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Meynard C, Huertas A, Dariane C, Toublanc S, Dubourg Q, Urien S, Timsit MO, Méjean A, Thiounn N, Giraud P. Tumor burden and location as prognostic factors in patients treated by iodine seed implant brachytherapy for localized prostate cancers. Radiat Oncol 2019; 15:1. [PMID: 31892338 PMCID: PMC6938614 DOI: 10.1186/s13014-019-1449-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Iodine seed implant brachytherapy is indicated for low risk and selected favorable intermediate risk prostate cancers. A percentage of positive biopsies > 50% is usually considered as a contra-indication, and the tumor location could also influence the treatment efficacy. We studied the association of the percentage of positive biopsy cores, and tumor location, with progression-free survival. Methods Among the 382 patients treated at our center by permanent implant iodine seed brachytherapy for a localized prostate cancer between 2006 and 2013, 282 had accessible detailed pathology reports, a minimum follow-up of 6 months, and were included. Progression was defined as a biochemical, local, nodal, or distant metastatic relapse. We studied cancer location on biopsies (base, midgland or apex of the prostate) and percentage of positive biopsy cores, as well as potential confounders (pre-treatment PSA, tumor stage, Gleason score, risk group according to D’Amico’s classification modified by Zumsteg, adjunction of androgen deprivation therapy, and dosimetric data). Results Most patients (197; 69.9%) had a low risk, 67 (23.8%) a favorable intermediate risk, 16 (5.7%) an unfavorable intermediate risk, and 1 (0.3%) a high-risk prostate cancer. An involvement of the apex was found for 131 patients (46,5%), of the midgland for 149 (52,8%), and of the base for 145 (51,4%). The median percentage of positive biopsy cores was 17% [3–75%]. The median follow-up was 64 months [12–140]. Twenty patients (7%) progressed: 4 progressions (20%) were biochemical only, 7 (35%) were prostatic or seminal, 6 (30%) were nodal, and 3 (15%) were metastatic. The median time to failure was 39.5 months [9–108]. There were more Gleason scores ≥7 among patients who progressed (40% vs 19%; p = 0.042). None of the studied covariates (including tumor location, and percentage of positive biopsy cores), were significantly associated with progression-free survival. The risk group showed a trend towards an association (p = 0.055). Conclusions Brachytherapy is an efficient treatment (5-year control rate of 93%) for patients carefully selected with classical criteria. The percentage and location of positive biopsies were not significantly associated with progression-free survival. A Gleason score ≥ 7 was more frequent in case of progression.
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Affiliation(s)
- Claire Meynard
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Andres Huertas
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Charles Dariane
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Sandra Toublanc
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Quentin Dubourg
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Saik Urien
- Unité de Recherche Clinique, Hôpital Tarnier, 89 rue d'Assas, 75006, Paris, France
| | | | - Arnaud Méjean
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Nicolas Thiounn
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Philippe Giraud
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
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Cheney MD, Chen MH, Zhang D, Phillips JG, Loffredo MJ, D'Amico AV. Greatest percentage of involved core length and the risk of death from prostate cancer in men with highest Gleason score ≥ 7. Clin Genitourin Cancer 2014; 12:234-40. [PMID: 24594503 DOI: 10.1016/j.clgc.2014.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/BACKGROUND Men with highest GS ≥ 7 and a differing, lower GS core (ComboGS) have decreased PC-specific mortality (PCSM) risk after RT or RT and androgen deprivation therapy (ADT). Whether the greatest percentage of involved core length (GPC) modulates this risk is unknown. PATIENTS AND METHODS Men with GS ≥ 7 PC (n = 333) consecutively treated between December 1989 and July 2000 using RT (n = 268; 80%) or RT and 6 months of ADT (n = 65; 20%) comprised the study cohort. The GPC was calculated using biopsy core and tumor lengths. We used competing risks regression to assess whether increasing GPC was associated with increased PCSM risk in men with or without ComboGS adjusting for risk group, age, and treatment. RESULTS After a median follow-up of 5.36 years (interquartile range, 3.22-7.61 years), 92 (28%) men died, 28 (30%) of PC. Increasing GPC was significantly associated with increased risk of PCSM (adjusted hazard ratio, 1.02; 95% confidence interval, 1.01-1.03; P = .005). Men with GPC ≥ 50% versus < 50% had significantly greater PCSM estimates when ComboGS was present (P < .001) versus absent (P = .55). Of the 127 men with ComboGS and GPC < 50%, 83% were treated with RT alone and 2 PC deaths were observed; neither in men with GS 7 and favorable intermediate-risk PC. CONCLUSION Men treated with RT for ComboGS, GPC < 50%, GS 7, and favorable intermediate-risk PC have a very low risk of early PCSM. The RTOG 0815 trial will establish whether ADT is necessary to optimize curability in these men.
