Objectives
Sleep disturbances and fatigue are common in prostate cancer patients undergoing radiotherapy. Prior research suggests mind-body techniques may improve these outcomes. We conducted a randomized-controlled trial of qigong/tai chi (QGTC) in men with prostate cancer undergoing radiotherapy.
Methods
Men with prostate cancer starting definitive radiation were randomized to one of three groups: (1) QGTC; (2) light exercise (LE); or (3) wait list control (WLC). Sleep disturbances (PSQI) and fatigue (BFI) were assessed at baseline, mid-radiotherapy (T2), during the last week of radiotherapy (T3) and at 1 (T4) and 3 months (T5) after the end of radiotherapy. Patients in the QGTC and LE groups attended three 40-minute classes per week throughout radiotherapy.
Results
Ninety patients were randomized to the three groups (QGTC=26; LE=26; WLC=24). QGTC group reported longer sleep duration at mid-XRT (QGTC=7.01 hours; LE=6.42; WL=6.50; p=0.05) but this difference did not persist over time. There were no group differences in other domains of sleep or fatigue. Exploratory analyses conducted to examine the effect of health-related QOL (EPIC and AUA score) on sleep and fatigue showed significant correlations across multiple domains.
Conclusions
QGTC during radiation for prostate cancer resulted in superior sleep duration midway through radiation, but this effect was not durable and there were no differences in other domains of sleep or fatigue. Exploratory analysis demonstrated that both sleep and fatigue were highly correlated with prostate cancer related physical symptoms. Future mind-body intervention studies should incorporate multi-modal therapy focused on improving physical symptoms in this population.
In image-guided adaptive radiotherapy, it is important to have the capability to automatically and accurately delineate the rectal wall, which is a major dose-limiting organ in prostate cancer radiotherapy. As image registration is a process to find the spatial correspondence between two images, a major challenge in intensity-based deformable image registration is to deal with the situation where no correspondence exists for some objects between the two images to be registered. One example is the variation of rectal contents due to the presence and absence of bowel gas. The intensity-based deformable image registration methods alone cannot create the correct spatial transformation if there is no correspondence between the source and target images. In this study we implemented an automatic image intensity modification procedure to create artificial gas pockets in the planning computed tomography (CT) images. A diffusion-based deformable image registration algorithm was developed to use an adaptive smoothing algorithm to better handle large organ deformations. The process was tested in 15 prostate cancer cases and 30 daily CT images containing the largest distended rectums. The manually delineated rectums agreed well with the autodelineated rectums when using the image-intensity modification procedure.
radiation-induced subcutaneous fibrosis was found in 8 patients (5%) with a slight difference in disfavor of arm B (7%) vs 4% in arm A. Three patients (2%) presented a grade 2 pneumonitis (all in arm A). Overall, quality of life and cosmesis were good to excellent. Conclusions: Concurrent or sequential adjuvant radiohormonotherapy with letrozole is feasible in daily practice. Identifying hypersensitive patients with CD8 RIA or ATM screening will help tailoring treatments and details will be presented at the congress.
Purpose/Objective: The aim of this analysis is to study the use of year of therapy as an independent predictor of outcome, serving as a proxy for time-related changes in therapy and tumor factors. Accounting for these changes would facilitate the retrospective comparison of outcomes for patients treated in different time periods.
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