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Patient age as a predictive factor in biochemical recurrence following brachytherapy: Oncological outcomes at a single center. Prostate Int 2022; 10:224-228. [PMID: 36570651 PMCID: PMC9747569 DOI: 10.1016/j.prnil.2022.05.003] [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: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 12/27/2022] Open
Abstract
Background Iodine-125 low-dose-rate brachytherapy (LDR-BT) is a treatment modality utilized in both localized and advanced prostate cancer (PCa). We aimed to evaluate the long-term oncological outcomes in patients with PCa who underwent LDR-BT, at a single institution in Japan. Methods We retrospectively reviewed the clinical records of 340 consecutive patients with localized PCa who underwent LDR-BT between August 2004 and December 2014 at our institution. Patients with low-risk PCa who had a pretreatment prostate volume >50 mL received neoadjuvant androgen deprivation therapy (ADT) for at least 3 months before LDR-BT. Patients with intermediate-risk PCa were treated with a combination of LDR-BT and/or external beam radiation therapy (EBRT) and/or ADT for 9 months. Patients with high-risk PCa underwent LDR-BT, EBRT, and ADT for 24 months. The endpoints of this study were biochemical recurrence-free survival (BRFS) and overall survival (OS). Additionally, the association between biochemical recurrence (BCR) and clinical/pathological covariates was analyzed. Results At the end of the follow-up period, nine patients (2.6%) showed BCR, and six patients (1.8%) developed secondary cancers after LDR-BT. The 5-year and 10-year BRFS rates were 99.4% and 95.3%, respectively. Factoring in the patients' ages, the 5-year and 10-year BRFS rates were 99.1% and 99.1%, respectively, in patients aged >63 years. The rates were 100% and 89.4% in those aged ≤63 years, respectively. In the multivariate analysis, age ≤63 years was identified as a significant independent predictor of BCR after LDR-BT. Conclusion Age ≤63 years was a significant predictor of BCR following LDR-BT. Although the risk of secondary malignant neoplasms should be considered when opting for LDR-BT in younger patients with PCa, the prevalence of them in these patients is relatively low. Therefore, clinicians should weigh the risks and benefits of definitive therapy in PCa, particularly in younger patients.
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Miyazaki Y, Takenaka Y, Noda Y, Kawai N, Yoshikawa T, Wakamiya T, Hara I, Sonomura T. Reduction of toxicity in brachytherapy using a new technique. Brachytherapy 2021; 20:866-872. [PMID: 33896731 DOI: 10.1016/j.brachy.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/15/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to elucidate the usefulness of a dose evaluation method for reducing late genitourinary (GU) toxicity in high-dose-rate brachytherapy (HDR-BT) of prostate cancer. METHODS AND MATERIALS GU toxicity was scored in accordance with the Common Terminology Criteria for Adverse Events version 4.0. The prostatic urethra was divided into three segments (base = B, midgland = M, apex = A), which were subclassified into seven subgroups (B, M, A, BM, BA, MA, BMA) using a D10% color map of the urethra. Significance testing was conducted on urethral D0.1% and D10% among the seven subgroups. Grade < 2 GU toxicity was also implemented. RESULTS Data of 174 patients with localized prostate cancer treated with HDR-BT combined with external beam radiotherapy between November 2011 and July 2014 were analyzed retrospectively. Median age was 74 (53-84) years, and median followup period was 44 (6-69) months. The number of Grade < 2 and Grade ≥ 2 toxicity was significantly different in the M subgroup than in the other subgroups (p < 0.05), suggesting increased radioresistance in the midgland urethra. CONCLUSIONS A high-dose-area evaluation method using a urethral D10% color map may be helpful in reducing late GU toxicity in HDR-BT for prostate cancer.
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Affiliation(s)
- Yuji Miyazaki
- Department of Central Radiology, Wakayama Medical University Hospital, Wakayama, Japan.
