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Muralidhar A, Potluri HK, Jaiswal T, McNeel DG. Targeted Radiation and Immune Therapies-Advances and Opportunities for the Treatment of Prostate Cancer. Pharmaceutics 2023; 15:252. [PMID: 36678880 PMCID: PMC9863141 DOI: 10.3390/pharmaceutics15010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Prostate cancer is the most diagnosed malignancy in men in the United States and the second leading cause of cancer-related death. For localized disease, radiation therapy is a standard treatment that is often curative. For metastatic disease, radiation therapy has been primarily used for palliation, however, several newer systemic radiation therapies have been demonstrated to significantly improve patient outcomes and improve survival. In particular, several targeted radionuclide therapies have been approved for the treatment of advanced-stage cancer, including strontium-89, samarium-153, and radium-223 for bone-metastatic disease, and lutetium-177-labeled PSMA-617 for patients with prostate-specific membrane antigen (PSMA)-expressing metastatic castration-resistant prostate cancer (mCRPC). Contrarily, immune-based treatments have generally demonstrated little activity in advanced prostate cancer, with the exception of the autologous cellular vaccine, sipuleucel-T. This has been attributed to the presence of an immune-suppressive prostate cancer microenvironment. The ability of radiation therapy to not only eradicate tumor cells but also potentially other immune-regulatory cells within the tumor immune microenvironment suggests that targeted radionuclide therapies may be well poised to combine with immune-targeted therapies to eliminate prostate cancer metastases more effectively. This review provides an overview of the recent advances of targeted radiation agents currently approved for prostate cancer, and those being investigated in combination with immunotherapy, and discusses the challenges as well as the opportunities in this field.
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Affiliation(s)
- Anusha Muralidhar
- University of Wisconsin Carbone Cancer Center, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Hemanth K. Potluri
- University of Wisconsin Carbone Cancer Center, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Tanya Jaiswal
- University of Wisconsin Carbone Cancer Center, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Douglas G. McNeel
- University of Wisconsin Carbone Cancer Center, 1111 Highland Avenue, Madison, WI 53705, USA
- 7007 Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705, USA
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Gogineni E, Rana Z, Soberman D, Sidiqi B, D'Andrea V, Lee L, Potters L, Parashar B. Biochemical Control and Toxicity Outcomes of Stereotactic Body Radiation Therapy Versus Low-Dose-Rate Brachytherapy in the Treatment of Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 109:1232-1242. [PMID: 33171199 DOI: 10.1016/j.ijrobp.2020.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Low-dose-rate (LDR) brachytherapy and stereotactic body radiation therapy (SBRT) have both shown acceptable outcomes in the treatment of low- and intermediate-risk prostate cancer. Minimal data have been published directly comparing rates of biochemical control and toxicity with these 2 modalities. We hypothesize that LDR and SBRT will provide similar rates of biochemical control. METHODS AND MATERIALS All low- and intermediate-risk patients with prostate cancer treated definitively with SBRT or LDR between 2010 and 2018 were captured. Phoenix definition was used for biochemical failure. Independent t tests were used to compare baseline characteristics, and repeated measure analysis of variance test was used to compare American Urologic Association (AUA) and the Expanded Prostate Cancer Index Composite (EPIC) scores between treatment arms over time. Biochemical control was estimated using the Kaplan-Meier method. Differences in acute and late toxicity were assessed via Pearson χ2. RESULTS In the study, 219 and 118 patients were treated with LDR and SBRT. Median follow-up was 4.3 years (interquartile range, 3.1-6.1). All patients treated with LDR received 125.0 Gy in a single fraction. SBRT consisted of 42.5 Gy in 5 fractions. Five-year biochemical control for LDR versus SBRT was 91.6% versus 97.6% (P = .108). LDR patients had a larger increase in mean AUA scores at 1 month (17.2 vs 10.3, P < .001) and 3 months posttreatment (14.0 vs 9.7, P < .001), and in mean EPIC scores at 1 month (15.7 vs 13.8, P < .001). There was no significant difference between LDR and SBRT in late grade 3 genitourinary toxicity (0.9% vs 2.5%, P = .238); however, LDR had lower rates of late grade 3 gastrointestinal toxicity (0.0% vs 2.5%, P = .018). CONCLUSIONS Our data show similar biochemical control and genitourinary toxicity rates at 5 years for both SBRT and LDR, with slightly higher gastrointestinal toxicity with SBRT and higher AUA and EPIC scores with LDR.
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Affiliation(s)
- Emile Gogineni
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Zaker Rana
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Danielle Soberman
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Baho Sidiqi
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Vincent D'Andrea
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Lucille Lee
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Louis Potters
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bhupesh Parashar
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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Zhou X, Jiao D, Dou M, Chen J, Han B, Li Z, Li Y, Liu J, Han X. Brachytherapy Combined With or Without Hormone Therapy for Localized Prostate Cancer: A Meta-Analysis and Systematic Review. Front Oncol 2020; 10:169. [PMID: 32140449 PMCID: PMC7042206 DOI: 10.3389/fonc.2020.00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/30/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the efficacy of brachytherapy combined with or without hormone therapy in patients with localized prostate cancer. Methods and Materials: We systemically searched the Medline, Web of Science, Cochrane Library and Embase databases for studies published between the databases' dates of inception and February 2019. The primary endpoints were the 5-year overall survival (OS) rates, 5-year biochemical progression-free survival (bPFS) rates and 10-year bPFS rates. The results were expressed as the relative risk (RR) and 95% confidence interval (CI). Based on the heterogeneity evaluated with the I2 statistic, a meta-analysis was performed using either a random- or fixed-effects model. Results: A total of 16 cohort studies including 9,359 patients met all the criteria for inclusion in the analysis. Our data showed that brachytherapy (BT) combined with hormone therapy (HT) increased the patients' 5-year bPFS rates (RR = 1.04, 95% CI: 1.01–1.08, P = 0.005) and 10-year bPFS rates (RR = 1.12, 95% CI: 1.02–1.23, P = 0.001) compared with BT monotherapy. However, BT combined with HT did not increase the patients' 5-year OS rates (RR = 1.02, 95% CI: 0.99–1.095, P = 0.1) compared with BT monotherapy. Conclusions: BT combined with HT can increase the bPFS rates of patients with localized prostate cancer, but it does not improve patients' OS rates.
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Affiliation(s)
- Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengmeng Dou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjian Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Han
- Radiotherapy Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaonan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xinwei Han
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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: 2.7] [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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Renard-Penna R, Sanchez-Salas R, Barret E, Cosset JM, de Vergie S, Sapetti J, Ingels A, Gangi A, Lang H, Cathelineau X. [Evaluation and results of ablative therapies in prostate cancer]. Prog Urol 2017; 27:887-908. [PMID: 28939336 DOI: 10.1016/j.purol.2017.08.003] [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: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed. RESULTS Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization. CONCLUSION The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.
