1
(IMRT) used after that time (dose prescribed to encompass at least 98% of the cl-PTV). Results: One thousand seven hundred seventeen patients were available for analysis. Median follow-up was 4.9 years (range, 0.6-17.1 years). Thirty-seven percent of patients underwent 3DCRT and 63% IMRT. Median prescription dose was 75.6 Gy for patients with low-risk and 77.4 Gy for patients with intermediate and high-risk disease. Overall 10-year biochemical failure (BF) rate was 29%: 18% for low-risk, 32% for inter- mediate-risk, and 49% for high-risk patients. Clinical failure rates were 1%, 5%, and 10%, respectively, for the 3 risk groups. Ten-year likelihood of biopsy-proven local failure was <1%, and overall local failure rate (biopsy proven plus BF without regional or distant disease) was 13%. Ten- year rates of distant metastases were 0.5%, 3.8%, and 10.3%, and cause- specific survival was 99%, 99%, and 93% for low, intermediate, and high- risk patients, respectively. Chronic grade > 2 gastrointestinal and genito- urinary toxicity was 18.5% and 23.8% for the entire cohort, respectively, and 9.2% (<1% grade 3) and 18.8% for those receiving IGART in combination with IMRT. Conclusions: Image guidance using an off-line, adaptive technique was associated with excellent clinical outcomes in a large patient cohort with extended follow-up. This data provides strong support for continued implementation and development of IGRT techniques in standard prostate cancer management. Author Disclosure: D.J. Krauss: None. D. Yan: None. G.S. Gustafson: None. H. Ye: None. N. Tonlaar: None. P.Y. Chen: None. G.Z. Gustafson: None. L.L. Kestin: None. A.A. Martinez: None. D.S. Brabbins: None. 2397 Update of Risk Factors for Biochemical Recurrence of Prostate Cancer After Salvage Radiation Therapy Post-Radical Prostatectomy R.J. Lee, K.S. Tzou, M.G. Heckman, B. Rawal, J.L. Peterson, N.N. Paryani, S.J. Ko, and S.J. Buskirk; Mayo Clinic Jacksonville, Jacksonville, FL Purpose/Objective(s): Our group has previously evaluated risk factors for biochemical recurrence (BCR) of prostate cancer after salvage radiation therapy (SRT) with BCR defined as a prostate-specific antigen (PSA) value of 0.4 ng/mL and rising. We now report an update of these risk factors using the current American Urological Association (AUA) definition of BCR as a PSA value of 0.2 ng/mL and rising. Materials/Methods: This is a retrospective review of 308 patients who received SRT for a rising PSA following radical prostatectomy (RP) between June 1988 and February 2012 at our institution. Pre-RP PSA, pre- SRT PSA, SRT dose, age, length of time between RP and SRT initiation, pathological tumor stage, surgical margin, Gleason score, and pre-SRT hormone therapy were all evaluated as risk factors for BCR using relative risks (RR) from Cox proportional hazards regression models. BCR was defined in accordance with the current AUA guidelines. Results: Median pre-RP PSA was 7.3 ng/mL (<0.1-108.0 ng/mL), median pre-SRT PSA was 0.6 ng/mL (<0.1-23.3 ng/mL), and median SRT dose was 66.6 Gy (60.0-72.0). With a median follow-up of 5.6 years (0.3-20.6 years), 191 patients (62%) experienced BCR. At 5 and 10 years following the start of SRT, estimated cumulative incidences of BCR were 62% (95% Confidence Interval [CI]: 56-68%) and 75% (95% CI, 67-81%), respec- tively. In multivariable analysis, pre-SRT PSA (RR [per each doubling]: 1.21, p < 0.001), pathological tumor stage (RR [T3a vs T2]: 1.18, p Z 0.32; RR [T3b/T4 vs T2]: 2.19, p < 0.001; overall P1.0 ng/mL, compared to patients with a pre-SRT PSA 1.0 ng/mL. Positive surgical margin was associated with a decreased risk of BCR (RR: 0.71, p Z 0.028), but this did not remain significant after adjustment for multiple testing. Conclusions: This review confirms that pre-SRT PSA, pathological tumor stage, and Gleason score are independently associated with BCR following SRT, using the current AUA definition for BCR. Risk of BCR was highest for patients with a pre-SRT PSA level above 1.0 ng/mL, T3b/T4 patho- logical tumor stage, and a Gleason score greater than 7. Author Disclosure: R.J. Lee: None. K.S. Tzou: None. M.G. Heckman: None. B. Rawal: None. J.L. Peterson: None. N.N. Paryani: None. S.J. Ko: None. S.J. Buskirk: None. 2398 Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy J. Price, N.N. Stone, and R.G. Stock; Icahn School of Medicine at Mount Sinai Hospital, New York, NY Purpose/Objective(s): We report on the incidence, nature, and manage- ment of rectal toxicities following brachytherapy treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute Grade 2 proctitis. Materials/Methods: A total of 2,752 patients were treated for prostate cancer between October 1990 and April 2007 with either brachytherapy alone or in combination with androgen depletion therapy or external beam radiation therapy and were followed for a median of 6.47 years. We investigated the incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate and multivariate analyses we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Overall incidence of Grade 2 rectal bleeding was 6.4%, although notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for rectal bleeding, 18 underwent formalin treat- ment and 9 underwent cauterization. Post-hoc univariate statistical analysis revealed that alcohol use, history of coronary artery disease (CAD), BED, RV100, and treatment modality predict the likelihood of Grade 2 rectal bleeding. Alcohol, CAD, treatment modality, and RV100 fit a Cox- regression multivariate model in predicting predisposition to grade 2 rectal bleeding. Conclusions: Prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT Poster Viewing Abstract 2398; Table Factors evaluated as predictors of grade 2 proctitis Freedom from grade >2 proctitis Univariate analysis P value Multivariate analysis P value Treatment Type BT/BT+EBRT/ BT+ADT/BT+ADT+EBRT 92.8%/93.5%/95.8%/93.1% ns/ns/.009/ns .013 BED Less than 219 Gy/Greater than 219 Gy 94.1%/91.1% .01 .141 RV100 <1.5 cc/>1.5 cc 95.2%/88.1% .0001 .0001 Alcohol +/- (n Z 1257) 94.3%/92.9% .025 .027 CAD +/- (n Z 154) 93.9%/89.6% .026 .010 Volume 87 Number 2S Supplement 2013 Poster Viewing Abstracts S355