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Affiliation(s)
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Danjie Zhang
- Department of Statistics, University of Connecticut, Storrs, CT
| | | | - Marian J Loffredo
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
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Ohashi T, Yorozu A, Saito S, Momma T, Nishiyama T, Yamashita S, Shiraishi Y, Shigematsu N. Combined brachytherapy and external beam radiotherapy without adjuvant androgen deprivation therapy for high-risk prostate cancer. Radiat Oncol 2014; 9:13. [PMID: 24401540 PMCID: PMC3904455 DOI: 10.1186/1748-717x-9-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/03/2014] [Indexed: 11/26/2022] Open
Abstract
Background To report the outcomes of patients treated with combined iodine-125 (I-125) brachytherapy and external beam radiotherapy (EBRT) for high-risk prostate cancer. Methods Between 2003 and 2009, I-125 permanent prostate brachytherapy plus EBRT was performed for 206 patients with high-risk prostate cancer. High-risk patients had prostate-specific antigen ≥ 20 ng/mL, and/or Gleason score ≥ 8, and/or Stage ≥ T3. One hundred and one patients (49.0%) received neoadjuvant androgen deprivation therapy (ADT) but none were given adjuvant ADT. Biochemical failure-free survival (BFFS) was determined using the Phoenix definition. Results The 5-year actuarial BFFS rate was 84.8%. The 5-year cause-specific survival and overall survival rates were 98.7% and 97.6%, respectively. There were 8 deaths (3.9%), of which 2 were due to prostate cancer. On multivariate analysis, positive biopsy core rates and the number of high-risk factors were independent predictors of BFFS. The 5-year BFFS rates for patients in the positive biopsy core rate <50% and ≥50% groups were 89.3% and 78.2%, respectively (p = 0.03). The 5-year BFFS rate for patients with the any single high-risk factor was 86.1%, compared with 73.6% for those with any 2 or all 3 high-risk factors (p = 0.03). Neoadjuvant ADT did not impact the 5-year BFFS. Conclusions At a median follow-up of 60 months, high-risk prostate cancer patients undergoing combined I-125 brachytherapy and EBRT without adjuvant ADT have a high probability of achieving 5-year BFFS.
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Affiliation(s)
- Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Peinemann F, Grouven U, Hemkens LG, Bartel C, Borchers H, Pinkawa M, Heidenreich A, Sauerland S. Low-dose rate brachytherapy for men with localized prostate cancer. Cochrane Database Syst Rev 2011:CD008871. [PMID: 21735436 DOI: 10.1002/14651858.cd008871.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Localized prostate cancer is a slow growing tumor for many years for the majority of affected men. Low-dose rate brachytherapy (LDR-BT) is short-distance radiotherapy using low-energy radioactive sources. LDR-BT has been recommended for men with low risk localized prostate cancer. OBJECTIVES To assess the benefit and harm of LDR-BT compared to radical prostatectomy (RP), external beam radiotherapy (EBRT), and no primary therapy (NPT) in men with localized prostatic cancer. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1950), and EMBASE (from 1980) were searched in June 2010 as well as online trials registers and reference lists of reviews. SELECTION CRITERIA Randomized, controlled trials comparing LDR-BT versus RP, EBRT, and NPT in men with clinically localized prostate cancer. DATA COLLECTION AND ANALYSIS Data on study methods, participants, treatment regimens, observation period and outcomes were recorded by two reviewers independently. MAIN RESULTS We identified only one RCT (N = 200; mean follow up 68 months). This trial compared LDR-BT and RP. The risk of bias was deemed high. Primary outcomes (overall survival, cause-specific mortality, or metastatic-free survival) were not reported. Biochemical recurrence-free survival at 5 years follow up was not significantly different between LDR-BT (78/85 (91.8%)) and RP (81/89 (91.0%)); P = 0.875; relative risk 0.92 (95% CI: 0.35 to 2.42).For severe adverse events reported at 6 months follow up, results favored LDR-BT for urinary incontinence (LDR-BT 0/85 (0.0%) versus RP 16/89 (18.0%); P < 0.001; relative risk 0) and favored RP for urinary irritation (LDR-BT 68/85 (80.0%) versus RP 4/89 (4.5%); P < 0.001; relative risk 17.80, 95% CI 6.79 to 46.66). The occurrence of urinary stricture did not significantly differ between the treatment groups (LDR-BT 2/85 (2.4%) versus RP 6/89 (6.7%); P = 0.221; relative risk 0.35, 95% CI: 0.07 to 1.68). Long-term information was not available.We did not identify significant differences of mean scores between treatment groups for patient-reported outcomes function and bother as well as generic health-related quality of life. AUTHORS' CONCLUSIONS Low-dose rate brachytherapy did not reduce biochemical recurrence-free survival versus radical prostatectomy at 5 years. For short-term severe adverse events, low-dose rate brachytherapy was significantly more favorable for urinary incontinence, but radical prostatectomy was significantly more favorable for urinary irritation. Evidence is based on one RCT with high risk of bias.