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Affiliation(s)
- R Renard-Penna
- Service d'imagerie, hôpitaux Tenon-Pitié Salpêtrière, AP-HP, UPMC université Paris VI, 75013 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - E Barret
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - J M Cosset
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - S de Vergie
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - J Sapetti
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - A Ingels
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Cosset JM, Belin L, Wakil G, Flam T, Thiounn N, Pierrat N, Pontvert D, Savignoni A, Chauveinc L. Second malignancies after permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003. Cancer Radiother 2017; 21:210-215. [PMID: 28499661 DOI: 10.1016/j.canrad.2017.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/16/2017] [Accepted: 02/23/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse the rate of secondary malignancies observed in a series of 675 prostate cancer patients who underwent a permanent implant brachytherapy between 1999 and 2003, and to compare the incidence with the expected rate in a matched general French population. MATERIAL AND METHODS The cohort included low-risk patients and a selection of "favourable-intermediate" risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125-iodine seeds and a prescription dose of 145Gy. The mean follow-up was 132 months. RESULTS The 10-year overall survival for the entire cohort was 92% (95% confidence interval [CI]: 90-94). The 10-year relapse-free survival rate was 82% (95% CI: 79-85). Overall, 61 second cancers were registered. When comparing with a matched general French population, the standard incidence ratio (SIR) for bladder cancer was 1.02 (95% CI: 0.46-1.93). For colorectal cancer, the SIR was 0.45 (95% CI: 0.19-0.89). For lung cancer, the SIR was 0.38 (95% CI: 0.17-0.76). The SIR for all cancers was 0.61 (95% CI: 0.47-0.79). When excluding secondary colorectal and lung cancers (both with low SIRs in this series), the SIR for all cancers was 1.06 (95% CI: 0.77-1.29). CONCLUSION With a mean follow-up of more than 11 years, this series does not detect any excess risk of second cancers associated with permanent implant prostate brachytherapy. However, due to power limitation, a small increase in the risk of secondary malignancies cannot be totally ruled out.
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Affiliation(s)
- J-M Cosset
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Centre Charlebourg-La Défense, groupe Amethyst, 92250 La Garenne-Colombes, France.
| | - L Belin
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - G Wakil
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Charles Lemoyne hospital, 3120, boulevard Taschereau, Greenfield Park, J4V 2H1 Montréal, QC, Canada
| | - T Flam
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Fondation Saint-Jean-de-Dieu-Oudinot, 19, rue Oudinot, 75007 Paris, France
| | - N Thiounn
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Pierrat
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - D Pontvert
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Savignoni
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Chauveinc
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Centre de radiothérapie Hartmann, 4, rue Kléber, 93200 Levallois-Perret, France
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Glaser SM, Dohopolski MJ, Balasubramani GK, Benoit RM, Smith RP, Beriwal S. Brachytherapy boost for prostate cancer: Trends in care and survival outcomes. Brachytherapy 2017; 16:330-341. [PMID: 28159553 DOI: 10.1016/j.brachy.2016.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/12/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Androgen suppression combined with elective nodal and dose-escalated radiation therapy recently demonstrated an improved biochemical failure-free survival in men who received external beam radiation therapy (EBRT) plus a brachytherapy boost (BB) compared with dose-escalated external beam radiotherapy (DE-EBRT). We sought to analyze the factors predictive for use of EBRT + BB as compared with DE-EBRT and report resulting survival outcomes on a national level using a hospital-based registry. METHODS AND MATERIALS We identified 113,719 men from the National Cancer Database from 2004 to 2013 with intermediate- or high-risk prostate cancer who were treated with EBRT + BB or DE-EBRT. We performed univariate and multivariate analyses of all available factors potentially predictive of receipt of treatment selection. Survival was evaluated in a multivariable model with propensity adjustment. RESULTS For intermediate-risk patients, utilization of BB decreased from 33.1% (n = 1742) in 2004 to 12.5% (n = 766) in 2013 and for high-risk patients, utilization dropped from 27.6% (n = 879) to 10.8% (n = 479). Numerous factors predictive for use of BB were identified. Cox proportional hazards analysis was performed-adjusting for age, Charlson-Deyo comorbidity score, T stage, prostate-specific antigen, Gleason score, and sociodemographic factors-and demonstrated BB use was associated with a hazard ratio of 0.71 (95% confidence interval, 0.67-0.75; p < 0.0005) and 0.73 (95% confidence interval, 0.68-0.78; p < 0.0005) for intermediate- and high-risk patients, respectively. CONCLUSIONS There has been a concerning decline in the utilization of BB for intermediate- and high-risk prostate cancer patients despite an association with improved on overall survival. Numerous factors predictive for use of BB have been identified.
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Affiliation(s)
- S M Glaser
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - M J Dohopolski
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - G K Balasubramani
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - R M Benoit
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R P Smith
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - S Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
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Prostate-specific antigen density is predictive of outcome in suboptimal prostate seed brachytherapy. Brachytherapy 2017; 16:348-352. [PMID: 28143764 DOI: 10.1016/j.brachy.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE In prostate seed brachytherapy, a D90 of <130 Gy is an accepted predictive factor for biochemical failure (BF). We studied whether there is a subpopulation that does not need additional treatment after a suboptimal permanent seed brachytherapy implantation. METHODS AND MATERIALS A total of 486 patients who had either BF or a minimum followup of 48 months without BF were identified. BF was defined according to the Phoenix definition (nadir prostate-specific antigen + 2). Univariate and multivariate analyses were performed, adjusting for known prognostic factors such as D90 and prostate-specific antigen density (PSAD) of ≥0.15 ng/mL/cm3, to evaluate their ability to predict BF. RESULTS Median followup for patients without BF was 72 months (interquartile range 56-96). BF-free recurrence rate at 5 years was 95% and at 8 years 88%. In univariate analysis, PSAD and cancer of the prostate risk assessment score were predictive of BF. On multivariate analysis, none of the factors remained significant. The best prognosis had patients with a low PSAD (<0.15 ng/mL/cm3) and an optimal implant at 30 days after implantation (as defined by D90 ≥ 130 Gy) compared to patients with both factors unfavorable (p = 0.006). A favorable PSAD was associate with a good prognosis, independently of the D90 (<130 Gy vs. ≥130 Gy, p = 0.7). CONCLUSIONS Patients with a PSAD of <0.15 ng/mL/cm3 have little risk of BF, even in the case of a suboptimal implant. These results need to be validated in other patients' cohorts.
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Niu L, Luo X, Zeng J, Kong X, Fang G, Li Z, Li R, Xu K. Cryoablation Combined with Iodine-125 Implantation in the Treatment of Cardiac Metastasis from Alveolar Soft Part Sarcoma: A Case Report. Biomed Hub 2016; 1:1-8. [PMID: 31988888 PMCID: PMC6945912 DOI: 10.1159/000449403] [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: 06/20/2016] [Accepted: 08/25/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives A 36-year-old Asian man was referred to our hospital with cardiac metastasis. He had a history of alveolar soft part sarcoma and initially underwent resection in 2005. Methods After exposing the tumor by thoracotomy, cryoablation was performed under ultrasound guidance. This treatment was combined with iodine-125 seed implantation to treat the cardiac metastasis. Results The patient had an uneventful recovery, and his cardiac function shows no obvious abnormalities. Imaging techniques suggest that cardiac metastasis was well controlled, and the patient is still alive 12 months after treatment. Conclusions Tumor cryoablation, combined with iodine seed implantations, may be regarded as a means of palliative treatment.
