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Tagliaferri L, Valentini V. Brachyterapy: The radiation oncologist opinion. Urologia 2024; 91:8-10. [PMID: 38465607 DOI: 10.1177/03915603241231732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The role of the radiation oncologist in the management of patients affected by prostate cancer is increasingly considered thanks to important technological innovations that have marked the radiotherapeutic approach in its three main fields: external beam radiotherapy (EB-RT), brachytherapy (interventional radiotherapy, I-RT), and metabolic radiotherapy (M-RT) through the use of new radiopharmaceuticals. Regarding the modern brachytherapy, the introduction of intensity-modulated techniques (IM-IRT), thanks to the implementation of HDR remote-after loading machines, and image-guided techniques (IG-IRT), has led to advantages in optimizing dose distribution after implantation with the possibility of modulating the dose according to the intraprostatic dominant lesions, limiting the dose to the surrounding tissues with improvement in local control and a significant reduction in side effects. I-RT today represents a safe, scientifically established, effective and well-tolerated treatment for patients affected by prostate cancer. Like most special techniques, in order to obtain the best results, it must be performed in centers with a high volume of activity and consolidated experience with an interdisciplinary approach.
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Affiliation(s)
- Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Roma, Italy
- Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
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2
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Sanders JW, Tang C, Kudchadker RJ, Venkatesan AM, Mok H, Hanania AN, Thames HD, Bruno TL, Starks C, Santiago E, Cunningham M, Frank SJ. Uncertainty in magnetic resonance imaging-based prostate postimplant dosimetry: Results of a 10-person human observer study, and comparisons with automatic postimplant dosimetry. Brachytherapy 2023; 22:822-832. [PMID: 37716820 DOI: 10.1016/j.brachy.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/03/2023] [Accepted: 08/02/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Uncertainties in postimplant quality assessment (QA) for low-dose-rate prostate brachytherapy (LDRPBT) are introduced at two steps: seed localization and contouring. We quantified how interobserver variability (IoV) introduced in both steps impacts dose-volume-histogram (DVH) parameters for MRI-based LDRPBT, and compared it with automatically derived DVH parameters. METHODS AND MATERIALS Twenty-five patients received MRI-based LDRPBT. Seven clinical observers contoured the prostate and four organs at risk, and 4 dosimetrists performed seed localization, on each MRI. Twenty-eight unique manual postimplant QAs were created for each patient from unique observer pairs. Reference QA and automatic QA were also performed for each patient. IoV of prostate, rectum, and external urinary sphincter (EUS) DVH parameters owing to seed localization and contouring was quantified with coefficients of variation. Automatically derived DVH parameters were compared with those of the reference plans. RESULTS Coefficients of variation (CoVs) owing to contouring variability (CoVcontours) were significantly higher than those due to seed localization variability (CoVseeds) (median CoVcontours vs. median CoVseeds: prostate D90-15.12% vs. 0.65%, p < 0.001; prostate V100-5.36% vs. 0.37%, p < 0.001; rectum V100-79.23% vs. 8.69%, p < 0.001; EUS V200-107.74% vs. 21.18%, p < 0.001). CoVcontours were lower when the contouring observers were restricted to the 3 radiation oncologists, but were still markedly higher than CoVseeds. Median differences in prostate D90, prostate V100, rectum V100, and EUS V200 between automatically computed and reference dosimetry parameters were 3.16%, 1.63%, -0.00 mL, and -0.00 mL, respectively. CONCLUSIONS Seed localization introduces substantially less variability in postimplant QA than does contouring for MRI-based LDRPBT. While automatic seed localization may potentially help improve workflow efficiency, it has limited potential for improving the consistency and quality of postimplant dosimetry.
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Affiliation(s)
- Jeremiah W Sanders
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aradhana M Venkatesan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Henry Mok
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Howard D Thames
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine Starks
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edwin Santiago
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mandy Cunningham
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Katayama N, Yorozu A, Kikuchi T, Higashide S, Masui K, Kojima S, Saito S. Biochemical outcomes and toxicities in young men with prostate cancer after permanent iodine-125 seed implantation: Prospective cohort study in 6662 patients. Brachytherapy 2023; 22:293-303. [PMID: 36599746 DOI: 10.1016/j.brachy.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We evaluated the effect of age, <60 and ≥60 years, on biochemical outcomes and toxicities in patients with prostate cancer who underwent permanent seed implantation (PI) ± external beam radiation therapy ± hormone therapy in a national Japanese prospective cohort study (J-POPS). METHODS AND MATERIALS The safety and efficacy analyses included 6721 and 6662 patients, respectively. We categorized patients into two age groups: <60 (n = 716) and ≥60 (n = 6,005) years. We used propensity score matching (PSM) to estimate the marginal effect of age on biochemical freedom from failure (bFFF) using a Phoenix definition and Cox proportional hazard models. RESULTS The median followup period was 60.0 months. Without PSM, men <60 years demonstrated similar 5-year bFFF (96.3%) compared with men ≥60 years (95.6%; p = 0.576); percent positive biopsies, biologically effective dose, Gleason score, risk classification, and supplemental external beam radiation therapy (p <0.001, <0.001, <0.001, 0.008, and <0.001) were significantly associated with bFFF while age was not (p = 0.576). With PSM, bFFF was not significantly different between age groups (p = 0.664); however, men <60 years showed a significantly lower incidence of declining erectile function, grade ≥2 all urinary toxicities, urinary frequency/urgency, and rectal bleeding (p <0.001, 0.024, 0.031, and 0.010) than men ≥60 years. CONCLUSIONS After PI, men <60 years achieved a comparable 5-year biochemical control rate and showed a lower incidence of several toxicities compared to men ≥60 years. This suggests that PI should be an excellent treatment option for men <60 years with prostate cancer.
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Affiliation(s)
- Norihisa Katayama
- Department of Radiology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Kikuchi
- Translational Research Center for Medical Innovation, Kobe, Japan
| | | | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Kojima
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Shiro Saito
- Department of Urology, Ofuna Chuo Hospital, Kanagawa, Japan
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Kim TH, Lee JJB, Cho J. Prostate-Specific Antigen Bounce after 125I Brachytherapy Using Stranded Seeds with Intraoperative Optimization for Prostate Cancer. Cancers (Basel) 2022; 14:cancers14194907. [PMID: 36230829 PMCID: PMC9563276 DOI: 10.3390/cancers14194907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/17/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Prostate-specific antigen (PSA) bounce is common in patients undergoing 125I brachytherapy (BT), and our study investigated its clinical features. A total of 100 patients who underwent BT were analyzed. PSA bounce and large bounce were defined as an increase of ≥0.2 and ≥2.0 ng/mL above the initial PSA nadir, respectively, with a subsequent decline without treatment. Biochemical failure was defined using the Phoenix definition (nadir +2 ng/mL), except for a large bounce. With a median follow-up of 49 months, 45% and 7% of the patients experienced bounce and large bounce, respectively. The median time to bounce was 24 months, and the median PSA value at the bounce spike was 1.62 ng/mL, a median raise of 0.44 ng/mL compared to the pre-bounce nadir. The median time to bounce recovery was 4 months. The post-bounce nadir was obtained at a median of 36 months after low-dose-rate BT. On univariate analysis, age, the PSA nadir value at 2 years, and prostate volume were significant factors for PSA bounce. The PSA nadir value at 2 years remained significant in multivariate analysis. We should carefully monitor young patients with high prostate volume having a >0.5 PSA nadir value at 2 years for PSA bounce.
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Affiliation(s)
- Tae Hyung Kim
- Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Korea
| | - Jason Joon Bock Lee
- Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jaeho Cho
- Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-8095
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MRI-defined treatment margins, urinary toxicity, and PSA response in LDR prostate brachytherapy. Brachytherapy 2022; 21:216-223. [PMID: 35210018 DOI: 10.1016/j.brachy.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Implant quality metrics as measured by D90 and V100 do not address the adequacy of periprostatic margins. Relative margin deficiencies may relate to efficacy and margin excesses to post-implant toxicity. Our purpose is to determine MRI-defined treatment margins on prostate achieved with LDR brachytherapy. METHODS AND MATERIALS Post implant CT and MR images from 487 consecutive patients who received LDR brachytherapy from 2010 to 14 were co-registered. Four prostate quadrants were defined; anterior-superior (AS), posterior-superior (PS), anterior-inferior (AI), posterior-inferior (PI). Dosimetric variables were measured for prostate, and for each quadrant with a 0-, 2-, 3-, and 5-mm margin, as well as for the membranous urethra defined on MRI. RESULTS Prostate D90 (no margin) was associated with D90 to the volume enclosed by 2 mm, 3 mm and 5 mm margins (R2 = 0.9 - 1.0) with an average 7.1% decrease in dose per mm of margin. Mean D90 for PS, AI and PI quadrants were > 110% of prescription dose for margins of 2-, 3-, and 5-mm. AS quadrant mean D90s were generally lower (83.2% for 2 mm, 76.4% for 3 mm and 62.2% for 5 mm). Urethral strictures (n = 9) were associated with higher doses in the AI quadrant, and higher membranous urethral V125 (51 vs. 32%, p 0.013) and V150 (34.5 vs. 17.6%, p 0.01). CONCLUSIONS Using MR-CT post implant dosimetry, margin coverage up to 5 mm was excellent with less margin coverage in the AS quadrant. Late ≥ grade 2 toxicity and urinary strictures are more likely to occur with relative margin excess in the anterior-inferior quadrant and higher doses caudal to the prostate apex. Within this analysis, there was no relationship between treatment margins, and PSA outcome.
