A NEW MODEL USING NUMBER OF NEEDLES AND ANDROGEN DEPRIVATION TO PREDICT CHRONIC URINARY TOXICITY FOR HIGH OR LOW DOSE RATE PROSTATE BRACHYTHERAPY
2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 3 Linguagem: Inglês
10.1097/01.ju.0000169136.55891.21
ISSN1527-3792
AutoresCarlos Vargas, Michel Ghilezan, Mitchell Hollander, Gary Gustafson, Howard Korman, Jose A. Gonzalez, Alvaro A. Martinez,
Tópico(s)Advanced Radiotherapy Techniques
ResumoNo AccessJournal of UrologyAdult Urology: Oncology: Prostate/Testis/Penis/Urethra1 Sep 2005A NEW MODEL USING NUMBER OF NEEDLES AND ANDROGEN DEPRIVATION TO PREDICT CHRONIC URINARY TOXICITY FOR HIGH OR LOW DOSE RATE PROSTATE BRACHYTHERAPY CARLOS VARGAS, MICHEL GHILEZAN, MITCHELL HOLLANDER, GARY GUSTAFSON, HOWARD KORMAN, JOSE GONZALEZ, and ALVARO MARTINEZ CARLOS VARGASCARLOS VARGAS , MICHEL GHILEZANMICHEL GHILEZAN , MITCHELL HOLLANDERMITCHELL HOLLANDER , GARY GUSTAFSONGARY GUSTAFSON , HOWARD KORMANHOWARD KORMAN , JOSE GONZALEZJOSE GONZALEZ , and ALVARO MARTINEZALVARO MARTINEZ View All Author Informationhttps://doi.org/10.1097/01.ju.0000169136.55891.21AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prostate brachytherapy is an established treatment modality in early stage prostate cancer. We retrospectively reviewed our experience with low dose rate (LDR) and high dose rate (HDR) brachytherapy as a single treatment modality for early prostate cancer with emphasis on chronic toxicity. Materials and Methods: From June 1996 to August 2003, 253 patients with stage II prostate cancer, prostate specific antigen less than 12 and Gleason score less than 7 were treated with brachytherapy alone at our institution. A total of 92 patients underwent HDR brachytherapy with 192Ir, while 161 underwent LDR brachytherapy with 103Pd. HDR minimum prostate dose was 38 Gy, delivered in 4 fractions with a single implant during 36 hours. For HDR we used real-time dynamic 3-dimensional ultrasound base dosimetry. For 103Pd seed implants the dose was 120 Gy using selective peripheral weighted dose distribution. Treatment was given based on patient preference after pretreatment transrectal ultrasound. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria 2.0. Median followup in all 253 cases was 2.9 years. Results: In all patients the rate of 3-year urinary toxicity grade 2 or greater and grade 3 or greater was 26% and 6.9%, which was not significantly different between HDR and LDR (p = 0.3 and 0.4, respectively). However, grade 1 urogenital toxicity was lower for HDR (p = 0.002). The 3-year grade 2 rectal toxicity rate was 0.8% with no grade 3 or greater events, which was and similar in the HDR and LDR groups (1% and 0.6%, respectively). No cancer related deaths occurred and 4-year overall survival was 99% for HDR and 96.4% for LDR (p = 0.4). The 3-year American Society for Therapeutic Radiology and Oncology biochemical control rate was 90% for LDR and 93% for HDR. Cox multivariate analysis for grade 2 or greater urinary toxicity was significant for the use of 14 or greater needles (HR 6.1, p = 0.02) and hormonal therapy (HR 2.2, p = 0.02). In the absence of risk factors the 4-year grade 2 or greater urinary toxicity rate was 7% vs 65% if the 2 risk factors were present (p <0.001). Impotence crude rates were 18.3% for HDR and 41.3% for LDR (p = 0.002). Conclusions: HDR and LDR chronic urinary toxicity grade 2 or greater rates were equivalent. However, grade 1 was lower for HDR. The impotence rate was decrease by half with HDR. Neoadjuvant hormonal therapy and 14 or greater needles were significantly associated with increased chronic urinary toxicity on multivariate analysis. References 1 : Radical prostatectomy, external beam radiotherapy < 72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Radiat Oncol Biol Phys2004; 58: 25. Google Scholar 2 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Crossref, Medline, Google Scholar 3 : Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys2000; 47: 1261. Google Scholar 4 : What is the optimal dose for 125I prostate implants? A dose-response analysis of biochemical control, posttreatment prostate biopsies, and long-term urinary symptoms. Brachytherapy2002; 1: 83. Google Scholar 5 : Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys2000; 46: 839. Google Scholar 6 : Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys2001; 49: 61. Google Scholar 7 : High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys2000; 48: 675. Google Scholar 8 : Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys2002; 52: 6. Google Scholar 9 Ghilezan M., Vargas C., Gustafson G., Kestin L., Chen P., Brabbins D., et al. Erectile dysfunction (ED) after prostate cancer brachytherapy as sole treatment modality. The William Beaumont Hospital's experience with HDR vs. LDR (Pd103 permanent implants). Presented at Joint Brachytherapy Meeting GEC/ESTRO-ABS-GLAC, Barcelona, Spain, 2004 Google Scholar 10 : Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA2000; 283: 354. Crossref, Medline, Google Scholar 11 : Importance of post-implant dosimetry in permanent prostate brachytherapy. Eur Urol2002; 41: 434. Google Scholar 12 : Improved conformality and decreased toxicity with intraoperative computer-optimized transperineal ultrasound-guided prostate brachytherapy. Int J Radiat Oncol Biol Phys2003; 55: 956. Google Scholar 13 : Real-time optimized intraoperative dosimetry for prostate brachytherapy: a pilot study. Int J Radiat Oncol Biol Phys2000; 48: 1583. Google Scholar 14 : Prostate gland motion and deformation caused by needle placement during brachytherapy. Brachytherapy2002; 1: 154. Google Scholar 15 : 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study. Strahlenther Onkol2004; 180: 225. Google Scholar 16 : Factors predicting for postimplantation urinary retention after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys2000; 48: 1457. Google Scholar 17 : The impact of prostate volume following neoadjuvant androgen deprivation on quality of life and voiding symptoms in patients undergoing permanent prostate brachytherapy. Eur Urol2003; 43: 467. Google Scholar 18 : The robustness of dose distributions to displacement and migration of 125I permanent seed implants over a wide range of seed number, activity, and designs. Int J Radiat Oncol Biol Phys2004; 58: 1298. Google Scholar 19 : Prostate volume reduction with androgen deprivation therapy before interstitial brachytherapy. J Urol2002; 167: 2443. Link, Google Scholar 20 : Identification of patients at increased risk for prolonged urinary retention following radioactive seed implantation of the prostate. J Urol1998; 160: 1379. Link, Google Scholar 21 : The effect of hormonal manipulation on urinary function following permanent prostate brachytherapy. Brachytherapy2004; 3: 22. Google Scholar From the Departments of Radiation Oncology and Urology (MH, HK, JG), William Beaumont Hospital, Royal Oak, Michigan© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 3September 2005Page: 882-887 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsbrachytherapyadverse effectsprostatic neoplasmsprostateMetricsAuthor Information CARLOS VARGAS More articles by this author MICHEL GHILEZAN More articles by this author MITCHELL HOLLANDER More articles by this author GARY GUSTAFSON More articles by this author HOWARD KORMAN More articles by this author JOSE GONZALEZ More articles by this author ALVARO MARTINEZ More articles by this author Expand All Advertisement PDF downloadLoading ...
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