| | - Yukiho Takenaka
- Department of Central Radiology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yasutaka Noda
- Department of Radiology, Wakayama Medical University, Wakayama
| | - Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, Wakayama
| | | | - Takahito Wakamiya
- Department of Urology, Wakayama Medical University, Wakayama Prefecture, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama Prefecture, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama
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Tsumura H, Satoh T, Ishiyama H, Tabata KI, Takenaka K, Sekiguchi A, Nakamura M, Kitano M, Hayakawa K, Iwamura M. Perioperative Search for Circulating Tumor Cells in Patients Undergoing Prostate Brachytherapy for Clinically Nonmetastatic Prostate Cancer. Int J Mol Sci 2017; 18:ijms18010128. [PMID: 28085051 PMCID: PMC5297762 DOI: 10.3390/ijms18010128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022] Open
Abstract
Despite the absence of local prostate cancer recurrence, some patients develop distant metastases after prostate brachytherapy. We evaluate whether prostate brachytherapy procedures have a potential risk for hematogenous spillage of prostate cancer cells. Fifty-nine patients who were undergoing high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy participated in this prospective study. Thirty patients with high-risk or locally advanced cancer were treated with HDR brachytherapy after neoadjuvant androgen deprivation therapy (ADT). Twenty-nine patients with clinically localized cancer were treated with LDR brachytherapy without neoadjuvant ADT. Samples of peripheral blood were drawn in the operating room before insertion of needles (preoperative) and again immediately after the surgical manipulation (intraoperative). Blood samples of 7.5 mL were analyzed for circulating tumor cells (CTCs) using the CellSearch System. While no preoperative samples showed CTCs (0%), they were detected in intraoperative samples in 7 of the 59 patients (11.8%; preoperative vs. intraoperative, p = 0.012). Positive CTC status did not correlate with perioperative variables, including prostate-specific antigen (PSA) at diagnosis, use of neoadjuvant ADT, type of brachytherapy, Gleason score, and biopsy positive core rate. We detected CTCs from samples immediately after the surgical manipulation. Further study is needed to evaluate whether those CTCs actually can survive and proliferate at distant sites.
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Affiliation(s)
- Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Kouji Takenaka
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Akane Sekiguchi
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Masaki Nakamura
- Department of Microbiology, Kitasato University School of Allied Health Sciences, Kanagawa 252-0373, Japan.
| | - Masashi Kitano
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan.
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Abstract
Unresectable liver cancer presents a major problem in the treatment of solid tumors. Transarterial radioembolization is a modern approach toward primary and secondary liver malignancies. The mechanism of action is independent from other therapies that are based on ischemia or chemotoxicity. (90)Y-resin and (90)Y-glass microspheres are commercially available for transarterial radioembolization. Available data on the use of (90)Y-glass microspheres in hepatocellular carcinoma and metastatic disease indicate that this treatment is safe and effective. In hepatocellular carcinoma the results compare well with chemoembolization and might be considered more often. Current data in metastatic disease are promising, but there is a strong need for prospective randomized trials to identify the role of transarterial radioembolization with (90)Y-glass microspheres in metastatic liver disease.
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Oton CA, Blanco L, Oton LF, Moral S. Comparing CTVs for permanent prostate brachytherapy. Clin Transl Oncol 2014; 17:393-7. [PMID: 25351173 DOI: 10.1007/s12094-014-1245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To delineate the clinical target volume (CTV) in low dose rate (LDR) brachytherapy for prostate cancer, American Brachytherapy Society (ABS) recommends a CTV = prostate. ESTRO advocates a CTV = prostate + 3 mm excluding rectum and many authors use and recommend other different CTVs. This study aims to: (1) evaluate the appropriateness of these recommendations and (2) test the applicability of seed distributions on the different CTVs and contrast the dosimetric differences. MATERIALS AND METHODS Ninety-eight patients treated with (125)I seeds (dose 145 Gy; CTV = prostate) were studied. We established for every patient: (1) risk of extraprostatic extension (EPE), (2) adequacy of original plan to an extended CTV with 3 mm-margin (3) a new planning and seed distribution for this CTV and (4) comparison of dosimetry of both plans. RESULTS Mean risk of EPE was 28.46 %. Original plan, when applied to the extended CTV, resulted in unsatisfactory dosimetry. A plan was generated for the 98 extended CTVs meeting all dosimetric specifications. CONCLUSIONS The risk of EPE is high enough to consider a 3 mm-margin around prostate necessary for all cases. A CTV = prostate + 3 mm except rectum as ESTRO recommends is feasible and would adjust planning to the most probable extension of the tumor.
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Affiliation(s)
- C A Oton
- Department of Radiation Oncology, University of La Laguna Tenerife, Santa Cruz de Tenerife, Spain,
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Kido M, Kuruma H, Sasaki H, Miki K, Aoki M, Kimura T, Takahash H, Kanehira C, Egawa S. Pulmonary metastases after low-dose-rate brachytherapy for localized prostate cancer. Korean J Urol 2014; 55:309-14. [PMID: 24868334 PMCID: PMC4026656 DOI: 10.4111/kju.2014.55.5.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/27/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze unusual events and focus discussion on pulmonary metastasis in particular after low-dose-rate brachytherapy (LDR-BT) for prostate cancer (PCa). Materials and Methods A total of 616 consecutive patients who had undergone LDR-BT for clinically localized PCa at Jikei University Hospital between October 2003 and April 2010 were enrolled in this study. Follow-up information was summarized, and patterns of biochemical recurrence and clinical outcome were investigated. Results Disease risk was stratified as low-risk in 231 patients, intermediate-risk in 365, and high-risk in 20, respectively. Of these patients, 269 (43.7%) had received hormonal therapy (HT) in combination with LDR-BT, and 80 (13.0%) had received external beam radiotherapy (EBRT). Average dosimetric parameter values with and without EBRT were 95.3% and 94.2% for V100, 132.8 Gy and 164.2 Gy for D90, and 180.6 Gy2 and 173.7 Gy2 for the biologically effective dose. Biochemical recurrence was noted in 14 patients (6.1%) in the low-risk group, 25 patients (6.8%) in the intermediate-risk group, and 6 patients (30.0%) in the high-risk group, respectively. In these cases of biochemical recurrence, 9 (64.3%), 13 (52.0%), and 4 patients (66.7%) in each respective risk group showed signs of clinical recurrence. Five patients (19.2%) with clinical recurrence developed pulmonary metastases, of which 4 were isolated lesions. All tumors responded favorably to subsequent HT. Conclusions LDR-BT for biologically aggressive PCa may be linked to possible pulmonary metastasis owing to tumor dissemination during seed implantation. This information is important in planning adequate treatment for these patients.