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Patterns of Prostate Cancer Recurrence After Brachytherapy Determined by Prostate-Specific Membrane Antigen-Positron Emission Tomography and Computed Tomography Imaging. Int J Radiat Oncol Biol Phys 2022; 112:1126-1134. [PMID: 34986383 DOI: 10.1016/j.ijrobp.2021.12.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to characterize the patterns of prostate cancer recurrence after brachytherapy (BT) using 2-(3-[1-carboxy-5-([6-18F-fluoropyridine-3-carbonyl]-amino)-pentyl]-ureido)-pentanedioic acid ([18F]DCFPyL) prostate-specific membrane antigen (PSMA) positron emission tomography (PET) and computed tomography (CT) imaging. METHODS AND MATERIALS Patients were selected from an ongoing prospective institutional trial investigating the use of [18F]DCFPyL PSMA PET and CT in recurrent prostate cancer (NCT02899312). This report included patients who underwent BT (either monotherapy or boost) and experienced a biochemical failure (BF) defined by the Phoenix definition (prostate-specific antigen [PSA] > 2 ng/mL above nadir). RESULTS Between March 2017 and April 2020, 670 patients underwent [18F]DCFPyL PSMA PET and CT imaging. Of these 670 patients, 93 were treated with BT; 73 underwent monotherapy, and 20 underwent BT boost (19 low-dose rate and 1 high-dose rate). To report on patterns of recurrence outcomes, 86 patients (median prescan PSA 6.0) with a positive [18F]DCFPyL PSMA PET and CT scan and true BF were included. The most common location of relapse was local; 62.8% had a component of local failure (defined as prostate and/or seminal vesicles), and 46.5% had isolated local failure only, with no other sites of involvement. Regional failure occurred in 40.7% of patients, and 36.0% had metastatic failure. Isolated local recurrence was seen in 54.3% of monotherapy patients versus only in 12.5% of boost patients. Metastatic failure was seen in 28.6% of monotherapy patients versus 68.8% of the boost patients. Local recurrences (69.0%) were found within the same prostate biopsy sextant involved with the tumor at diagnosis, and 76.0% of patients with seminal vesicle recurrences had prostate-base involvement at diagnosis. CONCLUSIONS Contrary to previous evidence, our study suggests that in prostate BT patients with biochemical recurrence, the most common site of failure is local for the patients treated with monotherapy and metastatic for patients treated with a combination of external beam radiation and BT boost.
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Nuver TT, Hilgers GC, Kattevilder RA, Westendorp H. Local seed displacement from Day 0 to Day 30 in I-125 permanent prostate brachytherapy: A detailed, computed tomography-based analysis. Brachytherapy 2022; 21:208-215. [DOI: 10.1016/j.brachy.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/02/2022]
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Behmueller M, Tselis N, Zamboglou N, Zoga E, Baltas D, Rödel C, Chatzikonstantinou G. High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up. Front Oncol 2021; 11:770959. [PMID: 34926278 PMCID: PMC8674679 DOI: 10.3389/fonc.2021.770959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction To evaluate the oncological outcome of high dose rate (HDR) brachytherapy (BRT) as monotherapy for clinically localised prostate cancer (PCA). Material and Methods Between January 2002 and February 2004, 141 consecutive patients with clinically localised PCA were treated with HDR-BRT monotherapy. The cohort comprised 103 (73%) low-, 32 (22.7%) intermediate- and 6 (4.3%) high risk patients according to D’Amico classification or 104 (73.8%) low-, 24 (17.0%) intermediate favourable-, 12 (8.5%) intermediate unfavourable- and one (0.7%) very high risk patient according to National Comprehensive Cancer Network (NCCN) one. Patients received four fractions of 9.5 Gy delivered within a single implant up to a total physical dose of 38 Gy. Catheter-implantation was transrectal ultrasound-based whereas treatment planning CT-based. Thirty-three patients (23.4%) received ADT neoadjuvantly and continued concurrently with BRT. Biochemical relapse-free survival (BRFS) was defined according to the Phoenix Consensus Criteria and genitourinary (GU)/gastrointestinal (GI) toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 5.0. Results Median age at treatment and median follow-up time was 67.2 and 15.2 years, respectively. Twenty-three (16.3%) patients experienced a biochemical relapse and 5 (3.5%) developed distant metastases, with only one patient dying of PCA. The BRFS was 85.1% at 15 years and 78.7% at 18 years. The corresponding overall survival, metastases-free survival, and prostate cancer specific mortality at 15- and 18-years was 73.9%/59.1%, 98.3%/90.6%, and 100%/98.5% respectively. Late grade 3 GI and GU toxicity was 4.2% and 5.6% respectively. Erectile dysfunction grade 3 was reported by 27 (19%) patients. From the prognostic factors evaluated, tumor stage (≤T2b compared to ≥T2c) along with the risk group (low-intermediate vs. high) when using the D’Amico classification but not when the NCCN one was taken into account, correlated significantly with BRFS. Conclusion Our long-term results confirm HDR-BRT to be a safe and effective monotherapeutic treatment modality for low- and intermediate risk PCA.
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Affiliation(s)
- Manuel Behmueller
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Eleni Zoga
- Department of Radiation Oncology, Offenbach Hospital, Offenbach am Main, Germany
| | - Dimos Baltas
- Division of Medical Physics, University Hospital Freiburg, Albert-Ludwigs University, Freiburg im Breisgau, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Georgios Chatzikonstantinou
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
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Helou J, Charas T. Acute and late side-effects after low dose-rate brachytherapy for prostate cancer; incidence, management and technical considerations. Brachytherapy 2021; 20:956-965. [PMID: 33972182 DOI: 10.1016/j.brachy.2021.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To review common reported side effects and complications after primary LDR-BT (monotherapy) and discuss some of the technical aspects that could impact the treatment outcomes. METHODS AND MATERIALS A literature search was undertaken using medical subject headings (MeSH) complemented by the authors' personal and institutional expertise. RESULTS The reported incidence of acute and late grade 2 or above urinary, bowel and sexual side effects is very variable across the literature. The learning curve and the implant quality have a clear impact on the toxicity outcomes. Being aware of some of the technical challenges encountered during the procedure and ways to mitigate them could decrease the incidence of side effects. Careful planning of seed placement and seed deposition allow sparing of the organs at risk and a lower incidence of urinary and gastro-intestinal toxicity. CONCLUSIONS Low dose-rate brachytherapy remains a standard monotherapy treatment in the setting of favorable-risk prostate cancer. High disease control and low long-term toxicities are achievable in expert hands with a good technique.
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Affiliation(s)
- Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Tomer Charas
- Radiotherapy Unit, Oncology Division, Rambam Health Care Campus, Haifa, Israel
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10
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Tisseverasinghe S, Marbán M, Crook J, Petrik D, Araujo C. Comparison between postoperative TRUS-CT fusion with MRI-CT fusion for postimplant quality assurance in prostate LDR permanent seed brachytherapy. Brachytherapy 2021; 20:849-856. [PMID: 33867295 DOI: 10.1016/j.brachy.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE/OBJECTIVE Permanent seed Low-Dose-Rate brachytherapy is planned and delivered using transrectal ultrasound (TRUS). Post-implant evaluation for quality assurance is usually performed using Computed Tomography (CT). Registration of the CT images with MRI reduces subjectivity in contouring by improving prostate edge detection. We hypothesized that a set of TRUS images post procedure may provide the same benefit. MATERIAL/METHODS Consecutive patients undergoing Low-Dose-Rate prostate brachytherapy were recruited. TRUS images were recorded under anesthesia at completion of their implant. In addition, all patients underwent standard post-implant quality assurance including prostate CT and MRI at day 30. These were co-registered, contoured and seeds were identified. Three independent observers contoured and registered the post implant TRUS images to the Day 30 CT using seed matching. Prostate volumes and dosimetric parameters were compared through Intraclass Correlation Coefficient (ICC) to evaluate the concordance between MRI and ultrasound (US). RESULTS 26 patients were recruited from 10/17 to 01/18. Mean prostate volume was 34.5 (SD 10.8) cm3 at baseline on planning TRUS images, 37.4 (SD 11.3) cm3 on Day 0 post implant TRUS and 36.7 (SD 11.7) cm3 on Day 30 MRI. D90 was 112.6% (SD 9.3) on CT-MRI and 112.9% (SD 11.1) on CT-US. V100 was 94.6% (SD 3.8) for CT-MRI, 95.1% (SD 4.3) for CT-US. Student t-tests were used to compare groups. No significant differences were noted. CONCLUSION Post implant TRUS may be useful for quality assurance for post-implant dosimetry particularly if access to an MRI is limited.
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Affiliation(s)
- Steven Tisseverasinghe
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Marina Marbán
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Juanita Crook
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada.
| | - David Petrik
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Cynthia Araujo
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
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11
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Lamb DS, Greig L, FitzJohn T, Russell GL, Nacey JN, Iupati D, Woods L. Relapse patterns after low-dose-rate prostate brachytherapy. Brachytherapy 2020; 20:291-295. [PMID: 33158775 DOI: 10.1016/j.brachy.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE When biochemical failure (BF) develops after low-dose-rate prostate brachytherapy, the relapse site is frequently not found. We set out to find whether prostate-specific membrane antigen positron emission tomography -CT (PSMA PET-CT) scanning has improved knowledge of relapse patterns. METHODS AND MATERIALS A database was analyzed, which contained information and long-term followup on 903 men who had an iodine-125 seed implant as monotherapy for early-stage prostate cancer. There was a total of 68 BFs. RESULT In 38 men developing BF before PSMA PET-CT scanning was available, the site of relapse was local in six, distant in twelve, and unknown in twenty. In 30 men developing BF more recently who had a PSMA PET-CT scan, the relapse site was demonstrated in all cases, and 19 (63%) men had relapsed at the prostate base. Radiation dosimetry of base relapses and paired controls demonstrated that implants routinely delivered a lower radiation dose to the base than to the rest of the prostate. Eight of seventeen cases found to have prostate relapse only underwent salvage prostatectomy. CONCLUSION PSMA PET-CT scanning is highly effective in demonstrating the relapse site(s) when BF develops after low-dose-rate prostate brachytherapy. Knowledge of the relapse site increases management options for men developing BF.