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Affiliation(s)
- Frank Peinemann
- Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, Cologne, Germany, 51105
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Pe ML, Trabulsi EJ, Kedika R, Pequignot E, Dicker AP, Gomella LG, Valicenti RK. Effect of Percentage of Positive Prostate Biopsy Cores on Biochemical Outcome in Low-risk PCa Treated With Brachytherapy or 3D-CRT. Urology 2009; 73:1328-34. [DOI: 10.1016/j.urology.2008.09.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 08/12/2008] [Accepted: 09/06/2008] [Indexed: 10/20/2022]
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Liauw SL, Fricano J, Correa D, Weichselbaum RR, Jani AB. Dose-escalated radiation therapy for intermediate-risk prostate cancer. Cancer 2009; 115:1784-90. [DOI: 10.1002/cncr.24176] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Relationship of Biochemical Outcome to Percentage of Positive Biopsies in Men with Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Urology 2008; 71:723-7. [DOI: 10.1016/j.urology.2007.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/15/2007] [Accepted: 09/16/2007] [Indexed: 11/18/2022]
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Williams SG, Buyyounouski MK, Pickles T, Kestin L, Martinez A, Hanlon AL, Duchesne GM. Percentage of Biopsy Cores Positive for Malignancy and Biochemical Failure Following Prostate Cancer Radiotherapy in 3,264 Men: Statistical Significance Without Predictive Performance. Int J Radiat Oncol Biol Phys 2008; 70:1169-75. [DOI: 10.1016/j.ijrobp.2007.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/04/2007] [Accepted: 08/09/2007] [Indexed: 11/29/2022]
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Soto DE, McLaughlin PW. Combined Permanent Implant and External-Beam Radiation Therapy for Prostate Cancer. Semin Radiat Oncol 2008; 18:23-34. [DOI: 10.1016/j.semradonc.2007.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Merrick GS, Butler WM, Wallner KE, Galbreath RW, Allen ZA, Adamovich E, Lief J. Androgen deprivation therapy does not impact cause-specific or overall survival in high-risk prostate cancer managed with brachytherapy and supplemental external beam. Int J Radiat Oncol Biol Phys 2007; 68:34-40. [PMID: 17289288 DOI: 10.1016/j.ijrobp.2006.11.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 11/21/2006] [Accepted: 11/21/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in high-risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. METHODS AND MATERIALS Between April 1995 and July 2002, 204 patients with high-risk prostate cancer (Gleason score > or = 8 or prostate-specific antigen [PSA] >20 ng/mL or clinical stage > or = T2c) underwent brachytherapy. Median follow-up was 7.0 years. The bPFS was defined by a PSA < or = 0.40 ng/mL after nadir. Multiple clinical, treatment, and dosimetric parameters were evaluated for the impact on survival. RESULTS The 10-year CSS, bPFS, and OS were 88.9%, 86.6%, and 68.6%, respectively. A statistically significant difference in bPFS was discerned between hormone naive, ADT < or = 6 months, and ADT >6 month cohorts (79.7% vs. 95.% vs. 89.9%, p = 0.032). Androgen deprivation therapy (ADT) did not impact CSS or OS. For bPFS patients, the median posttreatment PSA was <0.04 ng/mL. A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS, whereas percent positive biopsies and duration of ADT best predicted for bPFS. The OS was best predicted by Gleason score and diabetes. Thirty-eight patients have died, with 26 of the deaths from cardiovascular/pulmonary disease or second malignancy. Eleven patients have died of metastatic prostate cancer. CONCLUSIONS The ADT improved 10-year bPFS without statistical impact on CSS or OS. Death as a result of cardiovascular/pulmonary disease and second malignancies were more than twice as common as prostate cancer deaths. Strategies to improve cardiovascular health should positively impact OS.