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Affiliation(s)
- Masahito Kido
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hidetoshi Kuruma
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahash
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Chihiro Kanehira
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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Ko EC, Liu JT, Stone NN, Stock RG. Association of early PSA failure time with increased distant metastasis and decreased survival in prostate brachytherapy patients. Radiother Oncol 2014; 110:261-7. [DOI: 10.1016/j.radonc.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 05/26/2013] [Accepted: 11/10/2013] [Indexed: 11/28/2022]
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Predictors of distant metastasis after combined HDR brachytherapy and external beam radiation for prostate cancer. J Contemp Brachytherapy 2013; 5:127-33. [PMID: 24143146 PMCID: PMC3797412 DOI: 10.5114/jcb.2013.37942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/20/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine predictors of distant metastases (DM) in prostate cancer patients treated with high dose rate brachytherapy boost (HDR-B) and external beam radiation therapy (EBRT). Material and methods From 1991 to 2002, 768 men with localized prostate cancer were treated with HDR-B and EBRT. The mean EBRT dose was 37.5 Gy (range: 30.6-45 Gy), and the HDR-B was 22 or 24 Gy delivered in 4 fractions. Univariate and multivariate analyses using a Cox proportional hazards model including age at diagnosis, T stage, Gleason score (GS), pretreatment PSA, biologically equivalent dose (BED), and use of androgen deprivation therapy (ADT) was used to determine predictors of developing distant metastases. Results The median follow-up time for the entire patient population was 4.2 years (range: 1-11.2 years). Distant metastases were identified in 22/768 (3%) of patients at a median of 4.1 years. PSA failure according to the Phoenix definition developed in 3%, 5%, and 14% of men with low, intermediate, and high risk disease with a median time to failure of 3.8 years. Prostate cancer specific mortality was observed in 2% of cases. T stage, GS, and use of ADT were significantly associated with developing DM on univariate analysis. GS, and use of ADT were the only factors significantly associated with developing DM on multivariate analysis (p < 0.01). Patients who received ADT had significantly higher risk features suggesting patient selection bias for higher DM in this group of patients rather than a negative interaction between HDR-B and EBRT. Conclusions In men treated with HDR-B and EBRT, GS is a significant factor on multivariate analysis for developing distant metastasis.
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Vargas C, Swartz D, Vashi A, Blasser M, Kasareian A, Cesaretti J, Kiley K, Terk M. Long-term outcomes and prognostic factors in patients treated with intraoperatively planned prostate brachytherapy. Brachytherapy 2012; 12:120-5. [PMID: 23062705 DOI: 10.1016/j.brachy.2012.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/14/2012] [Accepted: 08/23/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE Evaluate outcomes and prognostic factors in men with localized prostate cancer. METHODS AND MATERIALS A total of 3760 patients have undergone prostate seed implantation at our institution. This review is of our initial 304 consecutive patients treated before January 30, 2001. A total of 124 patients were treated with (125)I implant monotherapy and 180 with (103)Pd implant combined with 45-Gy external beam radiation therapy. RESULTS The median followup was 10.3 years. A 10-year biochemical control for low risk (LR) was 98% , intermediate risk (IR) 94%, high risk (HR) 78%, and HR with one HR factor 88% (p < 0.001); cause-specific survival was 99%, 98%, and 84% for LR, IR, and HR, respectively (p < 0.001); No significant difference in outcome was seen for LR and IR patients (p > 0.3). On multivariate analysis, only pretreatment PSA, Gleason score, and T-stage were significant for biochemical control. Most biochemical failures occurred within 5 years (93%). CONCLUSIONS With a minimum followup of 10 years, results are excellent and do not differ for LR or IR prostate cancer patients. HR patients are a very heterogeneous group, and excellent results can still be achieved for HR patients with only one HR feature.
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Affiliation(s)
- Carlos Vargas
- Florida Center for Prostate Care, Jacksonville, FL, USA.
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