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Affiliation(s)
- David S Lamb
- School of Biological Sciences, Victoria University of Wellington, New Zealand; Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand.
| | - Lynne Greig
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | - Trevor FitzJohn
- PET/CT Unit, Pacific Radiology Bowen Centre, Wellington, New Zealand
| | | | - John N Nacey
- Department of Surgery, University of Otago, Wellington, New Zealand
| | - Douglas Iupati
- Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand
| | - Lisa Woods
- School of Mathematics and Statistics, Victoria University of Wellington, New Zealand
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12
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Martell K, Roy S, Meyer T, Stosky J, Jiang W, Thind K, Roumeliotis M, Bosch J, Angyalfi S, Quon H, Husain S. Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy. Heliyon 2020; 6:e04092. [PMID: 32548323 PMCID: PMC7286970 DOI: 10.1016/j.heliyon.2020.e04092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To compare the outcomes of patients with intermediate risk prostate cancer (IR-PCa) treated with low-dose rate I-125 seed brachytherapy (LDR-BT) and targeted dose painting of a histologic dominant intra-epithelial lesion (DIL) to those without a DIL. Methods 455 patients with IR-PCa were treated at a single center with intra-operatively planned LDR-BT, each following the same in-house dose constraints. Patients with a DIL on pathology had hot spots localized to that region but no specific contouring during the procedure. Results 396 (87%) patients had a DIL. Baseline tumor characteristics and overall prostate dosimetry were similar between patients with and without DIL except the median number of biopsy cores taken: 10 (10–12) vs 12 (10–12) (p = 0.002). 19 (5%) and 18 (5%) of patients with and 1 (2%) and 0 (0%) of those without DIL experienced CTCAE grade 2 and 3 toxicity respectively. Overall, toxicity grade did not significantly correlate with presence of DIL (p = 0.10). Estimated 7-year freedom from biochemical failure (FFBF) was 84% (95% confidence interval: 79–89) and 70% (54–89) in patients with and without a DIL (log-rank p = 0.315). In DIL patients, cox regression revealed location of DIL (“Base” vs “Apex” HR: 1.03; 1.00–1.06; p = 0.03) and older age (70 vs 60 HR: 1.62; 1.06–2.49; p = 0.03) was associated with poor FFBF. Conclusions Targeting DIL through dose painting during intraoperatively planned LDR-BT provided no statistically significant change in FFBF. Patients with DILs in the prostate base had slightly lower FFBF despite DIL boost.
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Affiliation(s)
- Kevin Martell
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Soumyajit Roy
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada.,Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tyler Meyer
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Jordan Stosky
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Will Jiang
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Kundan Thind
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Michael Roumeliotis
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - John Bosch
- Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Steve Angyalfi
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Harvey Quon
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Siraj Husain
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
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13
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Fischer-Valuck BW, Gay HA, Patel S, Baumann BC, Michalski JM. A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate. Front Oncol 2019; 9:1378. [PMID: 31921640 PMCID: PMC6914687 DOI: 10.3389/fonc.2019.01378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/22/2019] [Indexed: 01/18/2023] Open
Abstract
For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LDR) or high-dose rate (HDR) brachytherapy to EBRT, although only ASCENDE-RT compared brachytherapy to dose-escalated EBRT but did report an over 50% improvement in biochemical failure with a LDR boost. Multiple single institution and comparative research series also support the use of a brachytherapy boost in the DE-EBRT era and demonstrate excellent prostate cancer specific outcomes. Despite improved oncologic outcomes with a brachytherapy boost in the high-risk setting, the utilization of both LDR, and HDR brachytherapy use is declining. The acute genitourinary toxicities when brachytherapy boost is combined with EBRT, particularly a LDR boost, are of concern in comparison to EBRT alone. HDR brachytherapy boost has many physical properties inherent to its rapid delivery of a large dose which may reduce acute toxicities and also appeal to the radiobiology of prostate cancer. We herein review the evidence for use of either LDR or HDR brachytherapy boost for high-risk prostate cancer and summarize comparisons between the two treatment modalities.
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Affiliation(s)
- Benjamin W. Fischer-Valuck
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Sagar Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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14
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Xu T, Peng WD, Gu X, Yu WJ. Endobronchial Ultrasound-Guided Iodine-125 Radioactive Seed Implantation as a Novel Therapy for Mediastinal Tumors. Cancer Biother Radiopharm 2019; 34:547-550. [PMID: 31524501 DOI: 10.1089/cbr.2019.2818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: This study aims to test the treatment effect of endobronchial ultrasound (EBUS)-guided interstitial iodine-125 (125I) seed implantation for mediastinal lymph node metastasis or advanced mediastinal lung cancer. Materials and Methods: The patients with mediastinal lymph node metastasis or advanced mediastinal lung cancer, who had undergone surgery for resection of primary lesions and repeated chemotherapy or external radiotherapy, were selected and scheduled to undergo EBUS-guided 125I seed implantation from December 2015 to May 2017. Forty patients were included into this study. Clinical data of these patients were collected and the short-term effects were observed. Then, the feasibility for treating mediastinal tumors was retrospectively analyzed. The follow-up period ranged within 1-6 months. Results: The procedure was successfully completed, and all patients well tolerated the procedure without any major complications. The response evaluation criteria in solid tumors were utilized to test the treatment effect, and the overall response rates (complete remission + partial remission) at postoperative 2, 4, and 6 months were 65.00% (13/20), 80.00% (16/20), and 85.0% (17/20), respectively. All patients of this study survived throughout the follow-up period. Conclusions: This experience revealed that EBUS-guided 125I radioactive seed implantation is effective and safe, and is a prospective approach for treating patients with mediastinal lymph node metastasis or advanced mediastinal lung cancer.
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Affiliation(s)
- Tao Xu
- Department of Respiration, The Yinzhou People's Hospital (The Yinzhou Hospital Affiliated to Medical School of Ningbo University), Ningbo, China
| | - Wei-Dong Peng
- Department of Respiration, The Yinzhou People's Hospital (The Yinzhou Hospital Affiliated to Medical School of Ningbo University), Ningbo, China
| | - Xiao Gu
- Department of Respiration, The Yinzhou People's Hospital (The Yinzhou Hospital Affiliated to Medical School of Ningbo University), Ningbo, China
| | - Wan-Jun Yu
- Department of Respiration, The Yinzhou People's Hospital (The Yinzhou Hospital Affiliated to Medical School of Ningbo University), Ningbo, China
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15
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Moran BJ, Rice SR, Chhabra AM, Amin N, Braccioforte M, Agarwal M. Long-term biochemical outcomes using cesium-131 in prostate brachytherapy. Brachytherapy 2019; 18:800-805. [PMID: 31427178 DOI: 10.1016/j.brachy.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Long-term outcomes reveal equivalent biochemical outcomes with low-dose-rate (LDR) brachytherapy (BT) compared with radical prostatectomy and external-beam radiotherapy for the management of prostate cancer. Iodine-125, the most commonly used isotope, may be associated with long-term urinary consequences. Cesium-131 (131Cs) has a higher dose rate and shorter dose delivery time, predicting a shorter duration of urinary morbidity. We report our institution's high-volume experience and the most mature data to date on outcomes with 131Cs prostate BT. METHODS AND MATERIALS 571 men (median age: 65.38 years) with low (55%)-, intermediate (36%)-, and high-risk disease (9%) received monobrachytherapy, dual-modality, or trimodality using 131Cs at a single institution. Risk groups were defined according to the National Comprehensive Cancer Network definition. Median prescription dose for definitive LDR-BT and LDR-BT boost was 115 Gy and 70 Gy, respectively. Median initial PSA was 6.1 ng/mL (IQR: 4.6-8.7). RESULTS Median followup time was 5 years. 5/7-year overall survival for low-, intermediate-, and high-risk patients was 96.9%/96/9%, 92.8%/89.7%, and 95.8%/87.1%, respectively (p = 0.02). 5/7-year freedom from biochemical failure for low-, intermediate-, and high-risk patients was 98.5%/96.3%, 94.1%/86.4%, and 93.2%/74.5%, respectively (p < 0.01). 5/7-year prostate cancer -specific survival was 100%/100%, 99.3%/99.3%, and 98.0%/98.0% for low-, intermediate-, and high-risk patients, respectively (p < 0.01). CONCLUSIONS 131Cs is a viable alternative isotope for prostate brachytherapy for organ-confined disease. Long-term biochemical control and survival outcomes are excellent and on par with those attained with the use of 125I or 103Pd. This report therefore supports the continued use of 131Cs as an effective and comparable alternative isotope.
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Affiliation(s)
| | - Stephanie R Rice
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - Arpit M Chhabra
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - Neha Amin
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Manuj Agarwal
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
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16
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Long-term biochemical progression-free survival following brachytherapy for prostate cancer: Further insight into the role of short-term androgen deprivation and intermediate risk group subclassification. PLoS One 2019; 14:e0215582. [PMID: 31002732 PMCID: PMC6474628 DOI: 10.1371/journal.pone.0215582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/04/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Brachytherapy is a well-established treatment of localized prostate cancer. Few studies have documented long-term results, specifically biochemical progression-free survival (bPFS) in men with brachytherapy alone, with or without short-term androgen deprivation therapy (ADT), or in combination with external beam radiotherapy (EBRT). Our aim was to analyze long-term bPFS of brachytherapy treated patients. Materials and methods Retrospective analysis of 1457 patients with low and intermediate risk prostate cancer treated with brachytherapy alone (1255) or combined with EBRT (202). Six-months ADT was administrated for all EBRT combined patients and for prostate volume downsizing when >55 cc (328). Failure was by the Phoenix definition. Kaplan-Meier analysis and multivariate Cox regression estimated and compared 10-yr and 15-yr rates of bPFS. Results Median follow-up was 6.1 yr. Ten and 15-yr bPFS rates of the entire cohort were 93.2% and 89.2%, respectively. On multivariate analysis, PSA density (PSAD), ADT and clinical stage were significantly associated with failure. The most powerful independent factor was PSAD with a HR of 3.5 (95% CI, 1.7–7.4) for PSAD above 0.15. No significant difference was found between low and intermediate risks patients regardless of treatment regimen. However, comparison of two intermediate risk groups, Gleason score (GS) 7, PSA<20 ng/ml versus GS≤6 and PSA = 10–20 ng/ml, revealed 10- and 15-yr bPFS rates of 94.2% and 94.2% compared to 88.2% and 79.9%, (P = 0.022), respectively. ADT improved bPFS rates in low risk patients. The ten and 15-yr bPFS rates were 97.6% and 94.6% compared to 92.3% and 88.2%, (P = 0.020), respectively. Conclusions Our retrospective large scale study suggests that brachytherapy provides excellent long-term bPFS rates in low and intermediate risk disease. Combination of brachytherapy with EBRT yields favorable outcomes in GS 7 intermediate risk patients and short-term ADT has a positive effect on outcomes in low risk patients. Further prospective studies are warranted to discriminate the role of adding either EBRT and/or ADT to brachytherapy protocols.