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Affiliation(s)
- Lizhi Niu
- Department of Surgery and Anesthesia, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Xiaomei Luo
- Jinan University School of Medicine, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | | | - Xiaofeng Kong
- Department of Oncology, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Gang Fang
- Department of Surgery and Anesthesia, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Zhonghai Li
- Department of Radiology, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Rongrong Li
- Department of Ultrasound, Fuda Cancer Hospital, Jinan University School of Medicine (Guangzhou Fuda Cancer Hospital), Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Kecheng Xu
- Department of Oncology, Guangzhou Fuda Cancer Institute, Guangzhou, China
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Mashouf S, Safigholi H, Merino T, Soliman A, Ravi A, Morton G, Song WY. Sensitivity of clinically relevant dosimetric parameters to contouring uncertainty in postimplant dosimetry of low-dose-rate prostate permanent seed brachytherapy. Brachytherapy 2016; 15:774-779. [DOI: 10.1016/j.brachy.2016.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
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Cosset JM, Flam T, Belin L, Thiounn N, Pierrat N, Pontvert D, Wakil G, Savignoni A, Chauveinc L. Long-term results of permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003. Cancer Radiother 2016; 20:261-7. [DOI: 10.1016/j.canrad.2016.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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Meier R. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer. Front Oncol 2015; 5:48. [PMID: 25905037 PMCID: PMC4387928 DOI: 10.3389/fonc.2015.00048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose-escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation; and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity-modulated radiotherapy (IMRT). Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife). Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low-dose rate brachytherapy. Patient-reported quality of life (QOL) outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After 5 years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I–II prostate cancer.
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Stone NN, Unger P, Crawford ED, Stock RG. Diagnosis and management of local recurrence after low-dose-rate brachytherapy. Brachytherapy 2015; 14:124-30. [DOI: 10.1016/j.brachy.2014.08.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Pre-plan parameters predict post-implant D90 ≥ 140 Gy for (125)I permanent prostate implants. J Contemp Brachytherapy 2014; 6:143-53. [PMID: 25097554 PMCID: PMC4105644 DOI: 10.5114/jcb.2014.43248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/26/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose To find permanent prostate implant (PPI) pre-plan dosimetric parameters that predict post-implant D90 ≥ 140 Gy. Material and methods Pre-plans were evaluated for 504 patients undergoing PPI with 125I seeds for low or intermediate risk prostate cancer. Baseline patient and disease factors, numbers of seeds, ratios of number of seeds to available positions (occupancy proportion), and distances between the 100% isodose line and edge of the prostate (margin) planned for the whole prostate (WP), superior (S), inferior (I), anterior (A), and posterior (P) halves, SA, SP, IA, and IP quarters, and superior (ST), inferior (IT), and middle (MT) thirds, and anterior (AT) and posterior (PT) middle one-sixth segments were analyzed by post-implant D90 subset (≥ 140 Gy vs. < 140 Gy). Results 20% had post-implant D90 < 140 Gy (mean: 128.0 Gy, range: 97.5-139.2) vs. ≥ 140 Gy (mean: 154.4 Gy, range: 140.0-193.5). The D90 ≥ 140 Gy subset had larger AT and IA segment mean numbers of seeds (p = 0.01, 0.046), larger WP, S, A, SA, ST, AT, and MT segment mean margins (p = 0.01, 0.01, 0.001, 0.0001, 0.03, 0.005, 0.02), and lower PT segment occupancy proportion (p = 0.004). On multivariate analysis, independent predictors of post-implant D90 ≥ 140 Gy were increased SA mean margin, no pre-implant 5-α-reductase inhibitor, higher pre-plan D90, decreased P occupancy proportion, no pre-implant hormone therapy, and decreased SP mean margin. Conclusions Higher occupancy proportion and larger margins anteriorly and reduced occupancy proportion, and smaller margins posteriorly on PPI pre-plans predict post-implant D90 ≥ 140 Gy.
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Yan W, Chen J, Zhou Y, Zhou Z, Mai Z, Ji Z, Li H, Zhang F. Long-term outcome of early stage prostate cancer treated with brachytherapy analysis after a mean follow-up of 7 years. SPRINGERPLUS 2014; 3:357. [PMID: 25089248 PMCID: PMC4117862 DOI: 10.1186/2193-1801-3-357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the long-term efficacy of 125I brachytherapy in early-stage prostate cancer and to identify correlating factors. Methods This study included 117 cases of early stage prostate cancer. The patients ranged in age from 51 to 84 years, with a mean of 73 years. The features of the study population were as follows: the PSA ranged from 0.4 to 47.6 ng/ml (median, 14.7); the Gleason score ranged from 4 to 9 (mean, 6.4); the clinical stage ranged from T1b to T2c; and the positive biopsy rate ranged from 0.08 to 1.0 (mean, 0.45). The mean D90 was 142 Gy and ranged from 106 Gy to 170 Gy. The numbers of low-risk, intermediate-risk and high-risk prostate cancer cases were 22, 29 and 66, respectively. The biochemical no evidence of disease (bNED) rate and overall survival were recorded. Factors that correlated with the outcomes were evaluated. Results With a mean follow up of 84 months, 33 cases had biochemical recurrence, with a bNED rate of 72%. The overall survival rate was 90%, and the cancer-specific survival rate was 97%. The bNED rates in the low-risk, intermediate-risk and high-risk groups were 86%, 79% and 64%, respectively (P = 0.040). The patients with PSA <20 ng/ml, a positive biopsy rate lower than 0.5, and D90 ≥ 140 Gy had lower biochemical recurrence (P = 0.028, 0.006, 0.009, respectively). Conclusions The long-term efficacy of 125I brachytherapy in early stage prostate cancer was shown. bNED is related to risk stratification, PSA level, positive biopsy rate and D90.
