PURPOSE: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation.
METHODS AND MATERIALS: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival.
RESULTS: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P< .0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed.
CONCLUSION: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis < 3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.
Written by:
Genebes C, Filleron T, Graff P, Jonca F, Huyghe E, Thoulouzan M, Soulie M, Malavaud B, Aziza R, Brun T, Delannes M, Bachaud JM. Are you the author?
Radiation Oncology Department, Institut Claudius Regaud, Toulouse, France.
Reference: Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):651-8.
doi: 10.1016/j.ijrobp.2013.08.010
PubMed Abstract
PMID: 24138913
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