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17
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Tissaverasinghe S, Crook J, Bachand F, Batchelar D, Hilts M, Araujo C, Anderson D, Bainbridge T, Farnquist B. Dose to the dominant intraprostatic lesion using HDR vs. LDR monotherapy: A Phase II randomized trial. Brachytherapy 2019; 18:299-305. [PMID: 30795889 DOI: 10.1016/j.brachy.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/12/2019] [Accepted: 01/17/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To present the dosimetric results of a Phase II randomized trial comparing dose escalation to the MRI-defined dominant intraprostatic lesion (DIL) using either low-dose-rate (LDR) or high-dose-rate (HDR) prostate brachytherapy. MATERIAL AND METHODS Patients receiving prostate brachytherapy as monotherapy were randomized to LDR or HDR brachytherapy. Prostate and DILs were contoured on preoperative multiparametric MRI. These images were registered with transrectal ultrasound for treatment planning. LDR brachytherapy was preplanned using I-125 seeds. HDR brachytherapy used intraoperative transrectal ultrasound-based planning to deliver 27 Gy/2 fractions in separate implants. DIL location was classified as peripheral, central, or anterior. A student t-test compared DIL D90 between modalities and DIL locations. RESULTS Of 60 patients, 31 underwent LDR and 29 HDR brachytherapy. Up to three DILs were identified per patient (100 total) with 74 peripheral, six central, and 20 anterior DILs. Mean DIL volume was 1.9 cc (SD: 1.7 cc) for LDR and 1.6 cc (SD 1.3 cc) for HDR (p = 0.279). Mean DIL D90 was 151% (SD 30%) for LDR and 132% (SD 13%) for HDR. For LDR, mean peripheral DIL D90 was 159% (SD 27%) and central or anterior 127% (SD 13%). HDR peripheral DILs received 137% (SD 12%) and central or anterior 119% (SD 7%). DIL D90 for peripheral lesions was higher than anterior and central (p < 0.001). CONCLUSIONS DIL location affects dose escalation, particularly because of urethral proximity, such as for anterior and central DILs. HDR brachytherapy may dose escalate better when target DIL is close to critical organs.
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Affiliation(s)
- Steven Tissaverasinghe
- Radiation Oncology, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Juanita Crook
- Radiation Oncology, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Francois Bachand
- Radiation Oncology, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Deidre Batchelar
- Medical Physics, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Hilts
- Medical Physics, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia Araujo
- Medical Physics, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Danielle Anderson
- Medical Physics, BC Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Bainbridge
- Department of Pathology, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Brenda Farnquist
- Department of Radiology, Kelowna General Hospital, Kelowna, British Columbia, Canada
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18
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Routman DM, Funk RK, Stish BJ, Mynderse LA, Wilson TM, McLaren R, Harmsen WS, Mara K, Deufel CL, Furutani KM, Haddock MG, Pisansky TM, Choo CR, Davis BJ. Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients. Brachytherapy 2019; 18:1-7. [DOI: 10.1016/j.brachy.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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19
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Niwa N, Matsumoto K, Nishiyama T, Yagi Y, Ozu C, Nakamura K, Saito S, Oya M. Selection of patients who would not require long-term prostate-specific antigen monitoring after low-dose-rate brachytherapy. Brachytherapy 2018; 17:899-905. [DOI: 10.1016/j.brachy.2018.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/19/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
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20
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Stish BJ, Davis BJ, Mynderse LA, McLaren RH, Deufel CL, Choo R. Low dose rate prostate brachytherapy. Transl Androl Urol 2018; 7:341-356. [PMID: 30050795 PMCID: PMC6043740 DOI: 10.21037/tau.2017.12.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Low dose rate (LDR) prostate brachytherapy is an evidence based radiation technique with excellent oncologic outcomes. By utilizing direct image guidance for radioactive source placement, LDR brachytherapy provides superior radiation dose escalation and conformality compared to external beam radiation therapy (EBRT). With this level of precision, late grade 3 or 4 genitourinary or gastrointestinal toxicity rates are typically between 1% and 4%. Furthermore, when performed as a same day surgical procedure, this technique provides a cost effective and convenient strategy. A large body of literature with robust follow-up has led multiple expert consensus groups to endorse the use of LDR brachytherapy as an appropriate management option for all risk groups of non-metastatic prostate cancer. LDR brachytherapy is often effective when delivered as a monotherapy, although for some patients with intermediate or high-risk disease, optimal outcome are achieved in combination with supplemental EBRT and/or androgen deprivation therapy (ADT). In addition to reviewing technical aspects and reported clinical outcomes of LDR prostate brachytherapy, this article will focus on the considerations related to appropriate patient selection and other aspects of its use in the treatment of prostate cancer.
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Affiliation(s)
- Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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21
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A Phase II trial of 8 weeks of degarelix for prostate volume reduction: Efficacy and hormonal recovery. Brachytherapy 2018; 17:530-536. [DOI: 10.1016/j.brachy.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
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22
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Beaulieu L, Radford DA, Eduardo Villarreal-Barajas J. COMP report: CPQR technical quality control guidelines for low-dose-rate permanent seed brachytherapy. J Appl Clin Med Phys 2018. [PMID: 29542269 PMCID: PMC5978974 DOI: 10.1002/acm2.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology. This article contains detailed performance objectives and safety criteria for low‐dose‐rate (LDR) permanent seed brachytherapy.
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Affiliation(s)
- Luc Beaulieu
- Department of Physics, Université Laval Cancer Research Centre, Quebec, QC, Canada.,Department of Radiation Oncology, CRCHU de Québec, CHU de Québec - Université Laval, Ville de Québec, QC, Canada
| | - Dee-Ann Radford
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - J Eduardo Villarreal-Barajas
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
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23
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Berlin A, Ahmad AE, Chua MLK, Moraes FY, Jiang H, Komisarenko M, Trimilshina N, Raziee H, Hosni A, Murgic J, Chung P, Bristow RG, Finelli A. Curative Radiation Therapy at Time of Progression Under Active Surveillance Compared With Up-front Radical Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 100:702-709. [PMID: 29249526 DOI: 10.1016/j.ijrobp.2017.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/15/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe and compare outcomes in men with initially presumed indolent prostate cancer receiving definitive radiation therapy after active surveillance (AS) versus those in a risk-matched cohort undergoing up-front radiation therapy. METHODS AND MATERIALS Men prospectively enrolled in an AS program between 1992 and 2014 and subsequently undergoing curative radiation therapy (ie, image guided radiation therapy [IGRT] or low-dose-rate brachytherapy [LDR-BT]) were identified. Biochemical relapse-free rate (bRFR), metastasis-free rate (mFR), and overall survival (OS) were compared against a cohort of men treated up front, matched by age, clinical prognostic indices (risk group, prostate-specific antigen, cT category, Gleason score, percentage of involved biopsy cores), and radiation therapy modality. RESULTS Of 1070 patients in the AS registry, 200 underwent definitive radiation therapy (143 IGRT and 57 LDR-BT) after a median of 32.9 (interquartile range [IQR] 20.6-59.8) months on surveillance. Main reasons for treatment were grade and volume upgrading (57.5% and 26%, respectively). Median follow-up after radiation therapy was 4.9 (IQR 3.1-7.5) years. At 5 years the bRFR, mFR, and OS were, respectively, 97%, 99%, and 98.5%. No patient died of prostate cancer. Adequate risk-matching was confirmed in an independent cohort comprising 359 patients receiving up-front IGRT (71%) or LDR-BT (29%) and followed for a median of 9 (IQR 3.1-7.5) years. There was no difference in the disease-specific outcomes (bRFR, mFR) between the 2 cohorts (Gray's P value of .257 and .934, respectively). In multivariate analyses, timing of radical radiation therapy (deferred vs up-front) was not correlated to biochemical relapse or metastases occurrence. CONCLUSIONS Curative-intent radiation therapy (ie, dose-escalated IGRT or LDR-BT) after a period of AS renders excellent oncologic outcomes at 5 years. Deferring radical therapy after a period of AS does not seem to result in inferior oncologic outcomes compared with patients with similar risk characteristics undergoing up-front treatment.
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Affiliation(s)
- Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Ardalan E Ahmad
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Melvin L K Chua
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fabio Y Moraes
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Haiyan Jiang
- Department of Biostatistics, Princess Margaret Cancer Centre-University Health Network, Toronto, Ontario, Canada
| | - Maria Komisarenko
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Narhari Trimilshina
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Raziee
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jure Murgic
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Robert G Bristow
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada.
