one 48 Gy in 4 fractions); one 60 Gy in 6 weeks and one 45 Gy in 30 bid fractions. Sites of treatment included 13 (72%) upper lobe, 2 (11%) right middle lobe and 3 (17%) lower lobe. The median drop in FEV1 posttreatment was 0.15. While 8 (44%) patients had grade I/II dyspnea prior to treatment, 14 (78%) patients had the same after treatment. Only 1 patient who received both SBRT to LUL and Conventional XRT to the mediastinum developed grade II dyspnea. His FEV1 dropped 37% or 0.37 from baseline. Symptomatically 11 (61%) had no increased dyspnea with a median FEV1 drop of 3% or 0.06 from baseline; while 7 (39%) patients had worsening of dyspnea after treatment with a median drop of 0.23 (11%) from baseline in FEV1. Patients treated in the middle and lower lobes had a median FEV1 drop of 0.43 from baseline There was no significant median change (+0.04) when treating the upper lobe. 38% of patients who had an upper lobe treated complained of worsening dyspnea, while 66% of patients with lower lobe treated reported worsening dyspnea.
Conclusions: After definitive XRT, 39% of patients had worsening in symptoms with a median drop of 11% in the FEV1, compared to only a 3% drop in FEV1 in patients who did not report a worsening of symptoms. Patients with lower lobe tumors had greater PFT changes with worsening dyspnea.
Background: Radiation therapy (RT) for lung cancer is a standard of care. Radiation exposure to normal lung tissue can cause loss of function due to pneumonitis and fibrosis. We evaluated subjectively and objectively with pulmonary function tests (PFT) for toxicity following RT.
Objective: The purpose of our retrospective study was to correlate post radiation PFT changes and symptoms.
Methods: We studied retrospectively 18 patients with lung cancer treated at the Jackson VAMC between 2014 and 2016. All patients had pretreatment and posttreatment PFTs. Symptoms of dyspnea were graded using the Common Terminology Criteria for Adverse Events (CTCAE).
Results: Sixteen received SBRT; (15 with 50 Gy in 5 fractions; one 48 Gy in 4 fractions); one 60 Gy in 6 weeks and one 45 Gy in 30 bid fractions. Sites of treatment included 13 (72%) upper lobe, 2 (11%) right middle lobe and 3 (17%) lower lobe. The median drop in FEV1 posttreatment was 0.15. While 8 (44%) patients had grade I/II dyspnea prior to treatment, 14 (78%) patients had the same after treatment. Only 1 patient who received both SBRT to LUL and Conventional XRT to the mediastinum developed grade II dyspnea. His FEV1 dropped 37% or 0.37 from baseline. Symptomatically 11 (61%) had no increased dyspnea with a median FEV1 drop of 3% or 0.06 from baseline; while 7 (39%) patients had worsening of dyspnea after treatment with a median drop of 0.23 (11%) from baseline in FEV1. Patients treated in the middle and lower lobes had a median FEV1 drop of 0.43 from baseline There was no significant median change (+0.04) when treating the upper lobe. 38% of patients who had an upper lobe treated complained of worsening dyspnea, while 66% of patients with lower lobe treated reported worsening dyspnea.
Conclusions: After definitive XRT, 39% of patients had worsening in symptoms with a median drop of 11% in the FEV1, compared to only a 3% drop in FEV1 in patients who did not report a worsening of symptoms. Patients with lower lobe tumors had greater PFT changes with worsening dyspnea.
Failure Patterns After Stereotactic Body Radiation Therapy for Early Non-Small Cell Lung Cancer and Their Implications for Future Management
Objective: Stereotactic body radiation therapy (SBRT) is an effective modality for patients with early stage nonsmall cell lung cancer (NSCLC) who are unsuitable for surgical management. We performed a retrospective review to evaluate the clinical outcomes and patterns of failure of patients who completed SBRT for early stage NSCLC.
Methods: Twenty-five veteran patients from G.V. Sonny Montgomery VA Medical Center, Jackson, MS (G.V. VAMC) with T1-3N0 NSCLC were referred to the neighboring University of Mississippi Medical Center for treatment with SBRT between July 2010 and June 2014. After completion of therapy, the patient’s care was then transferred back to G.V. VAMC for subsequent follow-up visits and surveillance imaging. All patients received a prescription of > 100 Gy biologically effective dose (BED). Fifty Gray (Gy) in 5 fractions was prescribed to 19 (76%) of the patients, while 3 (12%) patients received 60 Gy in 3 fractions, and another 3 (12%) patients received 48 Gy in 4 fractions. Clinical response was evaluated using RECIST 1.1 criteria. The primary endpoints included assessment of overall survival (OS), disease free survival (DFS), local control (LC), regional failure (RF), and distant failure (DF) rates.