Update of Risk Factors for Biochemical Recurrence of Prostate Cancer After Salvage Radiation Therapy Post-Radical Prostatectomy

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Page 1: Update of Risk Factors for Biochemical Recurrence of Prostate Cancer After Salvage Radiation Therapy Post-Radical Prostatectomy

Volume 87 � Number 2S � Supplement 2013 Poster Viewing Abstracts S355

(IMRT) used after that time (dose prescribed to encompass at least 98%

of the cl-PTV).

Results: One thousand seven hundred seventeen patients were available

for analysis. Median follow-up was 4.9 years (range, 0.6-17.1 years).

Thirty-seven percent of patients underwent 3DCRT and 63% IMRT.

Median prescription dose was 75.6 Gy for patients with low-risk and 77.4

Gy for patients with intermediate and high-risk disease. Overall 10-year

biochemical failure (BF) rate was 29%: 18% for low-risk, 32% for inter-

mediate-risk, and 49% for high-risk patients. Clinical failure rates were

1%, 5%, and 10%, respectively, for the 3 risk groups. Ten-year likelihood

of biopsy-proven local failure was <1%, and overall local failure rate

(biopsy proven plus BF without regional or distant disease) was 13%. Ten-

year rates of distant metastases were 0.5%, 3.8%, and 10.3%, and cause-

specific survival was 99%, 99%, and 93% for low, intermediate, and high-

risk patients, respectively. Chronic grade >2 gastrointestinal and genito-

urinary toxicity was 18.5% and 23.8% for the entire cohort, respectively,

and 9.2% (<1% grade 3) and 18.8% for those receiving IGART in

combination with IMRT.

Conclusions: Image guidance using an off-line, adaptive technique was

associated with excellent clinical outcomes in a large patient cohort with

extended follow-up. This data provides strong support for continued

implementation and development of IGRT techniques in standard prostate

cancer management.

Author Disclosure: D.J. Krauss: None. D. Yan: None. G.S. Gustafson:

None. H. Ye: None. N. Tonlaar: None. P.Y. Chen: None. G.Z. Gustafson:

None. L.L. Kestin: None. A.A. Martinez: None. D.S. Brabbins: None.

2397Update of Risk Factors for Biochemical Recurrence of ProstateCancer After Salvage Radiation Therapy Post-Radical ProstatectomyR.J. Lee, K.S. Tzou, M.G. Heckman, B. Rawal, J.L. Peterson,

N.N. Paryani, S.J. Ko, and S.J. Buskirk; Mayo Clinic Jacksonville,

Jacksonville, FL

Purpose/Objective(s): Our group has previously evaluated risk factors forbiochemical recurrence (BCR) of prostate cancer after salvage radiation

therapy (SRT) with BCR defined as a prostate-specific antigen (PSA) value

of 0.4 ng/mL and rising. We now report an update of these risk factors

using the current American Urological Association (AUA) definition of

BCR as a PSA value of 0.2 ng/mL and rising.