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24
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Taussky D, Bedwani S, Meissner N, Bahary JP, Lambert C, Barkati M, Beauchemin MC, Ménard C, Delouya G. A comparison of early prostate-specific antigen decline between prostate brachytherapy and different fractionation of external beam radiation-Impact on biochemical failure. Brachytherapy 2018; 17:277-282. [PMID: 29306674 DOI: 10.1016/j.brachy.2017.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to compare early prostate-specific antigen (PSA) decline patterns and PSA nadirs between low-dose-rate seed prostate brachytherapy (LDR-PB) and different fractionations of external beam radiotherapy (EBRT) and their predictive importance for biochemical failure (bF). METHODS AND MATERIALS Patients with D'Amico low- or intermediate-risk prostate cancer who underwent a single-modality treatment without androgen deprivation were included in this study. Three different treatment groups were compared: (1) normofractionation EBRT up to 70.2-79.2 Gy/1.8-2.0 Gy, (2) LDR-PB, and (3) EBRT with hypofractionation 60 Gy/3 Gy daily or 5-7.25 Gy once a week over 9-5 weeks, to a total dose of 45-36.25 Gy, respectively. The log-rank test, Cox regression analysis, and nonparametric tests were used. RESULTS We analyzed 892 patients: the median followup for patients without bF was 84 months (interquartile range 60-102 months), with 12% of patients experiencing bF. The PSA decline within the first 15 months was generally exponential. LDR-PB showed a faster early exponential decline compared with EBRT treatments, but whether decline was fast or slow had no influence on recurrence. The only factors that were positive predictive factors in univariate and multivariate analyses were the time to nadir >48 months (median), PSA nadir <0.5 ng/mL, and <0.2 ng/mL (all p < 0.001). CONCLUSIONS Although there are significant differences in early exponential PSA decline between different treatments, only the PSA nadir and longer time to nadir were predictive factors for bF.
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Affiliation(s)
- Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
| | - Stéphane Bedwani
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Nissan Meissner
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada
| | - Jean-Paul Bahary
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Carole Lambert
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Claude Beauchemin
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada
| | - Cynthia Ménard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada; CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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Thomas L, Chemin A, Leduc N, Belhomme S, Rich E, Lasbareilles O, Giraud A, Descat E, Roubaud G, Sargos P. Manual vs. automated implantation of seeds in prostate brachytherapy: Oncologic results from a single-center study. Brachytherapy 2018; 17:214-220. [DOI: 10.1016/j.brachy.2017.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
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Maki S, Itoh Y, Kubota S, Okada T, Nakahara R, Ito J, Kawamura M, Naganawa S, Yoshino Y, Fujita T, Kato M, Gotoh M, Ikeda M. Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan. JOURNAL OF RADIATION RESEARCH 2017; 58:870-880. [PMID: 28992050 PMCID: PMC5737336 DOI: 10.1093/jrr/rrx051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/11/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to determine the outcomes and adverse events for 300 men with prostate cancer treated with 125iodine (125I) brachytherapy with and without external-beam radiation therapy (EBRT) at a single institution in Japan. Between February 2005 and November 2011, 300 consecutive patients with clinically localized prostate cancer were treated with 125I brachytherapy at the Nagoya University Hospital. A total of 271 men were treated with implants with doses of 145 Gy, and 29 men were treated with implants with doses of 110 Gy combined with EBRT (40-50 Gy/20-25 fractions). The median patient age was 69 years (range, 53-83 years). The median follow-up period was 53 months (range, 5-99 months). According to the National Comprehensive Cancer Network risk classification, 132 men (44%) had low-risk, 147 men (29%) had intermediate-risk and 21 men (7%) had high-risk disease. The 5-year overall survival rate, biochemical relapse-free survival rate, and disease-specific survival rates were 93.5%, 97.3% and 98.5%, respectively. Two men (0.6%) died of prostate cancer and 10 men (3.3%) died of other causes. Seventeen men (5.6%) experienced Grade 2 rectal bleeding in all: 12 (41.4%) of 29 in brachytherapy with EBRT, and 5 (1.8%) of 271 in brachytherapy alone. The rates of Grade 2 and 3 genitourinary toxicity were 1.0% and 1.7%, respectively. Excellent local control was achieved at our hospital for localized prostate cancer with 125I brachytherapy with and without EBRT. Gastrointestinal and genitourinary toxicities were acceptable.
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Affiliation(s)
- Sayo Maki
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Radiation and Proton Therapy Center, Nagaizumi, Shizuoka, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Seiji Kubota
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tohru Okada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Rie Nakahara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Junji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Fujita
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mitsuru Ikeda
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Gnep K, Lizée T, Campillo-Gimenez B, Delpon G, Droupy S, Perrier L, de Crevoisier R. [Toxicity and quality of life comparison of iodine 125 brachytherapy and stereotactic radiotherapy for prostate cancers]. Cancer Radiother 2017; 21:478-490. [PMID: 28888746 DOI: 10.1016/j.canrad.2017.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
Quality of life is a major issue for good prognostic prostate cancer, for which brachytherapy is one of the reference treatments. Stereotactic Body Radiotherapy (SBRT) is a recent alternative however not yet validated as a standard treatment. This review of the literature reports and compares the toxicities and the quality of life, either after exclusive brachytherapy with iodine 125 or after SBRT. The comparison is made with the limitations of the absence of randomized trial comparing the two treatment techniques. Acute toxicity appears to be lower after SBRT compared to brachytherapy (from 10 to 40 % versus 30 to 40 %, respectively). Conversely, acute and late gastrointestinal toxicity (from 0 to 21 % and from 0 to 10 % of grade 2, respectively) appears more frequent with SBRT. Late urinary toxicity seems identical between both techniques (from 20 to 30 % of grade 2), with a possible urinary flare syndrome. Both treatments have an impact on erectile dysfunction, although it is not possible to conclude that a technique is superior because of the limited data on SBRT. SBRT has better bowel and urinary (irritation or obstruction) quality of life scores than brachytherapy; while sexual and urinary incontinence remain the same. The absence of randomized trial comparing SBRT with brachytherapy for prostate cancers does not allow to conclude on the superiority of one technique over another, thus justifying a phase III medicoeconomic evaluation.
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Affiliation(s)
- K Gnep
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France.
| | - T Lizée
- Département de radiothérapie, centre régional de lutte contre le cancer Paul-Papin, institut de cancérologie de l'Ouest, 49100 Angers, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - B Campillo-Gimenez
- Direction de la recherche clinique, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - G Delpon
- Département de radiothérapie, centre régional de lutte contre le cancer René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - S Droupy
- Département d'urologie, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - L Perrier
- Centre Léon-Bérard, université Lyon, direction de la recherche clinique et de l'innovation GATE L-SE UMR 5824, 69008 Lyon, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
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Multicenter Evaluation of Biochemical Relapse-Free Survival Outcomes for Intraoperatively Planned Prostate Brachytherapy Using an Automated Delivery System. Int J Radiat Oncol Biol Phys 2017; 99:895-903. [PMID: 28807532 DOI: 10.1016/j.ijrobp.2017.05.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/18/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To report biochemical recurrence in prostate cancer treated with intraoperatively planned low-dose-rate prostate brachytherapy using an automated delivery system (IO-LDRB). METHODS AND MATERIALS Between 2003 and 2013, 2608 patients from 3 centers were treated with IO-LDRB as single-modality treatment for low or low-tier intermediate-risk prostate cancer. Databases from the 3 centers have been analyzed. These independent databases were collected prospectively. Patient, tumor, and treatment characteristics were then compared, Kaplan-Meier survival estimates of biochemical relapse-free survival (bRFS) were generated, and the Cox proportional hazards model was used to determine factors predicting for relapse. RESULTS A total of 2608 patients with a median follow-up of 4.7 (interquartile range, 3.1-6.9) years were analyzed. Median age was 64 (range, 42-84) years. In these patients, median initial prostate-specific antigen was 5.5 ng/mL, 74% were T1, and 26% were T2; 73% were Gleason 6, and 25% Gleason 7. Median percentage of biopsy cores positive was 33%, and median gland volume was 34.2 cm3. Eleven percent of patients received hormones for a median of 3.0 months before implantation. Median seed activity was 0.437 mCi, D90 (dose covering 90% of the prostate volume) was 186.7 Gy, and V100 was 99.37%. Biochemical relapse was observed in 124 patients (4.8%), and median time to failure was 4.0 years. Predicted bRFS was 93% at 7 years. On Cox regression bRFS was dependent only on D90 at the time of implantation and prostate-specific antigen density. CONCLUSIONS This study demonstrates that IO-LDRB is an effective treatment option for patients with low and low-tier intermediate-risk prostate cancer. Rates of biochemical relapse remain low several years after treatment. These results compared favorably to published manual preplan technique results.
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Rose J, Liu D, Boychak O, Sloboda R, Pervez N, Murtha A, Yee D, Amanie J, Usmani N. Unexpected Seed Migration in Prostate Brachytherapy Implants Coincident with Change in Seed Stranding Product. Cureus 2017; 9:e1243. [PMID: 28620572 PMCID: PMC5467979 DOI: 10.7759/cureus.1243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: This study was undertaken to determine if significant seed migration occurred when our institution changed seed products by comparing patterns of seed migration in implants containing different stranding material. Methods and Materials: Day 0 and Day 30 CT scans were registered by the contoured prostate center of mass. An implant reconstruction program identified seeds on CT according to the pre-plan, enabling one-to-one correspondence between Day 0 and Day 30 seeds. Significant seed migration was defined by review of seeds that migrated > 2 cm outside the prostate or appearance in unexpected locations.
Results: Twenty-five (149, 16.8%) new strands displayed movement > 2 cm between Day 0 and Day 30 compared with just 2/118 (1.7%) of the standard strands. Six out of 26 (23%) patients with new strands displayed significant migration compared with 2/13 (14%) of patients with standard strands. In the six patients with new strands and significant migration, a mean of four strands (17%, range: 2-8 per patient) migrated significantly with 65% due to whole strand migration, 25% due to strand breakage, and 10% strand clumping. In the control group, only two strands (2%) migrated significantly, both due to strand breakage. Despite the greater seed movement with the new strands, Day 0 and Day 30 dosimetry was acceptable. Conclusion: In this short report, we identified that a change to a new strand type was associated with unexpected significant seed movement compared to our typical strands. Since seed movement can arise from unexpected causes, it is important to maintain quality assurance practices when a change in technique or infrastructure is instituted.
