1
|
Winoker JS, Say RK, Mehrazin R, Stock RG, Stone NN. Permanent prostate brachytherapy is safe in men with severe baseline lower urinary tract symptoms. Brachytherapy 2019; 18:332-337. [DOI: 10.1016/j.brachy.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022]
|
2
|
Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ. Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study. Brachytherapy 2017; 17:265-276. [PMID: 29269207 DOI: 10.1016/j.brachy.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.
Collapse
Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Houston, TX
| | - David A Swanson
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Usama Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J Graber
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa Bruno
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
3
|
Whiting PF, Moore TH, Jameson CM, Davies P, Rowlands MA, Burke M, Beynon R, Savovic J, Donovan JL. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. BJU Int 2016; 118:193-204. [DOI: 10.1111/bju.13499] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Penny F. Whiting
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Theresa H.M. Moore
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | | | - Philippa Davies
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Mari-Anne Rowlands
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Margaret Burke
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Rebecca Beynon
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Jelena Savovic
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Jenny L. Donovan
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| |
Collapse
|
4
|
Raleigh DR, Chang AJ, Tomlin B, Cunha JA, Braunstein SE, Shinohara K, Gottschalk AR, Roach M, Hsu IC. Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
5
|
Thiruchelvam N, Cruz F, Kirby M, Tubaro A, Chapple CR, Sievert KD. A review of detrusor overactivity and the overactive bladder after radical prostate cancer treatment. BJU Int 2015; 116:853-61. [DOI: 10.1111/bju.13078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology; Cambridge University Hospitals NHS Trust; Cambridge UK
| | | | - Mike Kirby
- Faculty of Health and Human Sciences; University of Hertfordshire and the Prostate Centre; London UK
| | - Andrea Tubaro
- Department of Urology; La Sapienza; University of Rome; Rome Italy
| | | | - Karl-Dietrich Sievert
- Department of Urology; Eberhard-Karls-University; Hoppe-Seyler Strasse 3 72076 Tuebingen Germany
- Department of Urology; Lübeck; Schleswig-Holstein; Ratzeburger Allee 160 23538 Lübeck Germany
- Dept of Urology and Andrology; SALK Clinic/Paracelsus Medical University; Salzburg Austria
| |
Collapse
|
6
|
Gordon A, Skarecky DW, Ahlering T. Long-term Outcomes in Severe Lower Urinary Tract Symptoms in Men Undergoing Robotic-assisted Radical Prostatectomy. Urology 2014; 84:826-31. [DOI: 10.1016/j.urology.2014.05.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 10/24/2022]
|
7
|
Steggerda MJ, Witteveen T, van den Boom F, Moonen LM. Is there a relation between the radiation dose to the different sub-segments of the lower urinary tract and urinary morbidity after brachytherapy of the prostate with I-125 seeds? Radiother Oncol 2013; 109:251-5. [DOI: 10.1016/j.radonc.2013.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
|
8
|
Long-term follow-up of International Prostate Symptom Score (IPSS) in men following prostate brachytherapy. World J Urol 2013; 32:1061-6. [DOI: 10.1007/s00345-013-1188-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022] Open
|
9
|
Ryu B, Bax J, Edirisinge C, Lewis C, Chen J, D’Souza D, Fenster A, Wong E. Prostate Brachytherapy With Oblique Needles to Treat Large Glands and Overcome Pubic Arch Interference. Int J Radiat Oncol Biol Phys 2012; 83:1463-72. [DOI: 10.1016/j.ijrobp.2011.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/27/2011] [Accepted: 10/04/2011] [Indexed: 10/14/2022]
|
10
|
Pinkawa M, Holy R, Piroth MD, Klotz J, Pfister D, Heidenreich A, Eble MJ. Urinary morbidity after permanent prostate brachytherapy - impact of dose to the urethra vs. sources placed in close vicinity to the urethra. Radiother Oncol 2012; 103:247-51. [PMID: 22300607 DOI: 10.1016/j.radonc.2011.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 11/17/2011] [Accepted: 12/28/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The impact of the dose to the urethra and sources placed close to the urethra on urinary morbidity after permanent prostate brachytherapy (PPB) is not well known. MATERIALS AND METHODS Fifty-nine patients were surveyed prospectively before treatment (A), 1 month after (B) and > 1 year after PPB (C) using a validated questionnaire (Expanded Prostate Cancer Index Composite). Computed tomography (CT) postimplant scans were performed at days 1 (Foley catheter in situ) and 30 after PPB and sources within 5mm of the urethra at day 1 were identified. RESULTS As opposed to the urethral dose-volume histogram, a larger number of sources within 5mm of the urethra at day 1 predicted significantly larger urinary bother score changes at times B and C - with an impact on incontinence and frequency (e.g. moderate/big problem with leaking urine in 25% vs. 3%, p = 0.02; moderate/big problem with frequent urination in 33% vs. 7%, p < 0.01, at time C with vs. without ≥ 3 sources in a single strand placed close to the urethra). CONCLUSIONS Placement of sources with a minimum distance of a few mm to the urethra should be a major aim to avoid urinary morbidity irrespective of the urethral dose-volume histogram.