Materials/Methods: This is a retrospective review of 308 patients who

received SRT for a rising PSA following radical prostatectomy (RP)

between June 1988 and February 2012 at our institution. Pre-RP PSA, pre-

SRT PSA, SRT dose, age, length of time between RP and SRT initiation,

pathological tumor stage, surgical margin, Gleason score, and pre-SRT

hormone therapy were all evaluated as risk factors for BCR using relative

risks (RR) from Cox proportional hazards regression models. BCR was

defined in accordance with the current AUA guidelines.

Results: Median pre-RP PSAwas 7.3 ng/mL (<0.1-108.0 ng/mL), median

pre-SRT PSA was 0.6 ng/mL (<0.1-23.3 ng/mL), and median SRT dose

was 66.6 Gy (60.0-72.0). With a median follow-up of 5.6 years (0.3-20.6

Poster Viewing Abstract 2398; Table Factors evaluated as predictors of grade 2 proc

Freedom from grade >2 proctitis

Treatment TypeBT/BT+EBRT/BT+ADT/BT+ADT+EBRT

92.8%/93.5%/95.8%/93.1%

BEDLess than 219 Gy/Greater than 219 Gy

94.1%/91.1%

RV100<1.5 cc/>1.5 cc

95.2%/88.1%

Alcohol +/-(n Z 1257)

94.3%/92.9%

CAD +/-(n Z 154)

93.9%/89.6%

years), 191 patients (62%) experienced BCR. At 5 and 10 years following

the start of SRT, estimated cumulative incidences of BCR were 62% (95%

Confidence Interval [CI]: 56-68%) and 75% (95% CI, 67-81%), respec-

tively. In multivariable analysis, pre-SRT PSA (RR [per each doubling]:

1.21, p < 0.001), pathological tumor stage (RR [T3a vs T2]: 1.18, p Z0.32; RR [T3b/T4 vs T2]: 2.19, p < 0.001; overall P1.0 ng/mL, compared

to patients with a pre-SRT PSA �1.0 ng/mL. Positive surgical margin was

associated with a decreased risk of BCR (RR: 0.71, p Z 0.028), but this

did not remain significant after adjustment for multiple testing.

Conclusions: This review confirms that pre-SRT PSA, pathological tumor

stage, and Gleason score are independently associated with BCR following

SRT, using the current AUA definition for BCR. Risk of BCR was highest

for patients with a pre-SRT PSA level above 1.0 ng/mL, T3b/T4 patho-

logical tumor stage, and a Gleason score greater than 7.

Author Disclosure: R.J. Lee: None. K.S. Tzou: None. M.G. Heckman:

None. B. Rawal: None. J.L. Peterson: None. N.N. Paryani: None. S.J. Ko:

None. S.J. Buskirk: None.

2398Predictive Factors and Management of Rectal Bleeding Side EffectsFollowing Prostate Cancer BrachytherapyJ. Price, N.N. Stone, and R.G. Stock; Icahn School of Medicine at Mount

Sinai Hospital, New York, NY

Purpose/Objective(s): We report on the incidence, nature, and manage-

ment of rectal toxicities following brachytherapy treatment for prostate

cancer over a 17-year period. We also report the patient and treatment

factors predisposing to acute Grade 2 proctitis.

Materials/Methods: A total of 2,752 patients were treated for prostate

cancer between October 1990 and April 2007 with either brachytherapy

alone or in combination with androgen depletion therapy or external beam

radiation therapy and were followed for a median of 6.47 years. We

investigated the incidence, nature, and treatment of acute and chronic

rectal toxicities following BT. Using univariate and multivariate analyses

we determined the treatment and comorbidity factors predisposing to rectal

toxicities. We also outline the most common and effective management for

these toxicities.

Results: Overall incidence of Grade 2 rectal bleeding was 6.4%, although

notably only 0.9% of all patients required medical intervention to manage

this toxicity. The majority of rectal bleeding episodes (72%) occurred

within the first 3 years following placement of BT seeds. Of the 27 patients

requiring management for rectal bleeding, 18 underwent formalin treat-

ment and 9 underwent cauterization. Post-hoc univariate statistical analysis

revealed that alcohol use, history of coronary artery disease (CAD), BED,

RV100, and treatment modality predict the likelihood of Grade �2 rectal

bleeding. Alcohol, CAD, treatment modality, and RV100 fit a Cox-

regression multivariate model in predicting predisposition to grade 2 rectal

bleeding.

Conclusions: Prostate brachytherapy is very well tolerated and rectal

bleeding toxicities are either self-resolving or effectively managed by

medical intervention. Treatment planning incorporating adjuvant ADT

titis

Univariate analysis P value Multivariate analysis P value

ns/ns/.009/ns .013

.01 .141

.0001 .0001

.025 .027

.026 .010