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Affiliation(s)
- Jim Rose
- Radiation Oncology, BC Cancer Agency - Abbotsford Centre
| | - Derek Liu
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | | | - Ron Sloboda
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Nadeem Pervez
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Albert Murtha
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Don Yee
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - John Amanie
- Radiation Oncology, Cross Cancer Institute, University of Alberta
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Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more! Brachytherapy 2017; 16:490-496. [DOI: 10.1016/j.brachy.2016.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 01/19/2023]
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Peacock M, Martell K, Taggar A, Meyer T, Smith W, Sia M, Angyalfi S, Husain S. Institutional long-term outcomes at the first Canadian center performing intraoperatively planned low-dose-rate brachytherapy alone in low- and intermediate-risk prostate cancer. Brachytherapy 2017; 16:822-830. [PMID: 28460998 DOI: 10.1016/j.brachy.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study is to report the long-term outcomes and toxicities from a large cohort of patients with localized prostate cancer treated with low-dose-rate intraoperatively planned brachytherapy. METHODS AND MATERIALS Prostate-specific antigen levels, urinary symptoms, and erectile function were recorded at baseline, and each followup visit was then entered into a prospective database. Urinary toxicity requiring procedural intervention was retrospectively verified using an integrated electronic medical system. A separate cross-sectional survey was performed to measure postimplant sexual function. RESULTS A total of 822 patients with low and favorable intermediate-risk prostate cancer were treated at our institution between 2003 and 2013. The Kaplan-Meier estimates for biochemical recurrence for our cohort were 95% and 87% at 5 and 10 years, respectively. Cystoscopy, transurethral resection of prostate, or dilatation was required for 7.1% of 720 patients with more than 2 years of followup. At a median followup of 3.7 years, 64.4% of patients retained adequate erectile function for intercourse, with 54% of patients who were no longer sexually active postimplant reporting social factors as the primary reason. CONCLUSIONS Our institutional experience with intraoperative low-dose-rate prostate brachytherapy yielded excellent long-term results with a low incidence of urinary and sexual toxicity.
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Affiliation(s)
- Michael Peacock
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Amandeep Taggar
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Tyler Meyer
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Wendy Smith
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Michael Sia
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Steve Angyalfi
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Siraj Husain
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
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Westendorp H, Hoekstra CJ, Immerzeel JJ, van de Pol SMG, Niël CGHJ, Kattevilder RAJ, Nuver TT, Minken AW, Moerland MA. Cone-beam CT-based adaptive planning improves permanent prostate brachytherapy dosimetry: An analysis of 1266 patients. Med Phys 2017; 44:1257-1267. [PMID: 28192614 DOI: 10.1002/mp.12156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/12/2017] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate adaptive planning for permanent prostate brachytherapy and to identify the prostate regions that needed adaptation. METHODS AND MATERIALS After the implantation of stranded seeds, using real-time intraoperative planning, a transrectal ultrasound (TRUS)-scan was obtained and contoured. The positions of seeds were determined on a C-arm cone-beam computed tomography (CBCT)-scan. The CBCT-scan was registered to the TRUS-scan using fiducial gold markers. If dose coverage on the combined image-dataset was inadequate, an intraoperative adaptation was performed by placing remedial seeds. CBCT-based intraoperative dosimetry was analyzed for the prostate (D90, V100, and V150) and the urethra (D30). The effects of the adaptive dosimetry procedure for Day 30 were separately assessed. RESULTS We analyzed 1266 patients. In 17.4% of the procedures, an adaptation was performed. Without the dose contribution of the adaptation Day 30 V100 would be < 95% for half of this group. On Day 0, the increase due to the adaptation was 11.8 ± 7.2% (1SD) for D90 and 9.0 ± 6.4% for V100. On Day 30, we observed an increase in D90 of 12.3 ± 6.0% and in V100 of 4.2 ± 4.3%. For the total group, a D90 of 119.6 ± 9.1% and V100 of 97.7 ± 2.5% was achieved. Most remedial seeds were placed anteriorly near the base of the prostate. CONCLUSION CBCT-based adaptive planning enables identification of implants needing adaptation and improves prostate dose coverage. Adaptations were predominantly performed near the anterior base of the prostate.
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Affiliation(s)
- Hendrik Westendorp
- Department of Medical Physics, Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Carel J Hoekstra
- Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Jos J Immerzeel
- Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Sandrine M G van de Pol
- Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Charles G H J Niël
- Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Robert A J Kattevilder
- Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Tonnis T Nuver
- Department of Medical Physics, Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - André W Minken
- Department of Medical Physics, Department of Radiation Oncology, Radiotherapiegroep behandellocatie Deventer, Nico Bolkesteinlaan 85, 7416 SE, Deventer, The Netherlands
| | - Marinus A Moerland
- Department of Medical Physics, Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Kovalainen E, Vaarala MH. Prostate-specific antigen nadir concentration, hypertension and diabetes as risk factors for biochemical failure after permanent 125I seed brachytherapy for prostate cancer. Mol Clin Oncol 2016; 5:647-650. [PMID: 27900104 DOI: 10.3892/mco.2016.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/18/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate risk factors for biochemical failure (BF) following permanent prostate seed 125I brachytherapy for prostate cancer. The study reviewed the medical records of 607 patients with biopsy-proven prostate adenocarcinoma who were treated at Oulu University Hospital between 2001 and 2014. Clinical characteristics at diagnosis, treatment-related data and follow-up data were collected to identify potential risk factors for BF, which was defined using the Phoenix criteria [prostate-specific antigen (PSA) increase >2 µg/l from the PSA nadir concentration, which defined as the lowest PSA concentration observed after BT]. The median follow-up was 81 months. BF was detected in 117 (19.3%) patients. The PSA nadir concentration was associated with BF. The mean times to BF were 114 [95% confidence interval (CI): 112-116] and 55 (95% CI: 47-63) months for patients with PSA nadir concentrations <0.5 and ≥0.5 µg/l, respectively (P<0.001). Patients with underlying hypertension or diabetes tended to develop BF more rapidly. For patients without and with hypertension, the mean times to BF were 104 (95% CI: 100-107) and 98 (95% CI: 93-103) months, respectively (P=0.035). For patients without and with diabetes, the mean times to BF were 103 (95% CI: 100-106) and 89 (95% CI: 77-102) months, respectively (P=0.006). The overall survival and prostate cancer-specific survival rates were 90.3 and 98.0%, respectively. The mean overall survival and prostate-cancer specific survival times were 147 and 158 months, respectively. Therefore, PSA nadir level was identified as a clear risk factor for BF. In addition, BF tended to develop more rapidly among patients with underlying hypertension or diabetes. These risk factors should be considered, and individually tailored follow-up may be useful for identifying patients requiring more intense follow-up for early BF detection.
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Affiliation(s)
- Essi Kovalainen
- Department of Operative Care, Division of Urology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
| | - Markku H Vaarala
- Department of Operative Care, Division of Urology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
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Makino T, Miwa S, Koshida K. Impact of Gleason Pattern 5 on outcomes of patients with prostate cancer and iodine-125 prostate brachytherapy. Prostate Int 2016; 4:152-155. [PMID: 27995115 PMCID: PMC5153429 DOI: 10.1016/j.prnil.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022] Open
Abstract
Background The Gleason grading system is a powerful predictor of prostate cancer (PCa) prognosis. Gleason scores (GS) of 8–10 are considered as a single high-risk grade category, and Gleason Pattern 5 (GP5) predicts biochemical recurrence. We report the clinical outcomes of patients treated with 125I prostate brachytherapy for clinically localized PCa and prognosis in the presence or absence of GP5. Methods We enrolled 316 patients with T1c–T2N0M0 PCa and undergoing prostate brachytherapy treatment. All patients were followed up for ≥ 1 year. The primary endpoint was biochemical recurrence-free survival. Biochemical recurrence was defined by the Phoenix criteria. Survival curves were calculated by the Kaplan–Meier method, and the prognostic impact of biochemical recurrence was analyzed using a Cox proportional hazards model. Results The 5-year biochemical recurrence-free survival rate for all patients was 95.2%, and according to the D’Amico risk classification criteria, the rates were 98.7% for patients in low-risk, 96.9% in intermediate-risk, and 81.1% in high-risk groups (P < 0.0001). The 5-year biochemical recurrence-free survival rates for patients with GS8 or GS9–10 were 87.7% and 61.5%, respectively (P = 0.0057). Multivariate analysis found that GS and clinical T stage were independent predictors of biochemical recurrence. Conclusions The presence of GP5 in GS9–10 prostate cancer has a worse prognosis than GS8 prostate cancer in the absence of GP5 for patients undergoing prostate brachytherapy.
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Affiliation(s)
- Tomoyuki Makino
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Sotaro Miwa
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Kiyoshi Koshida
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
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35
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Goy BW, Soper MS, Chang T, Slezak JM, Cosmatos HA, Tome M. Treatment results of brachytherapy vs. external beam radiation therapy for intermediate-risk prostate cancer with 10-year followup. Brachytherapy 2016; 15:687-694. [PMID: 27600607 DOI: 10.1016/j.brachy.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare 10-year treatment outcomes of brachytherapy vs. external beam radiation therapy for patients with intermediate-risk prostate cancer (IRPC). METHODS AND MATERIALS Between 2004 and 2007, 93 IRPC patients underwent brachytherapy using iodine-125 to a dose of 145 Gy without supplemental external radiation. A retrospective comparison was performed to a contemporary cohort of 597 patients treated with external beam radiation therapy to a median dose of 75.3 Gy using a propensity score-matched analysis. RESULTS Median followup was 7.8 years. With brachytherapy, 51.6% had Gleason score 7 vs. 72.0% for external radiation (p < 0.001). Median initial prostate-specific antigen was 8.3 for brachytherapy vs. 9.4 for external radiation (p = 0.01). Neoadjuvant androgen deprivation therapy was given in 59.5% of external radiation vs. 10.8% of brachytherapy patients (p < 0.001). The 10-year freedom from biochemical failure (FFBF) for brachytherapy was 81.7% vs. 54.5% for external radiation (p = 0.002). Unfavorable intermediate-risk patients experienced borderline significant improved FFBF with brachytherapy (p = 0.08). The 10-year freedom from salvage therapy for brachytherapy was 93.2% vs. 72.2% for external radiation (p = 0.006). There were no significant differences in distant metastases-free survival, prostate cancer-specific survival, or overall survival after adjusting for age. Multivariate analysis with propensity score matching showed that brachytherapy remained an independent predictor for improved FFBF (p = 0.007). Grade 1 and 2 late rectal complication rate was 6.5% for brachytherapy vs. 15.2% for external radiation (p = 0.02). CONCLUSIONS Brachytherapy using iodine-125 without supplemental external radiation is a reasonable treatment option for selected IRPC patients.
