D. Chevallier

Prostate cancer boost using high-dose-rate brachytherapy: early toxicity analysis of 3 different fractionation schemes

Purpose To analyse early toxicity of high-dose-rate brachytherapy (HDRB) boost for prostate cancer using 3 fractionation schemes. Material and methods From February 2009 to May 2012, after the first course of external beam radiation therapy (EBRT 46 Gy/23 f), 124 patients underwent HDRB boost for low (7%), intermediate (19%), and high-risk (73%) prostate cancers. From February to December 2009, Group 1 (G1) = 18 Gy/3 f/2 d (24%); from January 2010 to April 2011, Group 2 (G2) = 18 Gy/2 f/2 d (42%), and from May to September 2011, Group 3 (G3) = 14 Gy/1 f/1 d (34%). Planning and CT-scan was performed before each fraction. Dose constraints for G1/G2 were V100 rectum = 0 and V125 urethra = 0, while for G3 V90 rectum = 0 and V115 urethra = 0. Genito-urinary (GU) and Gastro-intestinal (GI) acute toxicities were assessed at 1 month (for the 3 fractionation schemes) and 6 months (for 18 Gy/3 f and 18 Gy/2 f) after the boost (CTCv3.0). Results Median follow-up was 25 months (8-46.9), median age was 71 years (50-82), and median CTV was 31 cc (16-71). The grades of acute GI and GU toxicities at 1 and 6 months after HDRB were mainly Grade 1 with few Grade 2 (GU: 5% at 1 month; GI: 1% at 6 months). One patient developed G4 sepsis toxicity 2 days after HDRB and recovered without after-effects. No significant differences were observed at 1 and 6 months after the HDRB between treatment groups. Conclusions The right fractionation remains under discussion, but prostate cancer HDRB boost using a single fraction (providing similar results in terms of acute toxicity) is more comfortable for the patient, and less time consuming for the medical staff.

Real-time in vivo periprostatic nerve tracking using multiphoton microscopy in a rat survival surgery model: a promising pre-clinical study for enhanced nerve-sparing surgery.

To assess the ability of multiphoton microscopy (MPM) to visualise, differentiate and track periprostatic nerves in an in vivo rat model, mimicking real‐time imaging in humans during RP and to investigate the tissue toxicity and reproducibility of in vivo MPM on prostatic glands in the rat after imaging and final histological correlation study.

Traitements de rattrapage par HIFU après radiothérapie première et par radiothérapie après HIFU première dans la récidive locale du cancer de prostate : analyse rétrospective de la toxicité

OBJECTIVES To evaluate the toxicity of therapeutic sequences High Intensity Focused Ultrasound (HIFU)-salvage radiotherapy (HIFU-RT) or radiotherapy-salvage HIFU (RT-HIFU) in case of locally recurrent prostate cancer. MATERIALS AND METHODS Nineteen patients had a local recurrence of prostate cancer. Among them, 10 patients were treated by HIFU-RT and 9 patients by RT- HIFU (4 by external beam radiotherapy [EBR] and 5 by brachytherapy [BRACHY]). Urinary side effects were assessed using CTCAE v4. RESULTS At the time of the initial management, the median age was 66.5 years (53-72), the median PSA was 10.8ng/mL (3.4-50) and the median initial Gleason score was 6.3 (5-8). Median follow-up after salvage treatment was 46.3 months (2-108). Thirty percent of the patients in the HIFU-RT group and 33.3 % of the patients in the RT-HIFU group, all belonging to the sub-group BRACHY-HIFU, had urinary complication greater than or equal to grade 2. Among all the patients, only 1 had grade 1 gastrointestinal toxicity. CONCLUSION BRACHY-HIFU sequence seems to be purveyor of many significant urinary side effects. A larger database is needed to confirm this conclusion.

L’évolution de la curiethérapie du cancer de prostate

Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.

L’évolution de la curiethérapie du cancer de prostateEvolution of prostate cancer brachytherapy

Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.