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Affiliation(s)
- Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Jian Chen
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Zhipeng Mai
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Reis LO, Sanches BCF, Zani EL, Castilho LN, Monti CR. PSA-nadir at 1 year as a sound contemporary prognostic factor for low-dose-rate iodine-125 seeds brachytherapy. World J Urol 2014; 32:753-759. [PMID: 23933706 DOI: 10.1007/s00345-013-1148-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To identify predictors of outcomes in patients with localized prostate cancer treated with iodine-125 brachytherapy in a longitudinal uncontrolled study. METHODS Between 2000 and 2011, 560 histologically confirmed patients were treated with brachytherapy of whom 305 with ≥24-month follow-up and localized tumor were evaluated after exclusion of those locally advanced and under androgen ablation. RESULTS Patients' mean age was 63.93 years (44-88), mean pretreatment prostate-specific antigen (PSA) was 6.34 ng/mL (0.67-33.09), overall median follow-up was 75.35 months (24-158.37), biochemical recurrence occurred in 17 patients (5.57 %), cancer-specific survival was 100 %, and overall survival was 98.03 %. At multivariate analyses, only PSA-nadir at 1 year and age were related to disease-free survival: To each unit of PSA-nadir, the risk increases 87.3 %-OR 1.87 (p < 0.001; 95 % CI 1.31-2.67), and risk was 4.7 times higher for those under 50 years (vs. >70)-OR 4.69 (p = 0.04; 95 % CI 1.39-18.47). Best cutoff for PSA-nadir at one year was 0.285 (AUC = 0.78; p < 0.001; 95 % CI 0.68-0.89). Kaplan-Meier analysis confirmed PSA-nadir (p < 0.001) as prognostic, while D'Amico's classification failed (p = 0.24). No grade 3 or 4 complication was reported, and only 31.4 % of patients had grade 2 urinary or rectal toxicity. PSA bounce ≥0.4 ng/mL occurred in 18.4 % with no impact on biochemical recurrence. CONCLUSIONS Half (50.49 %) of patients in the scenario of localized prostate cancer treated with iodine-125 brachytherapy reach PSA-nadir at 1 year <0.285, recognized as a key independent prognostic factor.
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Affiliation(s)
- Leonardo Oliveira Reis
- Faculty of Medicine (Urology), Center for Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, SP, Brazil,
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Percutaneous cryoablation for stage IV lung cancer: a retrospective analysis. Cryobiology 2013; 67:151-5. [PMID: 23806858 DOI: 10.1016/j.cryobiol.2013.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 12/25/2022]
Abstract
The aim of this study was to investigate the therapeutic effect of cryoablation treatment and palliative treatment in stage IV lung cancer. Fifty-four patients were enrolled into the study. Thirty-one patients received cryoablation treatment (including intra- and extrapulmonary tumors), and 23 patients had palliative treatment (no cryoablation). Both the safety of the procedure and overall survival (OS) for stage IV lung cancer were assessed during a 6.5 year follow-up period. The OS of patients in both groups and the effects of treatment timing and frequency were compared. The OS in the cryoablation group was significantly longer than in the palliative group (median OS: 14 months vs. 7 months, P = 0.0009). The OS of those who received delayed cryoablation treatment was longer than that observed for those who received timely treatment (median OS: 18.5 months vs. 10 months, P = 0.0485), but this was not observed in those who received palliative treatment (median OS: 7 months vs. 7.5 months, P = 0.9814). Multiple treatments played an important role in improving the OS of patients who received cryoablation treatment (median OS: 18 months vs. 14 months, P = 0.0376). There was a significant difference between cryoablation and palliative treatment, in terms of OS. In addition, multiple cryoablation treatments may have an advantage over single treatments.
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Chen JB, Li JL, He LH, Liu WQ, Yao F, Zeng JY, Zhang Y, Xu KQ, Niu LZ, Zuo JS, Xu KC. Radical treatment of stage IV pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation. World J Gastroenterol 2012; 18:7056-62. [PMID: 23323008 PMCID: PMC3531694 DOI: 10.3748/wjg.v18.i47.7056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/20/2012] [Accepted: 04/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the therapeutic effect of radical treatment and palliative treatment in stage IV pancreatic cancer patients.
METHODS: 81 patients were enrolled in the study. Radical treatment was performed on 51 patients, while 30 patients were put under palliative treatment. The procedural safety and interval survival for stage IV pancreatic cancer (IS-IV) was assessed by almost 2.5 years of follow-ups. The IS-IV of patients under the two kinds of treatment, and the effects of treatment timing and frequency on IS-IV, were compared.
RESULTS: The IS-IV of patients who received radical treatment was significantly longer than those who received palliative treatment (P < 0.001). The IS-IV of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment (P = 0.0034 and 0.0415, respectively). Multiple treatments can play an important role in improving the IS-IV of patients who received radical treatment (P = 0.0389), but not for those who received palliative treatment (P = 0.99).
CONCLUSION: The effect of radical treatment was significantly more obvious than that of palliative treatment, and multiple radical treatments may contribute more to patients than a single radical treatment.
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Le Fur E, Malhaire J, Baverez D, Delage F, Perrouin-Verbe M, Schlurmann F, Guerif S, Fournier G, Pradier O, Valeri A. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer. Strahlenther Onkol 2012; 188:1091-5. [DOI: 10.1007/s00066-012-0242-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
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Wernicke AG, Shamis M, Yan W, Trichter S, Sabbas AM, Goltser Y, Christos PJ, Brennan JS, Parashar B, Nori D. Role of isotope selection in long-term outcomes in patients with intermediate-risk prostate cancer treated with a combination of external beam radiotherapy and low-dose-rate interstitial brachytherapy. Urology 2012; 79:1098-104. [PMID: 22546388 PMCID: PMC3623292 DOI: 10.1016/j.urology.2012.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/11/2012] [Accepted: 01/24/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the rates of long-term biochemical recurrence-free survival (BRFS) with respect to isotope in intermediate-risk prostate cancer treated with external beam radiotherapy (EBRT) and brachytherapy. METHODS A total of 242 consecutive patients with intermediate-risk prostate cancer were treated with iodine-125 ((125)I) or palladium-103 ((103)Pd) implants after EBRT (range 45.0-50.4 Gy) from 1996 to 2002. Of the 242 patients, 119 (49.2%) were treated with (125)I and 123 (50.8%) with (103)Pd. Multivariate Cox regression analysis was used to analyze BRFS, defined according to the Phoenix definition (prostate-specific antigen nadir plus 2 ng/mL) with respect to Gleason score, stage, pretreatment prostate-specific antigen level, and source selection. Late genitourinary/gastrointestinal toxicities were assessed using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. RESULTS At a median follow-up of 10 years, the BRFS rate was 77.3%. A statistically significant difference was found in the 10-year BRFS rate between the (125)I- and (103)Pd-treated groups (82.7% and 70.6%, respectively; P = .001). The addition of hormonal therapy did not improve the 10-year BRFS rate (77.6%) compared with RT alone (77.1%; P = .22). However, a statistically significant difference in the BRFS rate was found with the addition of hormonal therapy to (103)Pd, improving the 10-year BRFS rate for (73.8%) compared with (103)Pd alone (69.1%; P = .008). On multivariate analysis, isotope type ((103)Pd vs (125)I), pretreatment prostate-specific antigen level >10 ng/mL, and greater tumor stage increased the risk of recurrence by 2.6-fold (P = .007), 5.9-fold (P < .0001), and 1.7-fold (P = .14), respectively. CONCLUSION (125)I renders a superior rate of BRFS compared with (103)Pd when used with EBRT. Hormonal therapy does not provide additional benefit in patients with intermediate-risk prostate cancer treated with a combination of EBRT and brachytherapy, except for the addition of hormonal therapy to (103)Pd.
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Affiliation(s)
- A Gabriella Wernicke
- Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York 10065, USA.