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Affiliation(s)
- Barry W Goy
- Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA.
| | - Margaret S Soper
- Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA
| | - Tangel Chang
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA
| | - Harry A Cosmatos
- Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA
| | - Michael Tome
- Department of Radiation Oncology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA
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Fernandez Ots A, Browne L, Chin YS, Malouf D, Wong K, Bucci J. The risk of second malignancies after 125I prostate brachytherapy as monotherapy in a single Australian institution. Brachytherapy 2016; 15:752-759. [PMID: 27475483 DOI: 10.1016/j.brachy.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence of second primary cancer (SPC) after 125I brachytherapy (BT) for early prostate cancer in an Australian institution. METHODS AND MATERIALS All the patients in our cohort had a cystoscopy before the implant. Data were prospectively collected on all subsequent SPC diagnoses. Standardized incidence ratios (SIRs) were calculated to compare data with the Australian population. Kaplan-Meier analysis was used to determine the actuarial second malignancy and pelvic malignancy rates and the death from SPC and from any cause. RESULTS A total of 889 patients were followed up for a median of 4.16 (0-13) years with 370 (42%) patients having ≥5 years of followup. Sixty patients subsequently developed an SPC of which 11 were pelvic malignancies. The 5- and 10-year cumulative incidences were 1.3% (95% confidence interval [CI]: 0.6-3) and 3.3% (95% CI: 1-7) for any pelvic malignancy and 1% (95% CI: 0.4-2) and 2.6% (1-6) for bladder cancer, respectively. The SIR was significantly higher than expected for all bladder cancers at 2.9 (95% CI: 1-6) and close to significance (SIR, 3.0; 95% CI: 0.97-7) for bladder cancers within the first 5 years of followup in the subgroup analysis. On multivariate analysis, older age was associated with increased SPC risk and older age and positive smoking status were associated with increased overall mortality, mortality due to SPC, and mortality from second malignancy (p < 0.05). CONCLUSIONS There may be a small increased risk of bladder SPC after prostate BT. A tendency toward a higher risk of bladder SPC after BT was found within the first 5 years of followup probably reflecting screening bias.
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Affiliation(s)
- Ana Fernandez Ots
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia.
| | - Lois Browne
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | - Yaw Sinn Chin
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | | | - Keith Wong
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | - Joseph Bucci
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
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Fellin G, Mirri MA, Santoro L, Jereczek-Fossa BA, Divan C, Mussari S, Ziglio F, La Face B, Barbera F, Buglione M, Bandera L, Ghedi B, Di Muzio NG, Losa A, Mangili P, Nava L, Chiarlone R, Ciscognetti N, Gastaldi E, Cattani F, Spoto R, Vavassori A, Giglioli FR, Guarneri A, Cerboneschi V, Mignogna M, Paoluzzi M, Ravaglia V, Chiumento C, Clemente S, Fusco V, Santini R, Stefanacci M, Mangiacotti FP, Martini M, Palloni T, Schinaia G, Lazzari G, Silvano G, Magrini S, Ricardi U, Santoni R, Orecchia R. Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions. Br J Radiol 2016; 89:20150981. [PMID: 27384381 DOI: 10.1259/bjr.20150981] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
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Affiliation(s)
- Giovanni Fellin
- 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Maria A Mirri
- 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy
| | - Luigi Santoro
- 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Barbara A Jereczek-Fossa
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Claudio Divan
- 6 Division of Urology, Santa Chiara Hospital, Trento, Italy
| | - Salvatore Mussari
- 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Francesco Ziglio
- 7 Service of Health Physics, Santa Chiara Hospital, Trento, Italy
| | - Beniamino La Face
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy
| | - Fernando Barbera
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Laura Bandera
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Barbara Ghedi
- 10 Department of Health Physics, Spedali Civili Hospital, Brescia, Italy
| | - Nadia G Di Muzio
- 11 Department of Radiotherapy, San Raffaele Turro Hospital, Milan, Italy
| | - Andrea Losa
- 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy
| | - Paola Mangili
- 13 Service of Health Physics, San Raffaele Turro Hospital, Milan, Italy
| | - Luciano Nava
- 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy
| | - Renato Chiarlone
- 14 Department of Radiotherapy, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Nunzia Ciscognetti
- 15 Service of Health Physics, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Emilio Gastaldi
- 16 Department of Urology, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Federica Cattani
- 17 Service of Health Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Francesca R Giglioli
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessia Guarneri
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Valentina Cerboneschi
- 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy
| | - Marcello Mignogna
- 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy
| | - Mauro Paoluzzi
- 20 Operative Unit of Urology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy
| | - Valentina Ravaglia
- 21 Department of Medical Physics, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy
| | | | | | | | - Roberto Santini
- 23 Unit of Radiotherapy, Pistoia Hospital, USL3, Pistoia, Italy
| | | | | | - Marco Martini
- 25 Department of Urology, San Filippo Neri Hospital, ASL RME, Rome, Italy
| | - Tiziana Palloni
- 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy
| | | | - Grazia Lazzari
- 27 Division of Radiation Oncology, Azienda USL, Taranto, Italy
| | | | - Stefano Magrini
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Umberto Ricardi
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Roberto Orecchia
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Fernandez Ots A, Bucci J, Chin YS, Malouf D, Howie A, Enari KE. Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol. JMIR Res Protoc 2016; 5:e98. [PMID: 27296781 PMCID: PMC4923592 DOI: 10.2196/resprot.5433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way. OBJECTIVE The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT. METHODS The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years. RESULTS To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled trial (RCT). CONCLUSIONS This protocol is designed to show feasibility in delivering hemigland focal therapy with seed BT. It may answer crucial questions and obtain data which will enable downstream decisions on focal low dose rate (LDR) prostate BT. CLINICALTRIAL Clinicaltrial.gov NCT02643511; https://www.clinicaltrials.gov/ct2/show/NCT02643511 (Archived by Webcite at http://www.webcitation.org/6ghLCzIhY).
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Affiliation(s)
- Ana Fernandez Ots
- Cancer Care Centre, Radiation Oncology, St George Hospital, Sydney, Australia.
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Comparison of permanent (125)I seeds implants with two different techniques in 500 cases of prostate cancer. J Contemp Brachytherapy 2015; 7:258-64. [PMID: 26622228 PMCID: PMC4643727 DOI: 10.5114/jcb.2015.53525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 12/28/2022] Open
Abstract
Purpose To perform a comparative study of 500 consecutive 125I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning. Material and methods From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%. Results Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy. Conclusions The outcome of patients with low risk prostate carcinoma treated with 125I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.
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Kittel JA, Reddy CA, Smith KL, Stephans KL, Tendulkar RD, Ulchaker J, Angermeier K, Campbell S, Stephenson A, Klein EA, Wilkinson DA, Ciezki JP. Long-Term Efficacy and Toxicity of Low-Dose-Rate 125 I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 92:884-93. [DOI: 10.1016/j.ijrobp.2015.02.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 11/16/2022]
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Evaluation of the dosimetric impact of loss and displacement of seeds in prostate low-dose-rate brachytherapy. J Contemp Brachytherapy 2015. [PMID: 26207108 PMCID: PMC4499516 DOI: 10.5114/jcb.2015.52127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyze the seed loss and displacement and their dosimetric impact in prostate low-dose-rate (LDR) brachytherapy while utilizing the combination of loose and stranded seeds. MATERIAL AND METHODS Two hundred and seventeen prostate cancer patients have been treated with LDR brachytherapy. Loose seeds were implanted in the prostate center and stranded seeds in the periphery of the gland. Patients were imaged with transrectal ultrasound before implant and with computerized tomography/magnetic resonance imaging (CT/MR) one month after implant. The seed loss and displacement had been analyzed. Their impact on prostate dosimetry had been examined. The seed distribution beyond the prostate inferior boundary had been studied. RESULTS The mean number of seeds per patient that were lost to lung, pelvis/abdomen, urine, or unknown destinations was 0.21, 0.13, 0.03, and 0.29, respectively. Overall, 40.1% of patients had seed loss. Seed migration to lung and pelvis/abdomen occurred in 15.5% and 10.5% of the patients, respectively. Documented seed loss to urine was found in 3% of the patients while 20% of patients had seed loss to unknown destinations. Prostate length difference between pre-plan and post-implant images was within 6 mm in more than 98% of cases. The difference in number of seeds inferior to prostate between pre-plan and post-implant dosimetry was within 7 seeds for 93% of patients. At time of implant, 98% of seeds, inferior to prostate, were within 5 mm and 100% within 15 mm, and in one month post-implant 83% within 9 mm and 96.3% within 15 mm. Prostate post-implant V100, D90, and rectal wall RV100 for patients without seed loss were 94.6%, 113.9%, and 0.98 cm(3), respectively, as compared to 95.0%, 114.8%, and 0.95 cm(3) for the group with seed loss. CONCLUSIONS Seed loss and displacement have been observed to be frequent. No correlation between seed loss and displacement and post-plan dosimetry has been reported.
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Ohashi T, Yorozu A, Saito S, Tanaka N, Katayama N, Kojima S, Maruo S, Kikuchi T, Dokiya T, Fukushima M, Yamanaka H. Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study. Int J Radiat Oncol Biol Phys 2015; 93:141-9. [PMID: 26279031 DOI: 10.1016/j.ijrobp.2015.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). METHODS AND MATERIALS Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy. RESULTS Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. CONCLUSIONS The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.
