Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer.

PURPOSE: The aim of this study was to evaluate quality-of-life changes up to 10 years following three different radiotherapy concepts. METHODS AND MATERIALS: In the years 2000-2003, 295 patients were treated with external beam radiotherapy (EBRT; n = 135; 70.2 Gy in 1.8 Gy fractions), low-dose-rate brachytherapy (LDR-BT with I-125; n = 94; 145 Gy), and high-dose-rate brachytherapy (HDR-BT with Ir-192; n = 66; 18 Gy in two fractions using 4-6 needles) as a boost to EBRT (50.4 Gy in 1.8 Gy fractions). Quality of life was assessed using the Expanded Prostate Cancer Index Composite at median time of 2, 6, and 10 years after treatment. RESULTS: The urinary function score 2 years after EBRT (mean 93 points) was significantly higher in comparison to HDR-BT + EBRT (80 points, higher doses to the urethra relevant) and LDR-BT (88 points). After 10 years, only HDR-BT + EBRT (75 points) remained worse (LDR-BT 92 points; EBRT 91 points). Urinary incontinence score decreased from 83 to 76 points in the HDR-BT + EBRT group. No significant differences or changes resulted in the bowel domain. The mean sexual function score (i.e., sexuality score) was significantly higher after LDR-BT versus HDR-BT + EBRT and EBRT (30 vs. 19 and 24 points after 2 years and 25 vs. 13 and 15 points after 10 years, respectively)-a lower patient age and a lower percentage with hormonal treatment need to be considered. CONCLUSION: Apart from decreasing sexual function for all patients, decreasing urinary scores were found in the HDR-BT + EBRT group predominantly as a result of increasing incontinence. This study demonstrates the need for optimum BT treatment planning.

Prognostic impact of postoperative, pre-irradiation (18)F-fluoroethyl-l-tyrosine uptake in glioblastoma patients treated with radiochemotherapy.

BACKGROUND AND PURPOSE: Resection is considered as essential for the efficacy of modern adjuvant treatment of glioblastoma multiforme (GBM). Previous studies have indicated that amino acid PET is more specific than contrast enhancement on MRI for detecting residual tumor tissue after surgery. In a prospective study we investigated the prognostic impact of postoperative tumor volume and tumor/brain ratios (TBR) in PET using O-(2-[(18)F]fluoroethyl)-l-tyrosine (FET) in comparison with MRI. MATERIALS AND METHODS: Forty-four patients with GBM were investigated by FET PET and MRI after surgery. Tumor volume in FET PET with a tumor/brain ratio (TBR)>1.6 and a TBR>2, mean and maximum TBR and gadolinium contrast-enhancement on MRI (Gd-volume) were determined. Thereafter patients received a fractionated radiotherapy with concomitant temozolomide (RCX). The median follow-up was 15.4 (3-35) months. The prognostic value of postoperative residual tumor volume in FET PET, TBR(mean,) TBR(max) and Gd-volume was evaluated using Kaplan-Maier estimates for disease-free survival (DFS) and overall survival (OS). RESULTS: Postoperative tumor volume in FET PET had a significant independent influence on OS and DFS (OS 20.0 vs. 6.9 months; DFS 9.6 vs. 5.1 months, p<0.001; cut-off 25 ml). Similar results were observed when a TBR ≥ 2 (cut-off 10 ml) was used to define the tumor volume in (18)F-FET PET. The TBR(mean) and TBR(max) of FET uptake had a significant influence on DFS (p<0.05). Gd-volume in MRI had significant effect on OS and DFS in the univariate analysis. No independent significant influence in OS or DFS could be observed for Gd-volume in MRI. CONCLUSIONS: Our data indicate that the tumor volume in FET PET after surgery of GBM has a strong prognostic impact for these patients. FET PET appears to be helpful to determine the residual tumor volume after surgery of GBM and may serve as a valuable tool for optimal planning of radiation treatment.

Contrast-enhanced color duplex sonography (CDS): an alternative for the evaluation of therapy-relevant tumor oxygenation?

PURPOSE: To evaluate the predictive value of radiotherapeutically relevant tumor hypoxia by contrast-enhanced color duplex sonography (CDS). The objectification was based on pO(2) histography. MATERIAL AND METHODS: 25 patients with metastatic neck lymph node from a primary squamous carcinoma of the head and neck were examined. To visualize as many vessels as possible, a contrast enhancer (Levovist), Schering Corp., Germany) was administered. Horizontal and longitudinal sonographic scans with a thickness of 5 mm were performed on the metastatic neck lymph node. Color pixel density (CPD) was defined as the ratio of colored to gray pixels in a region of interest. It represents the extent of vascularization in the investigated slice. To assess the biological and clinical relevance of oxygenation measurement, the relative frequency of pO(2) readings < or = 2.5, 5.0, and 10.0 mmHg, as well as mean and median pO(2), were documented. RESULTS: In order to investigate the degree of linear association, the Pearson correlation coefficient was calculated. Moderate (/r/ > 0.5) to high (/r/ > 0.7) correlation was found between the CPD and the parameters of hypoxic fraction (pO(2) readings with values < or = 5.0 and 10.0 mmHg, as well as mean and median). There was only a slight correlation between CPD and the fraction of pO(2) values < or = 2.5 mmHg (r = -0.479). CONCLUSION: CPD represents the mean degree of vascularization. As a noninvasive measurement, this method seems feasible for evaluating the state of global oxygenation in superficial tumors. Nevertheless, this method is limited through its deficiency in describing the vascular heterogeneity of tumors.