Collapse
Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
11
|
Stone NN, Gerber NK, Blacksburg S, Stone J, Stock RG. Factors influencing urinary symptoms 10 years after permanent prostate seed implantation. J Urol 2011; 187:117-23. [PMID: 22114818 DOI: 10.1016/j.juro.2011.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE We investigated the factors that influenced urinary symptoms in the first 10 years after prostate brachytherapy. MATERIALS AND METHODS A total of 1,932 men were treated with prostate brachytherapy alone or with external beam irradiation and followed a mean of 6.8 years. The influence of pretreatment American Urological Association symptom score (7 or less, 8 to 19, 20 or greater), external beam radiotherapy, (125)I or (103)Pd, biological effective dose, age, prostate size and hormone therapy on the change in American Urological Association symptom score (11,491) was compared. RESULTS The mean change from initial score (7.4) was 11.4, 5.5, 3.3, 2.7, 1.5, 1.2, 1, 1, 1, 1, 1.3 and 1.4 points at 3, 6 months and 1 to 10 years, respectively (p <0.001). Factors that resulted in a greater increase in urinary symptoms at year 1 were low pretreatment score (p <0.001), no hormonal therapy (p <0.001), younger age (p = 0.046) and higher biological effective dose (p = 0.025). At 10 years patients with an initial score of 20 or greater had an average decrease of 11 points compared to a decrease of 0.9 for an initial score of 8 to 19 and an increase of 2.7 for an initial score of 7 or less (p <0.001). On linear regression the scores at 1 year were influenced by initial score (p <0.001), biological effective dose (p = 0.022), prostate size (p <0.001) and hormonal therapy (p = 0.009). At 10 years only the pretreatment score remained significant (p <0.001). CONCLUSIONS There is minimal change in mean American Urological Association symptom score (1.4 points) 10 years after prostate brachytherapy. Patients presenting with high initial scores have the greatest improvement from baseline. Biological effective dose, external beam radiotherapy, hormonal therapy, isotope, patient age and prostate size do not appear to influence long-term urinary symptoms.
Collapse
Affiliation(s)
- Nelson N Stone
- Department of Urology, NNS and Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.
| | | | | | | | | |
Collapse
|
12
|
Smith RP, Jones HA, Beriwal S, Gokhale A, Benoit R. Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants. Int J Radiat Oncol Biol Phys 2011; 81:745-50. [DOI: 10.1016/j.ijrobp.2010.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/08/2010] [Accepted: 06/15/2010] [Indexed: 11/25/2022]
|
13
|
Roeloffzen EM, van Vulpen M, Battermann JJ, van Roermund JG, Saibishkumar EP, Monninkhof EM. Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 81:737-44. [DOI: 10.1016/j.ijrobp.2010.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/29/2022]
|
14
|
Crook J. The role of brachytherapy in the definitive management of prostate cancer. Cancer Radiother 2011; 15:230-7. [DOI: 10.1016/j.canrad.2011.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/22/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
|
15
|
Prostatic length predicts functional outcomes after iodine-125 prostate brachytherapy. Brachytherapy 2011; 10:107-16. [DOI: 10.1016/j.brachy.2010.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 11/23/2022]
|
16
|
Crook J, Patil N, Wallace K, Borg J, Zhou D, Ma C, Pond G. A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 77:496-501. [DOI: 10.1016/j.ijrobp.2009.04.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/19/2009] [Accepted: 04/24/2009] [Indexed: 10/19/2022]
|
17
|
Longitudinal Analysis of Genitourinary and Bowel Symptoms in Prostate Cancer Patients Following Brachytherapy. Am J Clin Oncol 2010; 33:1-10. [DOI: 10.1097/coc.0b013e31819cd364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
18
|
Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle. Cancer Radiother 2009; 13:721-30. [DOI: 10.1016/j.canrad.2009.08.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/22/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
|
19
|
Vordermark D, Noe M, Markert K, Wulf J, Müller G, Bratengeier K, Beckmann G, Baier F, Guckenberger M, Schiefelbein F, Schön G, Flentje M, Baier K. Prospective evaluation of quality of life after permanent prostate brachytherapy with I-125: Importance of baseline symptoms and of prostate-V150. Radiother Oncol 2009; 91:217-24. [DOI: 10.1016/j.radonc.2008.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 06/26/2008] [Accepted: 09/12/2008] [Indexed: 11/12/2022]
|
20
|
Keyes M, Miller S, Moravan V, Pickles T, McKenzie M, Pai H, Liu M, Kwan W, Agranovich A, Spadinger I, Lapointe V, Halperin R, Morris WJ. Predictive factors for acute and late urinary toxicity after permanent prostate brachytherapy: long-term outcome in 712 consecutive patients. Int J Radiat Oncol Biol Phys 2008; 73:1023-32. [PMID: 19111402 DOI: 10.1016/j.ijrobp.2008.05.022] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients. METHODS AND MATERIALS Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity. RESULTS The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02). CONCLUSION Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low. Refined patient selection and greater technical experience in prostate brachytherapy were associated with less urinary toxicity.