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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: 1.6] [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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Zelefsky MJ, Yamada Y, Pei X, Hunt M, Cohen G, Zhang Z, Zaider M. Comparison of tumor control and toxicity outcomes of high-dose intensity-modulated radiotherapy and brachytherapy for patients with favorable risk prostate cancer. Urology 2011; 77:986-90. [PMID: 21195465 PMCID: PMC4037156 DOI: 10.1016/j.urology.2010.07.539] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/17/2010] [Accepted: 07/17/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare the long-term, prostate-specific antigen relapse-free survival outcome and incidence of toxicity for patients with low-risk prostate cancer who underwent brachytherapy or intensity-modulated radiotherapy (RT). METHODS A total of 729 consecutive patients underwent brachytherapy (n = 448; prescription dose 144 Gy) or intensity-modulated RT alone (n = 281; prescription dose 81 Gy). The prostate-specific antigen relapse-free survival using the nadir plus 2 ng/mL definition and late toxicity using the National Cancer Institute's Common Terminology Criteria for Adverse Events were determined. RESULTS The 7-year prostate-specific antigen relapse-free survival rate for the brachytherapy and intensity-modulated RT groups was 95% and 89% for low-risk patients, respectively (P = .004). Cox regression analysis demonstrated that brachytherapy was associated with improved prostate-specific antigen relapse-free survival, even after adjustment for other variables. The incidence of metastatic disease between treatment sessions was low for both treatment groups. Late grade 2 gastrointestinal toxicity was observed in 5.1% and 1.4% of the brachytherapy and intensity-modulated RT groups, respectively (P = .02). No significant differences were seen between treatment groups for late grade 3 or greater rectal complications (brachytherapy 1.1% and intensity-modulated RT 0%; P = .19). Late grade 2 urinary toxicity occurred more often in the brachytherapy group than in the intensity-modulated RT group (15.6% and 4.3%, respectively; P < .0001). No significant differences were seen between the 2 treatment groups for late grade 3 urinary toxicity (brachytherapy 2.2% and intensity-modulated RT 1.4%; P = .62). CONCLUSIONS Among low-risk prostate cancer patients, the 7-year biochemical tumor control was superior for intraoperatively planned brachytherapy compared with high-dose intensity-modulated RT. Although significant toxicities were minimal for both groups, modest, but significant, increases in grade 2 urinary and rectal symptoms were noted for brachytherapy compared with intensity-modulated RT.
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Affiliation(s)
- Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Hinnen KA, van Vulpen M. Predictors in the outcome of 125I brachytherapy as monotherapy for prostate cancer. Expert Rev Anticancer Ther 2011; 11:115-23. [PMID: 21166516 DOI: 10.1586/era.10.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A number of different prostate cancer treatment modalities exist. Nomograms are used to assist clinicians and patients in choosing the most appropriate treatment. However, the predicted outcome for (125)I brachytherapy is much worse than what would be expected considering the actual survival rates. This underestimation may result in suboptimal treatment decisions. Therefore, better predictors for outcome after (125)I brachytherapy are necessary. The following factors, which may either influence outcome or predict outcome after brachytherapy, are discussed: tumor characteristics and risk stratification, patient age at treatment, obesity, adjuvant androgen-deprivation therapy, prostate-specific antigen bounce, implantation technique and dosimetry. For the prediction of outcome after (125)I brachytherapy, as long as the quality of the implant is optimal, only high-risk prostate cancer was found to have a negative impact on outcome.
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Affiliation(s)
- Karel A Hinnen
- Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA, The Netherlands
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Abstract
INTRODUCTION A locally advanced prostate cancer is defined as a malignant process spreading beyond the prostate capsule or in seminal vesicles but without distant metastasis or regional lymph nodes invasion. CLINICAL CLASSIFICATION, PREDICTION AND TREATMENT OF PROSTATE CANCER An exact staging of clinical T3 stadium is usually difficult because of the frequent over and under staging. The risk prognostic stratification is performed through nomograms and ANN (artificial neural networks). The options for treatment are: radical prostatectomy, external radiotherapy and interstitial implantation of radioisotopes, hormonal therapy by androgen blockade. Radical prostatectomy is considered in patients with T3 stage but extensive dissection of lymph nodes, dissection of neurovascular bundle (on tumor side), total removal of seminal vesicle and sometimes resection of bladder neck are obligatory. Postoperative radiotherapy is performed in patients with invasion of seminal vesicles and capsular penetration or with prostate specific antigen value over 0.1 ng/ml, one month after the surgical treatment. Definitive radiotherapy could be used as the best treatment option considering clinical stage, Gleason score, age, starting prostate specific antigen (PSA) value, concomitant diseases, life expectancy, quality of life, through multidisciplinary approach (combined with androgen deprivation). Hormonal therapy in intended for patients who are not eligible for surgical treatment or radiotherapy. Conclusion Management of locally advanced prostate cancer is still controversial and studies fbr better diagnosis and new treatment modalities are ongoing.
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Stone NN, Stone MM, Rosenstein BS, Unger P, Stock RG. Influence of Pretreatment and Treatment Factors on Intermediate to Long-Term Outcome After Prostate Brachytherapy. J Urol 2011; 185:495-500. [DOI: 10.1016/j.juro.2010.09.099] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Nelson N. Stone
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - Mariana M. Stone
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Barry S. Rosenstein
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Pam Unger
- Department of Pathology, Mount Sinai School of Medicine, New York, New York
| | - Richard G. Stock
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
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One-step customized transurethral resection of the prostate and permanent implant brachytherapy for selected prostate cancer patients: Technically feasible but too toxic. Brachytherapy 2011; 10:29-34. [DOI: 10.1016/j.brachy.2010.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hinnen KA, Battermann JJ, van Roermund JG, Moerland MA, Jürgenliemk-Schulz IM, Frank SJ, van Vulpen M. Long-Term Biochemical and Survival Outcome of 921 Patients Treated With I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76:1433-8. [DOI: 10.1016/j.ijrobp.2009.03.049] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/20/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Stone NN, Stock RG, Cesaretti JA, Unger P. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Biol Phys 2010; 76:355-60. [DOI: 10.1016/j.ijrobp.2009.01.078] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/20/2009] [Accepted: 01/29/2009] [Indexed: 11/15/2022]
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Taira AV, Merrick GS, Galbreath RW, Wallner KE, Butler WM. Natural History of Clinically Staged Low- and Intermediate-Risk Prostate Cancer Treated With Monotherapeutic Permanent Interstitial Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76:349-54. [DOI: 10.1016/j.ijrobp.2009.02.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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Jabbari S, Weinberg VK, Shinohara K, Speight JL, Gottschalk AR, Hsu IC, Pickett B, McLaughlin PW, Sandler HM, Roach M. Equivalent Biochemical Control and Improved Prostate-Specific Antigen Nadir After Permanent Prostate Seed Implant Brachytherapy Versus High-Dose Three-Dimensional Conformal Radiotherapy and High-Dose Conformal Proton Beam Radiotherapy Boost. Int J Radiat Oncol Biol Phys 2010; 76:36-42. [DOI: 10.1016/j.ijrobp.2009.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/10/2009] [Accepted: 01/14/2009] [Indexed: 11/27/2022]
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Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle. Cancer Radiother 2009; 13:721-30. [DOI: 10.1016/j.canrad.2009.08.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/22/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
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Favorable toxicity and biochemical control using real-time inverse optimization technique for prostate brachytherapy. Brachytherapy 2009; 8:297-303. [DOI: 10.1016/j.brachy.2008.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/25/2008] [Accepted: 12/17/2008] [Indexed: 11/20/2022]
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Tanaka N, Asakawa I, Kondo H, Tanaka M, Fujimoto K, Hasegawa M, Konishi N, Hirao Y. Technical acquisition and dosimetric assessment of iodine-125 permanent brachytherapy in localized prostate cancer: our first series of 100 patients. Int J Urol 2009; 16:70-4. [PMID: 19120529 DOI: 10.1111/j.1442-2042.2008.02172.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess our initial experience in the treatment of localized prostate cancer using low-dose-rate brachytherapy (LDR-brachytherapy) with iodine-125. METHODS One-hundred consecutive patients received LDR-brachytherapy between July 2004 and October 2006. Seventy-six patients were treated with seed implantation alone, whereas 24 patients were treated with a combination of brachytherapy and external beam radiotherapy. The minimal percentage of the dose received by 90% of the prostate gland (%D90), the percentage prostate volume receiving 100% of the prescribed minimal peripheral dose (V100), and the operation time were compared among every 10 consecutive patients. RESULTS The means of %D90 and V100 were 109.6% and 93.4%, respectively. When compared with the first 10 patients, both D90 and V100 showed significant improvement in the following 10 consecutive patients. Similarly, the mean operation time decreased significantly according to the accumulated number of patients. CONCLUSIONS Our initial experience with the first 100 cases suggests that LDR-brachytherapy needs accumulation of many more patients to obtain high-quality post-implant dosimetric outcomes.