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Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV, USA.
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Sylvester JE, Grimm PD, Blasko JC, Millar J, Orio PF, Skoglund S, Galbreath RW, Merrick G. 15-Year biochemical relapse free survival in clinical Stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007; 67:57-64. [PMID: 17084544 DOI: 10.1016/j.ijrobp.2006.07.1382] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 07/19/2006] [Accepted: 07/28/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE Long-term biochemical relapse-free survival (BRFS) rates in patients with clinical Stages T1-T3 prostate cancer continue to be scrutinized after treatment with external beam radiation therapy and brachytherapy. METHODS AND MATERIALS We report 15-year BRFS rates on 223 patients with clinically localized prostate cancer that were consecutively treated with I(125) or Pd (103) brachytherapy after 45-Gy neoadjuvant EBRT. Multivariate regression analysis was used to create a pretreatment clinical prognostic risk model using a modified American Society for Therapeutic Radiology and Oncology consensus definition (two consecutive serum prostate-specific antigen rises) as the outcome. Gleason scoring was performed by the pathologists at a community hospital. Time to biochemical failure was calculated and compared by using Kaplan-Meier plots. RESULTS Fifteen-year BRFS for the entire treatment group was 74%. BRFS using the Memorial Sloan-Kettering risk cohort analysis (95% confidence interval): low risk, 88%, intermediate risk 80%, and high risk 53%. Grouping by the risk classification described by D'Amico, the BRFS was: low risk 85.8%, intermediate risk 80.3%, and high risk 67.8% (p = 0.002). CONCLUSIONS I(125) or Pd(103) brachytherapy combined with supplemental EBRT results in excellent 15-year biochemical control. Different risk group classification schemes lead to different BRFS results in the high-risk group cohorts.
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Khaksar SJ, Langley SEM, Lovell D, Laing RW. Interstitial Low Dose Rate Brachytherapy for Prostate Cancer — A Focus on Intermediate- and High-risk Disease. Clin Oncol (R Coll Radiol) 2006; 18:513-8. [PMID: 16969980 DOI: 10.1016/j.clon.2006.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS To investigate the role of brachytherapy in intermediate- and high-risk prostate cancer. We report our results and a review of published studies. MATERIALS AND METHODS Between March 1999 and April 2003, 300 patients were treated with low dose rate 1-125 interstitial prostate brachytherapy and followed prospectively. The patients were stratified into low-, intermediate- and high-risk groups and received brachytherapy alone or in combination with external beam radiotherapy (EBRT) and/or neoadjuvant androgen deprivation (NAAD). One hundred and forty-six patients were classified as low risk, 111 as intermediate risk and 43 as high risk. Biochemical freedom from disease and prostate-specific antigen (PSA) nadirs were analysed for risk groups and for treatment received in each risk group. RESULTS The median follow-up was 45 months (range 33-82 months) with a mean age of 63 years. Actuarial 5-year biochemical relapse-free survival for the low-risk group was 96%, 89% for the intermediate-risk group and 93% for the high-risk group. When stratified by treatment group, low-risk patients had a 5-year actuarial biochemical relapse-free survival of 94% for brachytherapy alone (n=77), 92% for NAAD and brachytherapy (n=66) and 100% for NAAD, EBRT and brachytherapy (n=3). In the intermediate-risk patients, biochemical relapse-free survival was 93% for brachytherapy alone (n=15), 94% for NAAD and brachytherapy (n=67), 75% for EBRT and brachytherapy (n=4) and 92% for NAAD, EBRT and brachytherapy (n=25). In the high-risk group, biochemical relapse-free survival was 100% for brachytherapy alone (n=2), 88% for NAAD and brachytherapy (n=7), 80% for EBRT and brachytherapy (n=5) and 96% for NAAD, EBRT and brachytherapy (n=29). Overall 3- and 4-year PSA = 0.5 ng/ml were achieved by 71 and 86%, respectively, and a 4-year PSA = 0.2 ng/ml was achieved by 63%. CONCLUSION Although the role of combination treatment with pelvic EBRT and androgen therapy is not clear, our early results show that many patients with intermediate- and high-risk disease have excellent results with brachytherapy.
