Search

Purpose: To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and "low-tier" intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. Methods and Materials: A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi 125I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. Results: With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% +/- 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p < 0.001), but this did not translate into improved bNED. Conclusions: In contrast to some previous studies, dosimetric outcomes did not correlate with biochemical recurrence in the first 1,006 patients treated with 125I prostate brachytherapy at the British Columbia Cancer Agency. Despite a median D90 of only 105% of MPD, our bNED rates are indistinguishable from series that reported higher D90 values. [ABSTRACT FROM AUTHOR] more...

Local recurrences after previous radiotherapy (RT) are increasingly being identified with increasing use of molecular imaging in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option for radiorecurrent prostate cancer. While supported by multiple prospective studies, limited comparative data exists to guide optimal patient selection and treatment technique. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT. International experts in salvage prostate BT were invited (n=34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient- and cancer-specific criteria, type and technique of BT, and follow-up after salvage. An a priori threshold for consensus of ≥ 75% was set, with a majority opinion being set at ≥ 50%. Thirty international experts agreed to participate, and the response rates were 100% (30/30), 93.3% (28/30) and 100% (30/30) for the first, second and third rounds of the survey respectively. Consensus was achieved for 56% (18 of 32) statements. Consensus was achieved in several areas of patient selection, including: 1) A minimum of 2-3 years from initial RT and consideration of salvage BT; 2) MRI and PSMA PET should be acquired prior to salvage; 3) Both a targeted and systematic prostate biopsy should be performed; 4) Salvage BT can be considered after any initial RT technique; and 5) Any Gleason Score at recurrence could be considered for salvage. Several areas did not reach consensus and were controversial: 1) Cut off for maximum T stage and PSA at time of salvage; 2) Whether ADT should be used with salvage BT (and duration); 3) Whether it was appropriate to combine local salvage with SBRT for oligometastatic disease and 4) Whether salvage BT may be repeated more than once. More than 50% of respondents preferred High Dose-Rate salvage BT, and indicated that both focal and whole gland salvage could be appropriate depending on the clinical situation. There was no single preferred dose fractionation for salvage prostate BT. These findings will inform development of an international expert consensus statement for salvage prostate BT. Consensus was achieved on 56% of statements, though several controversial areas were identified. While our results highlight there is no single preferred approach for salvage BT, areas of controversy will be relevant for the design of future prospective studies and clinical trials of salvage BT. [ABSTRACT FROM AUTHOR] more...

Caregiving and parental responsibilities present multiple challenges for physicians including personal, family, professional, and financial. Our objective was to describe the experiences of Canadian radiation oncologists (RO) with caregiving/parental roles and to illustrate challenges that exist, whilst dealing with professional work. An online survey was administered (November – January 2022) to registered staff RO members of the Canadian Association of Radiation Oncology (CARO). The survey consisted of 57 multiple choice and 7 open-ended questions on demographics, parental and other family caregiver roles. Descriptive statistics summarized survey responses and thematic analysis was used to analyze open-ended questions. Qualitative data was analyzed using SAS with Chi-square and Wilcoxon rank sum tests, a two-sided p-value of <0.05 was deemed statistically significant (SS). Of the 271 CARO members, 103 staff RO responded (38%): 45% female and 55% male. Most participants were <50 years old (78, 76%), Canadian MD graduates (75, 73%) with <15-years of practice (76, 74%). The majority (76%) of respondents identified as having a parental and/or non-parental caregiving role (8%). There was no difference between respondents' gender and number of children (median 2 (range: 1-4), p=0.5). A SS higher proportion of females compared to males took parental leave for each pregnancy, with more females (71%) receiving financial support (employment insurance, employer contribution and/or paid vacation) compared to males (44%) for the 1st and 2nd parental leave only. Median duration of parental leave by female's vs males for 1st and 2nd child was 26 vs 4 weeks and 22 vs 4 weeks. Half of female respondents (52%) identified as having a positive parent mentor at work compared to 26% of male respondents (p=0.02). A higher proportion of females described having a child negatively impacted their career (50% vs 28%, p=0.06) with similar gender proportions describing attendance at conferences (77% vs 65%, p=0.3) and early/late work meetings (79% vs 76%, p=0.7) affected by having children. Respondents described balancing work-life, dealing with sudden illness of children and bringing children to pre- and post-school activities as examples of daily challenges experienced. Few respondents (8%; 4 females, 4 male) identified having a non-parental caregiving role, with 6 (75%) having both dependent child and adult caregiving roles. Challenges identified in caring for an older adult included taking time off during work hours to attend medical appointments, older adult being unable to drive, and ongoing medical concerns. Caregiving and parental responsibilities are not gender unique, but competing work and family roles may impact genders differently. Further studies to understand the gender differences and to determine strategies to support and address ongoing challenges of RO's balancing career and family caregiving demands are required. [ABSTRACT FROM AUTHOR] more...