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Affiliation(s)
- Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan.
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Prostogram Predicted Brachytherapy Outcomes are Not Universally Accurate: An Analysis Based on the M. D. Anderson Cancer Center Experience With
125
Iodine Brachytherapy. J Urol 2009; 181:1658-63; discussion 1663-4. [DOI: 10.1016/j.juro.2008.11.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Indexed: 11/19/2022]
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Current status and perspectives of brachytherapy for prostate cancer. Int J Clin Oncol 2009; 14:31-6. [DOI: 10.1007/s10147-008-0866-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Indexed: 10/21/2022]
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Cosset JM, Flam T, Thiounn N, Pontvert D, Pierrat N, Vallancien G, Chauveinc L. La curiethérapie du cancer prostatique par implants permanents. Cancer Radiother 2008; 12:503-11. [DOI: 10.1016/j.canrad.2008.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Selecting Patients for Exclusive Permanent Implant Prostate Brachytherapy: The Experience of the Paris Institut Curie/Cochin Hospital/Necker Hospital Group on 809 Patients. Int J Radiat Oncol Biol Phys 2008; 71:1042-8. [DOI: 10.1016/j.ijrobp.2007.11.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 11/13/2007] [Accepted: 11/14/2007] [Indexed: 11/22/2022]
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The time gap between Pd-103 prostate brachytherapy and supplemental beam radiation does not impact on rectal morbidity or likelihood of cure. Am J Clin Oncol 2008; 31:231-6. [PMID: 18525300 DOI: 10.1097/coc.0b013e31815a43ab] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether treatment gap between supplemental beam radiation and brachytherapy implant affects rectal morbidity and likelihood of cure in the treatment of intermediate-risk prostate cancer. MATERIALS AND METHODS Five hundred sixty-eight patients with AJCC clinical stage T1c-T2a prostate cancer, Gleason score 7 to 9 and/or prostate-specific antigen (PSA) 10 to 20 ng/mL, were randomized to implantation with Pd-103 (90 vs. 115 Gy) with 44 Gy versus 20 Gy preimplant supplemental beam radiation, respectively. Treatment-related morbidity was monitored by mailed questionnaires, using a modified Radiation Therapy Oncology Group rectal morbidity criteria at 1, 3, 6, 12, 18, and 24 months. Patients who reported grade 1 or worse rectal morbidity were interviewed by telephone to clarify details regarding their rectal bleeding. RESULTS Persistent rectal bleeding occurred in 36 of the 548 evaluable patients (7%). The mean gap among rectal bleeders was 3.8 days and among nonbleeders was 4.8 days (P = 0.236). Higher R100 and external beam dose of 44 Gy were significant predictors of rectal bleeding on univariate and multivariate analysis. Log-rank analysis did not demonstrate any improvement in biochemical failure free survival (BFFS) with shorter gap interval. On univariate analysis, Gleason score >7, PSA >10, D90 <100%, and treatment gap were all predictive of biochemical failure. On multivariate analysis, only Gleason score, PSA, and D90 remained significant predictors of BFFS. CONCLUSION Shorter gap intervals between supplemental beam radiation and brachytherapy implant are safe. Shorter gap intervals do not improve BFFS; however, they do allow for treatment completion in a more timely fashion.
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Bittner N, Merrick GS, Galbreath RW, Butler WM, Wallner KE, Allen ZA, Brammer SG, Moyad M. Primary causes of death after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008; 72:433-40. [PMID: 18448268 DOI: 10.1016/j.ijrobp.2008.02.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 01/29/2008] [Accepted: 02/08/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the primary causes of death in low-risk (low-risk), intermediate-risk (intermediate-risk), and high-risk (high-risk) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. METHODS AND MATERIALS From April 1995 through November 2004, a total of 1,354 consecutive patients underwent prostate brachytherapy. All patients underwent brachytherapy >3 years before analysis. Of the patients, 532 (39.3%) received androgen deprivation therapy and 703 (51.9%) received supplemental radiation therapy. The median follow-up was 5.4 years. Multiple parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. RESULTS The 10-year cause-specific survival was 97.0% (99.7%, 99.0%, and 90.1% for low-risk, intermediate-risk, and high-risk patients). Overall survival was 76.7% (82.5%, 78.3%, and 67.6% for low-, intermediate-, and high-risk patients, respectively). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3%, and 19.8% for low-, intermediate-, and high-risk patients). The death rate from second malignancies (nonprostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0%, and 10.8% for low-, intermediate-, and high-risk patients. In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group, whereas death from cardiovascular disease, nonprostate cancer, and all other causes were most closely related to patient age and tobacco use. CONCLUSIONS Although cardiovascular mortality was the predominant cause of death, prostate cancer was responsible for approximately 10% of all deaths. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients primarily resulted from an excess of cardiovascular deaths. Changes in lifestyle to improve cardiovascular health may improve overall survival in patients with clinically localized prostate cancer.
