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Session Item

Sunday

August 29

14:15 - 15:30

N105-N106

Next generation of brachytherapy treatment planning systems: What do we want and what do they need?

Chair: , Italy;

Chair: Frank-André Siebert, Germany

Overview: Treatment planning systems (TPS) play a central role in brachytherapy. Here, all important data is concentrated as dose prescription, patient image data, clinical goals, etc. TPS is used for decision making when assessing the dose calculation taking into account also clinical considerations. Thus, it is more than a tool for providing dose calculation. In the past brachytherapy TPS used TG-43 formalism, but since a few years also model-based algorithms were implemented in the clinics. In this symposium we want to learn how to efficiently commission a model-based algorithm in brachytherapy and if these modern algorithms are worth the effort when using them in the clinics. Apart from the question of the dose calculation algorithm it should be questioned if the existing TPS can fulfil the clinical requirements. In particular if the needed dose distribution can be prescribed by planning aims and if the typical dose constraints are sufficient input into a TPS or if more input data is needed besides dose values? We want to make an outlook to the next generation of brachytherapy TPS and analyze what we have now and what properties and features are mostly required in the future. This will be done with a closer look to the application of artificial intelligence in brachytherapy TPS.

Session Type: Symposium

Track: Brachytherapy

Journey:

Adjuvant HDR contact brachytherapy for localized penile cancer: long-term toxicities and outcomes

Presentation Number: PO-0261

Abstract

Abstract Title:

Adjuvant HDR contact brachytherapy for localized penile cancer: long-term toxicities and outcomes

Authors:

Paula Pircalab¹, Daniela Gordea¹, Cristina Pop-Casandra¹, Anamaria Sipos², Istvan Laszlo¹, Gabriel Kacso^2,3

¹’Prof. Dr. Ion Chiricuta’ Institute of Oncology, Radiation Oncology, Cluj-Napoca, Romania; ²RTC Amethyst Cluj, Radiation Oncology, Cluj-Napoca, Romania; ³Iuliu Hatieganu University of Medicine and Pharmacy, Radiation Oncology, Cluj-Napoca, Romania

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Purpose or Objective

The purpose of this study was to evaluate the outcomes of patients diagnosed with penile cancer and treated with High-dose rate (HDR) brachytherapy (BT) in our institution, with focus on local control rates and acute and late toxicities.

Material and Methods

According to our institution protocol, after conservative local excision, adjuvant HDR BT was offered in multidisciplinary tumor board as alternative to amputation for pT1-2N0-2 M0 penile squamous carcinoma if positive or close resection margins (< 5 mm).

Between February 2005 and July 2011 we retrospectively identified nine patients treated with HDR BT, having refused penile amputation.

The median dose was 36Gy (range: 15-54), with 3Gy/fr bid through flexible catheters attached to a personalized applicator. The treatment dose was prescribed at a depth of 5mm, while the urethra’s dose constraint wasn’t exceeded. In 2019, the files were retrospectively analyzed and patients were evaluated using the RTOG/EORTC Common Toxicity Criteria and the International Prostate Symptom Score.

Results

The median follow-up period was 55 months (range 8-114 months). Estimated overall survival was 131 months (CI 95%: 110.1-151.9). The mean disease-free survival (DFS) was 98 months (CI 95%: 55.3-140.7). The survival rate at 5 years was 100%, at 9 years 77%, and the recurrence rate at 5 years was 33%. Two patients (22%) were diagnosed with local relapses and one (11%) had loco-regional relapse.

Most patients presented with acute skin toxicities, mostly G2 to G3 mucositis, and one patient developed soft tissue necrosis. Two patients experienced dysuria. Late skin and urinary toxicities varied from G1 to G4. In 2019, at the 9 years follow-up, late lasting effects varied from mild to moderate urinary disfunction, and moderate to severe skin reactions. In 2020, the patients were recontacted and no changes to their toxicity grades was reported.

Conclusion

HDR contact BT is a valid option in penile cancer treatment for selected patients with good local control, excellent 5 year survival and acceptable toxicity profile.