Long-Term Efficacy and Toxicity of Low-Dose-Rate 125 I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer
| Autor: | Kristin L. Smith, Chandana A. Reddy, Andrew J. Stephenson, James Ulchaker, Eric A. Klein, J. Kittel, Kenneth W. Angermeier, D. Allan Wilkinson, Steven C. Campbell, Jay P. Ciezki, Rahul D. Tendulkar, Kevin L. Stephans |
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| Rok vydání: | 2015 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Radiation business.industry Genitourinary system medicine.medical_treatment Brachytherapy Common Terminology Criteria for Adverse Events medicine.disease Prostate cancer medicine.anatomical_structure Prostate Internal medicine Toxicity medicine Radiology Nuclear Medicine and imaging business Prostate brachytherapy Transurethral resection of the prostate |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 92:884-893 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2015.02.047 |
| Popis: | Purpose/Objectives To report long-term efficacy and toxicity for a single-institution cohort of patients treated with low-dose-rate prostate brachytherapy permanent implant (PI) monotherapy. Methods and Materials From 1996 to 2007, 1989 patients with low-risk (61.3%), intermediate-risk (29.8%), high-intermediate-risk (4.5%), and high-risk prostate cancer (4.4%) were treated with PI and followed up prospectively in a registry. All patients were treated with 125 I monotherapy to 144 Gy. Late toxicity was coded retrospectively according to a modified Common Terminology Criteria for Adverse Events 4.0 scale. The rates of biochemical relapse-free survival (bRFS), distant metastasis-free survival (DMFS), overall survival (OS), and prostate cancer–specific mortality (PCSM) were calculated. We identified factors associated with late grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity, bRFS, DMFS, OS, PCSM, and incontinence. Results The median age of the patients was 67 years, and the median overall and prostate-specific antigen follow-up times were 6.8 years and 5.8 years, respectively. The overall 5-year rates for bRFS, DMFS, OS, and PCSM were 91.9%, 97.8%, 93.7%, and 0.71%, respectively. The 10-year rates were 81.5%, 91.5%, 76.1%, and 2.5%, respectively. The overall rates of late grade ≥3 GU and GI toxicity were 7.6% and 0.8%, respectively. On multivariable analysis, age and prostate length were significantly associated with increased risk of late grade ≥3 GU toxicity. The risk of incontinence was highly correlated with both pre-PI and post-PI transurethral resection of the prostate. Conclusions Prostate brachytherapy as monotherapy is an effective treatment for low-risk and low-intermediate-risk prostate cancer and appears promising as a treatment for high-intermediate-risk and high-risk prostate cancer. Significant long-term toxicities are rare when brachytherapy is performed as monotherapy. |
| Databáze: | OpenAIRE |
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