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Affiliation(s)
- Nathan Bittner
- Department of Radiation Oncology, University of Washington, Seattle, WA 26003-6300, USA
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40
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Sahgal A, Roach M. Permanent prostate seed brachytherapy: a current perspective on the evolution of the technique and its application. ACTA ACUST UNITED AC 2008; 4:658-70. [PMID: 18059346 DOI: 10.1038/ncpuro0971] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 09/02/2007] [Indexed: 11/09/2022]
Abstract
This Review highlights current areas of controversy and development in the field of transperineal permanent prostate seed implantation brachytherapy (PPI), in particular the technological evolution of PPI treatment planning that has led to intra-operative treatment planning and execution, the use of MRI spectroscopy and ultrasonography to target intraprostatic tumor foci, and the introduction of (131)Cs as a new PPI isotope. Here we present a comprehensive review of mature data for PPI monotherapy and PPI combined with supplemental external beam radiation therapy, and a critical discussion of issues pertinent to supplemental EBRT. We also present our current policies in the treatment of prostate cancer at the University of California, San Francisco.
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Affiliation(s)
- Arjun Sahgal
- Odette Cancer Center of the Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada
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41
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Fuller DB, Jin H. Computed tomography-ultrasound fusion brachytherapy: description and evolution of the technique. Brachytherapy 2007; 6:272-9. [PMID: 17964222 DOI: 10.1016/j.brachy.2007.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 08/10/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE In this manuscript, we describe our computed tomography (CT)-ultrasound (US) fusion prostate brachytherapy method and report the updated dosimetry result and trend. METHODS AND MATERIALS This cohort of 132 consecutive patients received CT-US fusion prostate brachytherapy from the first author (DBF) from December 2002 to August 2006. The technique consists of a hybrid preplanned and intraoperative dynamic dosimetry method, which initially delivers a standard preplanned source distribution, and then uses interval CT-based source identification dosimetry, fused to an identically spaced intraoperative US volume study series, to direct remedial sources that correct initial dosimetry deficiencies. RESULTS The median and minimum prostate Day 0 prostate volume of interest receiving 100% of prescribed dose (V(100)) results in this patient cohort measured 98.26% and 92.61%, respectively, with all Day 0 prostate dose received by 90% of the volume of interest (D(90)) results exceeding 100% of the prescribed dose, and the maximum Day 0 prostate D(90) value measuring 128% of the prescribed dose. During the period of this analysis, a trend to the decreased quantity of dynamic remedial millicuries per case was identified, with the total sources decreasing from 116% to 106% of the preplanned level, resulting in minimal V(100) and D(90) decreases, while continuing to exceed the minimum Day 0 dosimetry requirements. CONCLUSIONS CT-US fusion dynamic prostate brachytherapy represents a consistent prostate brachytherapy dosimetry delivery mechanism, creating a tight lower and upper bound to the final Day 0 prostate V(100) and D(90) parameters. The practice and pitfalls of this technique are discussed in detail.
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Affiliation(s)
- Donald B Fuller
- Department of Radiation Oncology, Radiation Medical Group, Inc., San Diego, CA 92101, USA.
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Bittner N, Merrick GS, Wallner KE, Lief JH, Butler WM, Galbreath RW. The impact of acute urinary morbidity on late urinary function after permanent prostate brachytherapy. Brachytherapy 2007; 6:258-66. [DOI: 10.1016/j.brachy.2007.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 08/15/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
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Stone NN, Stock RG, White I, Unger P. Patterns of Local Failure Following Prostate Brachytherapy. J Urol 2007; 177:1759-63; duscussion 1763-4. [PMID: 17437808 DOI: 10.1016/j.juro.2007.01.069] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE We describe biopsy results in patients with prostate cancer treated with brachytherapy. MATERIALS AND METHODS A total of 1,562 men with localized prostate cancer were treated with permanent prostate brachytherapy, of whom 508 agreed to ultrasound guided biopsies 2 years after the completion of all therapy. Median followup was 6.7 years (range 2 to 14.6) and median prostate specific antigen was 7.4 ng/ml (range 0.3 to 300). Disease was categorized as Gleason score less than 7 in 74.8% of patients, stage T2a or less in 64.2%, low risk in 43.1%, intermediate risk in 24.2% and high risk in 32.7%. Of the 508 men 315 (62%) received (125)I, 110 (21.7%) received (103)Pd and 83 (16.3%) received (103)Pd and external beam radiotherapy. A total of 237 men (46.7%) received a short course of hormonal therapy (3 to 9 months). Subsequent biopsies were performed after 2 years if initial biopsy was positive or prostate specific antigen increased. Post-implantation dosimetry results were grouped into low, normal and high dose. Associations were tested by chi-square analysis. Survival functions were calculated with Kaplan-Meier analysis and Cox regression. RESULTS A total of 643 biopsies were performed in 508 men between 2 and 11 years after implantation. Of the 508 men 39 (7.7%) had a final positive biopsy. Positive biopsy was associated with high prostate specific antigen (p=0.035), stage (p=0.003), risk (p=0.024), no hormonal therapy (p=0.002) and low dose (p<0.0001). On multivariate analysis only dose and hormonal therapy were significant (p<0.0001 and p=0.004, respectively). Of the patients 80% were free of PSA failure at 10 years if final biopsy was negative compared to 27.3% with a positive biopsy (p<0.0001). Death from prostate cancer was associated with a positive biopsy (OR 18.5, 95% CI 2.3-143, p<0.0001). Of the 52 men with a positive biopsy at year 2, 23 (44.2%) had negative results on subsequent biopsy, while 10 of the 456 (2.2%) with negative 2-year biopsies showed positive results. Positive biopsy occurred in the prostate only in 31 of 39 men (79.5%), in the prostate and seminal vesicles in 3 (7.7%), and in the seminal vesicles only in 5 (12.8%). CONCLUSIONS Patients undergoing prostate brachytherapy must receive an adequate radiation dose to eradicate local disease. Hormonal therapy may benefit local control in patients with intermediate to high risk disease. Extraprostatic biopsies should be performed in patients with local failure who are considering salvage therapy to rule out seminal vesicle involvement.
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Affiliation(s)
- Nelson N Stone
- Department of Urology, Mount Sinai School of Medicine, New York, NY, USA.
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Smith WL, Lewis C, Bauman G, Rodrigues G, D'Souza D, Ash R, Ho D, Venkatesan V, Downey D, Fenster A. Prostate volume contouring: a 3D analysis of segmentation using 3DTRUS, CT, and MR. Int J Radiat Oncol Biol Phys 2007; 67:1238-47. [PMID: 17336224 DOI: 10.1016/j.ijrobp.2006.11.027] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/08/2006] [Accepted: 11/09/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE This study evaluated the reproducibility and modality differences of prostate contouring after brachytherapy implant using three-dimensional (3D) transrectal ultrasound (3DTRUS), T2-weighted magnetic resonance (MR), and computed tomography (CT) imaging. METHODS AND MATERIALS Seven blinded observers contoured 10 patients' prostates, 30 day postimplant, on 3DTRUS, MR, and CT images to assess interobserver variability. Randomized images were contoured twice by each observer. We analyzed length and volume measurements and performed a 3D analysis of intra- and intermodality variation. RESULTS Average volume ratios were 1.16 for CT/MR, 0.90 for 3DTRUS/MR, and 1.30 for CT/3DTRUS. Overall contouring variability was largest for CT and similar for MR and 3DTRUS. The greatest variability of CT contours occurred at the posterior and anterior portions of the midgland. On MR, overall variability was smaller, with a maximum in the anterior region. On 3DTRUS, high variability occurred in anterior regions of the apex and base, whereas the prostate-rectum interface had the smallest variability. The shape of the prostate on MR was rounder, with the base and apex of similar size, whereas CT contours had broad, flat bases narrowing toward the apex. The average percent of surface area that was significantly different (95% confidence interval) for CT/MR was 4.1%; 3DTRUS/MR, 10.7%; and CT/3DTRUS, 6.3%. The larger variability of CT measurements made significant differences more difficult to detect. CONCLUSIONS The contouring of prostates on CT, MR, and 3DTRUS results in systematic differences in the locations of and variability in prostate boundary definition between modalities. MR and 3DTRUS display the smallest variability and the closest correspondence.
