Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_29_2298 - Dosimetric and 7-Year Biochemical Results with a Robotic Prostate Brachytherapy System

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Dosimetric and 7-Year Biochemical Results with a Robotic Prostate Brachytherapy System
M. Manning1, E. A. Ashley2, L. Hayes2, H. Liu1, and B. J. Sintay1; 1Cone Health Cancer Center, Greensboro, NC, 2Cone Health, Greensboro, NC

Purpose/Objective(s): As healthcare increasingly moves to value-based treatment decisions, LDR brachytherapy represents a cost effective option for the treatment of selected prostate cancers. Brachytherapy outcomes are governed by dosimetric quality. Automated prostate brachytherapy with intraoperative planning and robotic delivery of seeds may be more amenable to widescale implementation over manual systems dependent on user expertise. This study presents the updated dosimetric and mature clinical outcomes of an automated brachytherapy program.

Materials/Methods: Between May 2006 and August 2017, a group of 17 urologists and 4 radiation oncologists, with widely varying levels of experience, used a radiotherapy treatment planning system and automated seedSelectron afterloader to implant 930 men. Based on NCCN risk groupings, the study population included 475 low, 390 intermediate, and 65 high risk subjects. 73.1% received 145 Gy as monotherapy, and 26.9% received 90-110 Gy as a boost following external radiotherapy to 45 Gy. Patients underwent post-implant CT approximately 30 days following brachytherapy. Patients with at least seven years follow-up were included to determine biochemical disease free survival (bDFS).

Results: The median post-implant D90 is 111% (range 74%-144%). 33 patients (3.5%) achieved a D90 of less than 90%. The median V100 rectum is 0.13 cc (range 0.0-3.11 cc). Forty patients (4.3%) had a suboptimal rectal V100 of greater than 1.0 cc. 510 patients were followed for 7 or more years. With a median PSA follow-up of 70 months (range 5-130), the actuarial bDFS is 91.6% and 81.9% at 5 and 10 years. The seven year bDFS is 91.3%, 87.7% and 82.3% in the low, intermediate and high risk groups.

Conclusion: In this largest US series of patients undergoing permanent prostate brachytherapy with a robotic system, acceptable dosimetric and clinical outcomes were achieved. This data helps confirm that an automated system independent of user skill level can be used to achieve acceptable dosimetric and clinical outcomes.

Author Disclosure: M. Manning: Independent Contractor; Cone Health System. Partner; Greensboro Radiation Oncologists. E.A. Ashley: None. L. Hayes: None. H. Liu: None. B.J. Sintay: Honoraria; Varian Medical Systems. Advisory Board; Varian Medical Systems. Travel Expenses; Varian Medical Systems. Website Editorial Board Member; American Association of Physicists in Medicine.

Matthew Manning, MD

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