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Affiliation(s)
| | - Atsunori Yorozu
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shiro Saito
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Raabe NK, Normann M, Lilleby W. Low-dose-rate brachytherapy for low-grade prostate cancer. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:548-52. [PMID: 25806763 DOI: 10.4045/tidsskr.13.1404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal radiotherapy technique which allows high doses of radiation to be delivered to a tumour at short range and with a high degree of precision. We have conducted a systematic review of the evidence base for this treatment. The method is not established in Norway. METHOD This review is based on systematic review articles and publications on treatment, outcomes, adverse effects and health economics considerations found by searching the databases Cochrane Library, Current Controlled Trials, Medline, Embase and NICE (National Institute of Clinical Excellence). RESULTS Subsequent to long-term observations of the efficacy, adverse effects and costs presented in 43 selected studies, including one randomised, controlled trial, there is still uncertainty as to which of the three methods low-dose brachytherapy, external radiotherapy and radical prostatectomy is optimal. The reason for this is the methodological differences in patient selection and in endpoints such as biochemical disease-free interval and cause-specific survival. The evidence base appears to suggest that low-dose-rate brachytherapy causes more frequent grade 2 and 3 doctor-reported urogenital adverse effects than prostatectomy, but better patient-reported sexual functions and fewer patients with urinary incontinence than after surgery. Low-dose-rate brachytherapy appears to be socioeconomically cost-effective. INTERPRETATION The evidence base with respect to therapeutic effect and toxicity in men with low-risk prostate cancer treated with low-dose brachytherapy is regarded as solidly documented. However, there are no good prospective randomised multi-centre trials with overall survival as an endpoint.
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Lo AC, Morris WJ, Pickles T, Keyes M, McKenzie M, Tyldesley S. Patterns of Recurrence After Low-Dose-Rate Prostate Brachytherapy: A Population-Based Study of 2223 Consecutive Low- and Intermediate-Risk Patients. Int J Radiat Oncol Biol Phys 2015; 91:745-51. [DOI: 10.1016/j.ijrobp.2014.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/04/2014] [Accepted: 12/05/2014] [Indexed: 10/23/2022]
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Delouya G, Bahary P, Carrier JF, Larouche RX, Hervieux Y, Béliveau-Nadeau D, Donath D, Taussky D. Refining prostate seed brachytherapy: Comparing high-, intermediate-, and low-activity seeds for I-125 permanent seed prostate brachytherapy. Brachytherapy 2015; 14:329-33. [PMID: 25630619 DOI: 10.1016/j.brachy.2014.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the difference in prostate coverage and dose to the rectum in men with prostate carcinoma treated with permanent seed brachytherapy with different seed activities. METHODS Forty-nine patients treated with iodine-125 permanent seed prostate brachytherapy with low-activity seeds of 0.30-0.37 mCi were identified. For each of these patients, 2 patients with similar prostate volume (±2 cc) were paired: one treated with intermediate seed activity (0.44-0.46 mCi) and one with high seed activity (0.60-0.66 mCi). The doses to prostate and rectum were compared using CT on Day 30. RESULTS A total of 147 patients divided into the three seed activity groups were analyzed. Mean prostate volume was 35.7 cc (standard deviation [SD], 11.70). Compared with low-activity seeds, implants with high-activity seeds consisted of an average of 22 seeds and 4.7 needles less. The dose to the prostate (prostate volume receiving 100% of the prescribed dose [V100], prostate volume receiving 150% of the prescribed dose, and minimal dose covering 90% of the prostate volume expressed in Gy) was not higher on Day 30 (p = 0.58-0.97). The mean volume (in cubic centimeters) of rectal wall receiving 100% of the prescribed dose (V100) increased with activity: low activity, 0.34 cc (SD, 0.49), intermediate activity, 0.47 cc (SD, 0.48), and high activity, 0.72 cc (SD, 0.79) (p = 0.009). There was a trend (p = 0.073) toward a higher frequency of clinically unfavorable rectal dosimetry (V100 > 1.3 cc) in patients with high-activity seeds (16.7%) compared with low-activity (6.3%) or intermediate-activity (4.2%) seeds. CONCLUSION High-activity seeds do not result in a higher dose to the prostate but in a higher dose to the rectum.
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Affiliation(s)
- Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada; CRCHUM-Centre de recherche du Centre Hospitalier de l'Universiténde Montréal, Quebec, Canada
| | - Pascal Bahary
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - Jean-François Carrier
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - Renée-Xavière Larouche
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - Yannick Hervieux
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - Dominic Béliveau-Nadeau
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - David Donath
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Universiténde Montréal (CHUM), Hôpital Notre-Dame, Montreal, Canada; CRCHUM-Centre de recherche du Centre Hospitalier de l'Universiténde Montréal, Quebec, Canada.
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Lediju Bell MA, Kuo NP, Song DY, Kang JU, Boctor EM. In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:126011. [PMID: 25531797 PMCID: PMC4272925 DOI: 10.1117/1.jbo.19.12.126011] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/02/2014] [Accepted: 10/13/2014] [Indexed: 05/18/2023]
Abstract
We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10-20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ≤ 2 mm. Results provide insights into the potential for clinical translation to humans.
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Affiliation(s)
- Muyinatu A. Lediju Bell
- Johns Hopkins University, CISST Engineering Research Center, Baltimore, Maryland 21218, United States
- Address all correspondence to: Muyinatu A. Lediju Bell, E-mail: ; Emad M. Boctor, E-mail:
| | - Nathanael P. Kuo
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland 21218, United States
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
| | - Danny Y. Song
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, Maryland 21205, United States
| | - Jin U. Kang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
| | - Emad M. Boctor
- Johns Hopkins University, CISST Engineering Research Center, Baltimore, Maryland 21218, United States
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
- Johns Hopkins University, School of Medicine, Department of Radiology, Baltimore, Maryland 21205, United States
- Address all correspondence to: Muyinatu A. Lediju Bell, E-mail: ; Emad M. Boctor, E-mail:
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48
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Nasser NJ, Sappiatzer J, Wang Y, Borg J, Saibishkumar EP. Dosimetric evaluation of clinical target volume in the postimplant analysis of low-dose-rate brachytherapy for prostate cancer. Brachytherapy 2014; 14:189-96. [PMID: 25301338 DOI: 10.1016/j.brachy.2014.08.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE Brachytherapy is an effective single treatment modality for low- and intermediate-risk prostate cancer. In this study, we defined a clinical target volume (CTV) and evaluated its dosimetry 1 month after the low-dose-rate brachytherapy procedure. METHODS AND MATERIALS One hundred ninety-eight consecutive patients treated for prostate cancer by iodine-125 seed brachytherapy were assessed. Prostate dosimetry was stratified according to British Columbia Cancer Agency criteria, with good implants having both V100 (percentage of target volume that receives 100% of the prescribed dose) > 85% and D90 (percentage of the prescribed dose received by 90% of the target volume) > 90%, suboptimal implants with V100 of 75-85%, or D90 80-90%, whereas poor implants were defined as those with V100 < 75 or D90 < 80%. CTV dosimetry stratification was performed according to the same dose coverage criteria, albeit to the CTV. RESULTS One hundred ninety-two patients (97%) had good prostate radiation coverage, whereas only 165 patients (83%) had good postimplant CTV dosimetry. Patients with suboptimal vs. good CTV dosimetry had prostate edema of 7.8 ± 0.2% vs. 0.2 ± 0.1%, respectively (p = 0.001). CONCLUSIONS Prostate seed implants with optimal dosimetry to prostate may still have suboptimal D90 and V100 for the CTV, especially in the presence of postimplant edema. A consensus is needed for definition and evaluation of CTV in postimplant setting for low-dose-rate prostate brachytherapy.
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Affiliation(s)
- Nicola J Nasser
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joshua Sappiatzer
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yinkun Wang
- Department of Radiation Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jette Borg
- Department of Radiation Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elantholi P Saibishkumar
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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49
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Pugh TJ, Mahmood U, Swanson DA, Munsell MF, Wang R, Kudchadker RJ, Bruno TL, Frank SJ. Sexual potency preservation and quality of life after prostate brachytherapy and low-dose tadalafil. Brachytherapy 2014; 14:160-5. [PMID: 25255712 DOI: 10.1016/j.brachy.2014.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively determine sexual function, bother, and potency preservation in men treated with prostate brachytherapy and twice-weekly tadalafil. METHODS AND MATERIALS From 2005 to 2011, men treated with low-dose-rate prostate brachytherapy were treated on a prospective registration study. All patients were prescribed tadalafil 10mg twice weekly. The expanded prostate cancer index composite questionnaire was administered before treatment and at each followup. A subgroup analysis of men with sexual potency at baseline was performed. RESULTS A total of 237 men were analyzed. Median age was 64 years (range, 44-86). Median followup was 24.8 months (range, 1-60). At baseline, 175 men (74%) reported erections firm enough for sexual activity and 148 (62%) were potent (erections firm enough for intercourse). Statistically significant changes in sexual function/bother were appreciated from baseline throughout the analysis period, although absolute changes were relatively small and did not meet criteria for clinical significance. At 24-months followup, 72% reported erections firm enough for sexual activity and 56% were potent. Of men with potency at baseline, 89% had erections firm enough for sexual activity and 76% remained potent 24 months after treatment. CONCLUSIONS Peri-procedural tadalafil and prostate brachytherapy resulted in high rates of sexual potency preservation and no clinically significant effect on sexual quality of life.
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Affiliation(s)
- Thomas J Pugh
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
| | - Usama Mahmood
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - David A Swanson
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Run Wang
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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50
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Lamb DS, Greig L, Russell GL, Nacey JN, Broome K, Studd R, Delahunt B, Iupati D, Jain M, Rooney C, Murray J, Lamb PJ, Bethwaite PB. Patterns of failure after iodine-125 seed implantation for prostate cancer. Radiother Oncol 2014; 112:68-71. [PMID: 25082097 DOI: 10.1016/j.radonc.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. MATERIALS AND METHODS From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. RESULTS Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. CONCLUSIONS If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.
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Affiliation(s)
- David S Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand.
| | - Lynne Greig
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | | | - John N Nacey
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Kim Broome
- Omahu Urology Clinic, Hawkes Bay, New Zealand
| | - Rod Studd
- Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Brett Delahunt
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Douglas Iupati
- Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand
| | - Mohua Jain
- Anesthetics, Southern Cross Hospital, Wellington, New Zealand
| | - Colin Rooney
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | - Judy Murray
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter J Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter B Bethwaite
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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