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Affiliation(s)
- Wendy L Smith
- Department of Medical Physics, Tom Baker Cancer Centre, and Departments of Oncology and Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada.
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Stone NN, Stock RG. Long-Term Urinary, Sexual, and Rectal Morbidity in Patients Treated with Iodine-125 Prostate Brachytherapy Followed Up for a Minimum of 5 Years. Urology 2007; 69:338-42. [PMID: 17320674 DOI: 10.1016/j.urology.2006.10.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 08/23/2006] [Accepted: 10/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To define the long-term morbidity in patients with prostate cancer who underwent iodine-125 brachytherapy. METHODS A total of 325 men with localized prostate cancer treated with iodine-125 brachytherapy had a median follow-up of 7 years (range 5 to 15). The American Urological Association symptom score, erectile function status, rectal bleeding incidence, and presence of urinary incontinence were collected prospectively before implantation and every 6 months thereafter. Comparisons were made between the pretreatment and treatment-related factors and their associations with quality-of-life changes. Associations were tested using the Student t, chi-square, and Wilcoxon signed rank tests. RESULTS The median prostate volume and maximal dose to 90% of the prostate was 36.6 cm3 and 167 Gy, respectively. Of the 325 men, 15.7% experienced prostate-specific antigen failure and 4% started androgen deprivation therapy. The mean total symptom and bother scores increased from baseline (P <0.001) to 6 months after implantation, steadily decreased, and were unchanged at the last follow-up visit (P = 0.6). There were no significant associations among patient age, race, hormonal therapy use, prostate size, radiation dose, and urinary morbidity. Incontinence occurred in 4 (1.2%) of the 325 patients at the last follow-up visit and was associated with transurethral resection of the prostate (odds ratio 8.8, 95% confidence interval 1.3 to 62, P = 0.008). Before implantation, 77.2% were able to have an erection adequate for intercourse and 50.6% were able to at the last follow-up visit. A significant correlation was found between potency preservation and age (P <0.001). Rectal bleeding occurred in 78 men (24%) 1 to 3 years after implantation. Nine patients (2.8%) complained of minor bleeding beyond 5 years, which was associated with greater radiation doses (P = 0.023). CONCLUSIONS The preservation of urinary, sexual, and rectal quality of life is excellent at long follow-up for patients implanted with iodine-125.
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Affiliation(s)
- Nelson N Stone
- Department of Urology, Mount Sinai School of Medicine, New York, New York, USA.
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Machtens S, Baumann R, Hagemann J, Warszawski A, Meyer A, Karstens JH, Jonas U. Long-term results of interstitial brachytherapy (LDR-Brachytherapy) in the treatment of patients with prostate cancer. World J Urol 2007; 24:289-95. [PMID: 16645877 DOI: 10.1007/s00345-006-0083-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Permanent interstitial brachytherapy represents the most conformal form of radiation therapy of the prostate and the number of patients with prostate cancers treated with permanent radioactive implants is increasing world wide. In the meanwhile long-term data on tumor control and treatment morbidity become available. Biochemical and clinical tumor control appears to be as effective as after radical prostatectomy or external beam radiation therapy in early prostate cancer. The risk of postreatment urinary incontinence and bowel dysfunction is low and erectile function can be preserved in the majority of patients. However, prostate brachytherapy requires a careful selection of patients as pretreatment factors predict for long-term outcome. The need for combined modality approaches in intermediate and high-risk patients remains controversely discussed. The continous refinement of intraoperative planning techniques and the elucidation of the etiology of urinary, sexual, and bowel dysfunction should result in further improvements in biochemical outcomes and decreased morbidity. Improved and standardized postimplantation evaluation will make outcome data more reliable and comparable.
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Affiliation(s)
- Stefan Machtens
- Department of Urology, Marien Krankenhaus Bergisch Gladbach gGmbH, Akademisches Lehrkrankenhaus der Universität Köln, Robert-Koch-Str.18, 51465, Bergisch Gladbach, Germany.
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Tormo Micó A, Francés A, Budía Alba A, Bosquet Sanz M, Boronat Tormo F, Alapont Alacreu J, Vera Donoso C, Jiménez Cruz J. Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado. Actas Urol Esp 2007. [DOI: 10.1016/s0210-4806(07)73668-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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: 9.8] [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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Rivard MJ, Butler WM, Devlin PM, Hayes JK, Hearn RA, Lief EP, Meigooni AS, Merrick GS, Williamson JF. American Brachytherapy Society recommends no change for prostate permanent implant dose prescriptions using iodine-125 or palladium-103. Brachytherapy 2007; 6:34-7. [PMID: 17284383 DOI: 10.1016/j.brachy.2006.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 10/28/2006] [Accepted: 11/07/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE In 2004, the American Association of Physicists in Medicine (AAPM) issued a report outlining recommended 125I and 103Pd datasets for consistency in calculating brachytherapy dose distributions. In 2005, to aid evaluating the clinical impact of implementing these datasets, the AAPM assessed the historical dependence of how prescribed doses differed from administered doses for 125I and 103Pd for permanent implantation of the prostate. Consequently, the American Brachytherapy Society (ABS) considered the nature of these changes towards issuing recommended dose prescriptions for 125I and 103Pd interstitial brachytherapy implants for monotherapy and standard boosts. METHODS AND MATERIALS An investigation was performed of the 2005 AAPM analysis to determine changes in administered dose while affixing prescribed dose using 2004 AAPM 125I and 103Pd brachytherapy dosimetry datasets for prostate implants. For 125I and 103Pd, administered dose would change by +1.4% and +4.2%, respectively. The biological and societal impact of changing prescribed dose was considered. RESULTS Based on the need for clinical constancy and in recognition of overall uncertainties, the ABS recommends immediate implementation of the 2004 AAPM consensus brachytherapy dosimetry datasets and no changes to 125I and 103Pd dose prescriptions at this time. CONCLUSIONS Radiation oncologists should continue to prescribe monotherapy doses of 145 Gy and 125 Gy for 125I and 103Pd, respectively, and standard boost doses of 100-110 Gy and 90-100 Gy for 125I and 103Pd, respectively.
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Affiliation(s)
- Mark J Rivard
- Departments of Radiation Oncology and Medical Physics, Tufts-New England Medical Center, Boston, MA 02111, USA.
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