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Comparison of permanent (125)I seeds implants with two different techniques in 500 cases of prostate cancer.

Guinot JL, Ricós JV, Tortajada MI, Santos MA, Casanova J, Clemente J, Samper J, Santamaría P, Arribas L - J Contemp Brachytherapy (2015)

Bottom Line: A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%.Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%.We have made this our standard technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To perform a comparative study of 500 consecutive (125)I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning.

Material and methods: From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%.

Results: Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy.

Conclusions: The outcome of patients with low risk prostate carcinoma treated with (125)I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.

No MeSH data available.


Related in: MedlinePlus

X-ray one month after the implant, with no displacement of seeds using Pro-Link system™ and real-time procedure
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Figure 0002: X-ray one month after the implant, with no displacement of seeds using Pro-Link system™ and real-time procedure

Mentions: Permanent LDR brachytherapy for prostate carcinoma achieves a ten-year bRFS of 87-96% in low risk cases and 63-86% in intermediate cases. In a study on 1313 patients, 48% of them with EBRT, 7-year bRFS was 98% in low risk and 93% in intermediate cases [16]. The 20-year experience at Mount Sinai Medical Center, on 2495 patients treated for localized prostate cancer with brachytherapy or combined treatment with EBRT, resulted in 12-year bRFS of 90%, 84%, and 64% in low, intermediate, and high risk cases [17]. A selection of 1656 cases with high-quality brachytherapy treated in the University of Washington, Seattle, achieved excellent long-term outcomes, with12-year bRFS of 98.6%, 96.5%, and 90.5%, respectively, results that compare favorably to alternative treatment modalities including prostatectomy [18]. We have compared two different techniques in 500 consecutive patients treated at a single institution by the same team. Median follow up is 4 years, it is a short term experience to draw conclusions but bRFS is always favoring the second technique, even if the differences are not statistically significant. With the first technique using RapidStrand™ and a preplanning system, we achieved five-year bRFS of 92% in low risk cases and 86% in intermediate cases. With the second technique using a real-time technique and the ProLink™ system, we achieved over 97% in both groups. Of course, the learning curve could have some influence in the outcome of the first group but the results of the second group are good enough, comparing other published papers, especially in intermediate risk cases. EBRT was used in intermediate cases in one quarter of the first group and three quarters of the second group. The dosimetric results are better using the real-time technique, which enables calculation of the actual dose during the implant and allows for insertion of extra seeds when needed. The ProLink™ system is very flexible allowing the use of consecutive or separated linked seeds with a rigid fixation (Figure 1), stable for at least six months, achieving better dosimetric isodose curves during the calculation in the operating room, and one month later in the CT, when less movement and misplacement of seeds was observed, remaining in place (Figure 2 and 3). A one-stage prostate brachytherapy technique (4D brachytherapy) using a combination of stranded and loose seeds showed significantly improved dosimetry [19]. With this technique, dosimetry at the end of the implant is excellent and we consider this is the reason for the improvement in the bRFS equivalent to the best published series [20]. Longer follow up will be required to confirm long term outcome.


Comparison of permanent (125)I seeds implants with two different techniques in 500 cases of prostate cancer.

Guinot JL, Ricós JV, Tortajada MI, Santos MA, Casanova J, Clemente J, Samper J, Santamaría P, Arribas L - J Contemp Brachytherapy (2015)

X-ray one month after the implant, with no displacement of seeds using Pro-Link system™ and real-time procedure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643727&req=5

Figure 0002: X-ray one month after the implant, with no displacement of seeds using Pro-Link system™ and real-time procedure
Mentions: Permanent LDR brachytherapy for prostate carcinoma achieves a ten-year bRFS of 87-96% in low risk cases and 63-86% in intermediate cases. In a study on 1313 patients, 48% of them with EBRT, 7-year bRFS was 98% in low risk and 93% in intermediate cases [16]. The 20-year experience at Mount Sinai Medical Center, on 2495 patients treated for localized prostate cancer with brachytherapy or combined treatment with EBRT, resulted in 12-year bRFS of 90%, 84%, and 64% in low, intermediate, and high risk cases [17]. A selection of 1656 cases with high-quality brachytherapy treated in the University of Washington, Seattle, achieved excellent long-term outcomes, with12-year bRFS of 98.6%, 96.5%, and 90.5%, respectively, results that compare favorably to alternative treatment modalities including prostatectomy [18]. We have compared two different techniques in 500 consecutive patients treated at a single institution by the same team. Median follow up is 4 years, it is a short term experience to draw conclusions but bRFS is always favoring the second technique, even if the differences are not statistically significant. With the first technique using RapidStrand™ and a preplanning system, we achieved five-year bRFS of 92% in low risk cases and 86% in intermediate cases. With the second technique using a real-time technique and the ProLink™ system, we achieved over 97% in both groups. Of course, the learning curve could have some influence in the outcome of the first group but the results of the second group are good enough, comparing other published papers, especially in intermediate risk cases. EBRT was used in intermediate cases in one quarter of the first group and three quarters of the second group. The dosimetric results are better using the real-time technique, which enables calculation of the actual dose during the implant and allows for insertion of extra seeds when needed. The ProLink™ system is very flexible allowing the use of consecutive or separated linked seeds with a rigid fixation (Figure 1), stable for at least six months, achieving better dosimetric isodose curves during the calculation in the operating room, and one month later in the CT, when less movement and misplacement of seeds was observed, remaining in place (Figure 2 and 3). A one-stage prostate brachytherapy technique (4D brachytherapy) using a combination of stranded and loose seeds showed significantly improved dosimetry [19]. With this technique, dosimetry at the end of the implant is excellent and we consider this is the reason for the improvement in the bRFS equivalent to the best published series [20]. Longer follow up will be required to confirm long term outcome.

Bottom Line: A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%.Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%.We have made this our standard technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To perform a comparative study of 500 consecutive (125)I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning.

Material and methods: From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%.

Results: Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy.

Conclusions: The outcome of patients with low risk prostate carcinoma treated with (125)I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.

No MeSH data available.


Related in: MedlinePlus