Based on classical clinicopathological factors as well as on some new biological parameters we have been able to identify subgroups of mastectomized patients with LR differing in their prognosis. Thus, at the present time it would be possible to select group of patients candidates for further and individualized therapeutic strategies.
Study Type – Therapy (case series) Level of Evidence 4
OBJECTIVE
To report our analysis of the oncological outcome, side‐effects and complications after 125I‐brachytherapy, based on 10 years of experience, as low dose‐rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer.
PATIENTS AND METHODS
Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow‐up of ≥30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3–4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the ‘Phoenix consensus’.
RESULTS
The median follow‐up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10‐year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low‐, intermediate‐ and high‐risk groups. Multivariate Cox regression analyses identified Gleason score and prostate‐specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of ≤6, 7 and >7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of ≤10, 10.1–20 and >20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy.
CONCLUSIONS
The excellent long‐term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ‐confined prostate cancer.
Resumen.-OBJETIVO: La braquiterapia prostática con implantes permanentes de semillas de I 125 ó 103Pd es una opción terapéutica en el tratamiento del cáncer prostático organoconfinado. Analizamos los resultados preliminares y las complicaciones a cinco años en el grupo de pacientes tratados con braquiterapia de baja tasa (I 125 ) como tratamiento único de intención curativa y evaluamos las diferencias existentes con el tratamiento estándar (cirugía). MÉTODOS: Sobre una casuística que supera los 400 pacientes tratados con braquiterapia como monoterapia y con intención curativa radical por adenocarcinoma de próstata organoconfinado, hemos excluido el grupo de pacientes con un seguimiento menor a 12 meses para el análisis estadístico de resultados y com- (12-68 m). Se consideró fallo bioquí-mico cuando los pacientes cumplieron los criterios marcados por la ASTRO. El análisis estadístico de supervivencia se realizó con el paquete estadístico SPSS y el método de Kaplan-Meyer. Las complicaciones urinarias y digestivas fueron evaluadas de acuerdo con los criterios de la RTOG RESULTADOS: La edad media del grupo fue de 68 años con un rango (49-83 años). El 93% de los pacientes presentaron un estadio clínico ≤ T2a y un 7% de estadios T2b con PSA ≤ 10 ng/ml en el 68% de los casos. El Gleason fue ≤ 6 en el 94% de los casos. Un 9% de los casos tratados presentaban un volumen prostático >50cc. la supervivencia global a los 5 años es del 96%, con una supervivencia libre de enfermedad de 97% y una con una supervivencia libre de fallo bioquímico del 99% al mismo tiempo. Las complicaciones de las diferentes series incluida la nuestra están recogidas en la Figura3 y Tablas II-VI. CONCLUSIÓN: Las múltiples series publicadas en la literatura parecen poner de manifiesto los mismos resultados de control bioquímico de la enfermedad cuando se compara la cirugía con la braquiterapia de baja tasa en enfermedad organoconfinada. La braquiterapia presenta frente a la cirugía la ventaja de tener menor porcentaje de complicaciones en el postoperatorio inmediato, menor índice de incontinencias y una preservación de la función eréctil en mayor número de pacientes.
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