Results: The median follow-up was 37 months and the median OS and DFS rates were 50 months and 45.3 months, respectively. The three-year OS, DFS, LC, RF, and DF rates were 68.2%, 64.7%, 78.6%, 35.3%, and 8.3%, respectively. Eleven (44%) patients failed. Two (8%) with LF alone, 4 (16%) with RF, and 3 (12%) patients had LR, RF and DF. Of the 5 LFs, 2 of the patients failed within the planning target volume (PTV), while 3 patients had failures outside the PTV. There were a total of 12 deaths at last follow-up. Three patients died due to the malignancy, while 1 patient died from complications with radiation-related pneumonitis.
Conclusions: Our results were comparable to several larger reported series. While LC is excellent, failure within the same lobe is a problem with SBRT. Strategies such as tighter constraints of normal structures need to be applied, as about a third of these patients will require retreatment of a new lesion in the same lobe that was outside the previously irradiated field.
Objective: Stereotactic body radiation therapy (SBRT) is an effective modality for patients with early stage nonsmall cell lung cancer (NSCLC) who are unsuitable for surgical management. We performed a retrospective review to evaluate the clinical outcomes and patterns of failure of patients who completed SBRT for early stage NSCLC.
Methods: Twenty-five veteran patients from G.V. Sonny Montgomery VA Medical Center, Jackson, MS (G.V. VAMC) with T1-3N0 NSCLC were referred to the neighboring University of Mississippi Medical Center for treatment with SBRT between July 2010 and June 2014. After completion of therapy, the patient’s care was then transferred back to G.V. VAMC for subsequent follow-up visits and surveillance imaging. All patients received a prescription of > 100 Gy biologically effective dose (BED). Fifty Gray (Gy) in 5 fractions was prescribed to 19 (76%) of the patients, while 3 (12%) patients received 60 Gy in 3 fractions, and another 3 (12%) patients received 48 Gy in 4 fractions. Clinical response was evaluated using RECIST 1.1 criteria. The primary endpoints included assessment of overall survival (OS), disease free survival (DFS), local control (LC), regional failure (RF), and distant failure (DF) rates.
Results: The median follow-up was 37 months and the median OS and DFS rates were 50 months and 45.3 months, respectively. The three-year OS, DFS, LC, RF, and DF rates were 68.2%, 64.7%, 78.6%, 35.3%, and 8.3%, respectively. Eleven (44%) patients failed. Two (8%) with LF alone, 4 (16%) with RF, and 3 (12%) patients had LR, RF and DF. Of the 5 LFs, 2 of the patients failed within the planning target volume (PTV), while 3 patients had failures outside the PTV. There were a total of 12 deaths at last follow-up. Three patients died due to the malignancy, while 1 patient died from complications with radiation-related pneumonitis.
Conclusions: Our results were comparable to several larger reported series. While LC is excellent, failure within the same lobe is a problem with SBRT. Strategies such as tighter constraints of normal structures need to be applied, as about a third of these patients will require retreatment of a new lesion in the same lobe that was outside the previously irradiated field.
Objective: Stereotactic body radiation therapy (SBRT) is an effective modality for patients with early stage nonsmall cell lung cancer (NSCLC) who are unsuitable for surgical management. We performed a retrospective review to evaluate the clinical outcomes and patterns of failure of patients who completed SBRT for early stage NSCLC.
Methods: Twenty-five veteran patients from G.V. Sonny Montgomery VA Medical Center, Jackson, MS (G.V. VAMC) with T1-3N0 NSCLC were referred to the neighboring University of Mississippi Medical Center for treatment with SBRT between July 2010 and June 2014. After completion of therapy, the patient’s care was then transferred back to G.V. VAMC for subsequent follow-up visits and surveillance imaging. All patients received a prescription of > 100 Gy biologically effective dose (BED). Fifty Gray (Gy) in 5 fractions was prescribed to 19 (76%) of the patients, while 3 (12%) patients received 60 Gy in 3 fractions, and another 3 (12%) patients received 48 Gy in 4 fractions. Clinical response was evaluated using RECIST 1.1 criteria. The primary endpoints included assessment of overall survival (OS), disease free survival (DFS), local control (LC), regional failure (RF), and distant failure (DF) rates.
Results: The median follow-up was 37 months and the median OS and DFS rates were 50 months and 45.3 months, respectively. The three-year OS, DFS, LC, RF, and DF rates were 68.2%, 64.7%, 78.6%, 35.3%, and 8.3%, respectively. Eleven (44%) patients failed. Two (8%) with LF alone, 4 (16%) with RF, and 3 (12%) patients had LR, RF and DF. Of the 5 LFs, 2 of the patients failed within the planning target volume (PTV), while 3 patients had failures outside the PTV. There were a total of 12 deaths at last follow-up. Three patients died due to the malignancy, while 1 patient died from complications with radiation-related pneumonitis.
Conclusions: Our results were comparable to several larger reported series. While LC is excellent, failure within the same lobe is a problem with SBRT. Strategies such as tighter constraints of normal structures need to be applied, as about a third of these patients will require retreatment of a new lesion in the same lobe that was outside the previously irradiated field.
Adjuvant and Salvage Radiation Therapy Following Radical Retropubic Prostatectomy: A Retrospective Review of a Single Institution
Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.
Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.
Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.
Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.
Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.
Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.
Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.
Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.
Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.
Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.
Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.
Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.