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Affiliation(s)
- S J Khaksar
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
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Merrick GS, Butler WM, Wallner KE, Galbreath RW, Adamovich E. Permanent interstitial brachytherapy in younger patients with clinically organ-confined prostate cancer. Urology 2004; 64:754-9. [PMID: 15491715 DOI: 10.1016/j.urology.2004.04.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Accepted: 04/23/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate biochemical progression-free survival in hormone-naive men 62 years of age or younger with clinically organ-confined prostate cancer who underwent brachytherapy with or without supplemental external beam radiotherapy. METHODS From April 1995 through December 2000, 119 hormone-naive patients 62 years of age or younger underwent permanent interstitial brachytherapy for clinical T1b-T2cNxM0 (2002 American Joint Committee on Cancer) prostate cancer. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The median follow-up was 5.4 years. Biochemical progression-free survival was defined by either a prostate-specific antigen (PSA) level of 0.4 ng/mL or less after a nadir or by the American Society for Therapeutic Radiology and Oncology consensus definition. No patient was lost to follow-up. The clinical, treatment, and dosimetric parameters evaluated for biochemical progression-free survival included age, clinical T stage, Gleason score, pretreatment PSA level, risk group, percentage of positive biopsies, isotope, supplemental external beam radiotherapy, prostate volume, brachytherapy planning volume, percentage of the target volume receiving 100%, 150%, and 200% of the prescribed dose, minimal percentage of the prescribed dose covering 90% of the target volume, and tobacco status. RESULTS For the entire group, the actuarial 7-year biochemical progression-free survival rate was 96.1% and 98.3% for a PSA cutpoint of 0.4 ng/mL or less and for the American Society for Therapeutic Radiology and Oncology consensus definition, respectively. Using a PSA biochemical control definition of 0.4 ng/mL or less, 93.1%, 100%, and 95.2% of the low-risk, intermediate-risk, and high-risk hormone-naive patients were free of biochemical progression. The median post-treatment PSA level for the biochemically disease-free group was less than 0.1 ng/mL. In multivariate analysis, only the pretreatment PSA level predicted the biochemical outcome. CONCLUSIONS Hormone-naive patients 62 years of age or younger have a high probability of 7-year biochemical progression-free survival after permanent interstitial brachytherapy with or without supplemental external beam radiotherapy.
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Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA
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Nori D, Reddy NMS, Vaughan ED, Shemtov MM. The impact of technological advances on the evolution of 3D conformal brachytherapy for early prostate cancer. Technol Cancer Res Treat 2004; 3:335-45. [PMID: 15270584 DOI: 10.1177/153303460400300403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Permanent implantation of I-125 and Pd-103 seeds is one of the widely used treatment options for the early stage prostate cancer with minimum normal tissue complications and long-term local control of the tumor. This is possible because of several technological advances made in the past decade to better understand the procedural aspects of implantations with the desired clinical outcome and with acceptable morbidities. In addition, with the widespread use of PSA testing, more widely disseminated information about prostate cancer and increased patient awareness, over 70% of patients are diagnosed early with localized disease and therefore are candidates for definitive local therapy. Delineation of soft tissue structures including the prostate, rectum, urethra and bladder has become more accurate with the use of imaging modalities including Ultrasound and MRI, with or without the CT. A re-evaluation of the dosimetric parameters of the radioactive sources has lead to a more precise estimate of the dose delivered to the prostate and the associated critical normal structures. Technological improvements in the post implant dosimetry have helped to understand the factors, which makes an implant a "good implant" or a "poor implant". Intraoperative treatment planning with on line dosimetry is emerging as one of the best approaches for prostate brachytherapy. In addition, better software is now available producing dose-volume histograms with 3D target and normal tissue reconstruction. The combination of seed implant followed by IMRT would provide scope for differentially boosting the regions under-dosed because of uncontrollable and unexpected reasons during the implant and unsuspected micro extensions of the tumor.
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Affiliation(s)
- Dattatreyudu Nori
- Department of Radiation Oncology, New York Hospital Queens, 56-45 Main Street, Flushing, NY 11355, USA.
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