Collapse
Affiliation(s)
- Mira Keyes
- Vancouver Cancer Center, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mitchell D, Mandall P, Bottomley D, Hoskin P, Logue J, Ash D, Ostler P, Elliott T, Henry A, Wylie J. Report on the Early Efficacy and Tolerability of I125 Permanent Prostate Brachytherapy from a UK Multi-institutional Database. Clin Oncol (R Coll Radiol) 2008; 20:738-44. [DOI: 10.1016/j.clon.2008.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 09/01/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
|
22
|
Mierzwa ML, Barrett WL, Redmond K, Shirazi R, Kastl A, Kumar N, Buncher R. Randomized trial to assess the efficacy of intraoperative steroid use in decreasing acute urinary retention after transperineal radioactive iodine-125 implantation for prostate cancer. Cancer 2008; 113:2605-9. [DOI: 10.1002/cncr.23905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
23
|
Hurwitz MD. Technology Insight: Combined external-beam radiation therapy and brachytherapy in the management of prostate cancer. ACTA ACUST UNITED AC 2008; 5:668-76. [PMID: 18825143 DOI: 10.1038/ncponc1224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 02/12/2008] [Indexed: 11/09/2022]
Abstract
External-beam radiation therapy (EBRT) combined with brachytherapy is an attractive treatment option for selected patients with clinically localized prostate cancer. This therapeutic strategy offers dosimetric coverage if local-regional microscopic disease is present and provides a highly conformal boost of radiation to the prostate and immediate surrounding tissues. Either low-dose-rate (LDR) permanent brachytherapy or high-dose-rate (HDR) temporary brachytherapy can be combined with EBRT; such combined-modality therapy (CMT) is typically used to treat patients with intermediate-risk to high-risk, clinically localized disease. Controversy persists with regard to indications for CMT, choice of LDR or HDR boost, isotope selection for LDR, and integration of EBRT and brachytherapy. Initial findings from prospective, multicenter trials of CMT support the feasibility of this strategy. Updated results from these trials as well as those of ongoing and new phase III trials should help to define the role of CMT in the management of prostate cancer. In the meantime, long-term expectations for outcomes of CMT are based largely on the experience of single institutions, which demonstrate that CMT with EBRT and either LDR or HDR brachytherapy can provide freedom from disease recurrence with acceptable toxicity.
Collapse
Affiliation(s)
- Mark D Hurwitz
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
24
|
Steggerda MJ, van der Poel HG, Moonen LM. An analysis of the relation between physical characteristics of prostate I-125 seed implants and lower urinary tract symptoms: Bladder hotspot dose and prostate size are significant predictors. Radiother Oncol 2008; 88:108-14. [DOI: 10.1016/j.radonc.2007.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 10/12/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
|
25
|
Crook J, Fleshner N, Roberts C, Pond G. Long-term urinary sequelae following 125iodine prostate brachytherapy. J Urol 2007; 179:141-5; discussion 146. [PMID: 17997424 DOI: 10.1016/j.juro.2007.08.136] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE We describe long-term urinary function in men treated with 125iodine brachytherapy without supplemental beam irradiation. MATERIALS AND METHODS A total of 484 men with favorable risk prostate cancer received 125I prostate brachytherapy with a followup ranging from 12 to 93 months (median 41). Prior hormonal therapy (2 to 6 months) was used in 14% of patients to reduce prostate size. Urinary function was assessed before implant by the International Prostate Symptom Score and a voiding study, and in followup by International Prostate Symptom Score. Urinary retention and catheterization, urgency and urge incontinence, persistently increased International Prostate Symptom Score, stricture, and the need for surgical intervention are reported. RESULTS Beyond 1 year 73.3% of men had no significant urinary sequelae. A flare in the International Prostate Symptom Score to greater than 15 and at least 5 points above baseline occurred in 23%, lasting a median of 3 months. Symptoms of retention requiring catheterization or surgical intervention were seen in 3.4% (1.7% stricture, 0.4% transurethral resection of the prostate, 2.7% catheter). Of the 13 men requiring catheterization at any time after 1 year, 5 (1% of total) remain dependent on clean intermittent catheterization. Median duration of catheter use for those with resolution is 4.5 months. Moderate to severe urinary urgency occurred in 6.4% of patients but it was unresponsive to anticholinergics in only 0.8%. CONCLUSIONS In this group 27% of men experienced late urinary morbidity following 125I prostate brachytherapy. Rates may vary according to technique and selection factors. The majority responded well to medical or surgical intervention, with 0.8% persistent urgency, and 1% catheter dependence.
Collapse
Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|