Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan

Abstract

The aim of this study was to determine the outcomes and adverse events for 300 men with prostate cancer treated with 125iodine (125I) brachytherapy with and without external-beam radiation therapy (EBRT) at a single institution in Japan. Between February 2005 and November 2011, 300 consecutive patients with clinically localized prostate cancer were treated with 125I brachytherapy at the Nagoya University Hospital. A total of 271 men were treated with implants with doses of 145 Gy, and 29 men were treated with implants with doses of 110 Gy combined with EBRT (40–50 Gy/20–25 fractions). The median patient age was 69 years (range, 53–83 years). The median follow-up period was 53 months (range, 5–99 months). According to the National Comprehensive Cancer Network risk classification, 132 men (44%) had low-risk, 147 men (29%) had intermediate-risk and 21 men (7%) had high-risk disease. The 5-year overall survival rate, biochemical relapse–free survival rate, and disease-specific survival rates were 93.5%, 97.3% and 98.5%, respectively. Two men (0.6%) died of prostate cancer and 10 men (3.3%) died of other causes. Seventeen men (5.6%) experienced Grade 2 rectal bleeding in all: 12 (41.4%) of 29 in brachytherapy with EBRT, and 5 (1.8%) of 271 in brachytherapy alone. The rates of Grade 2 and 3 genitourinary toxicity were 1.0% and 1.7%, respectively. Excellent local control was achieved at our hospital for localized prostate cancer with 125I brachytherapy with and without EBRT. Gastrointestinal and genitourinary toxicities were acceptable.

Comparison of chronic gastrointestinal and genitourinary toxicities between brachytherapy and external beam radiotherapy for patients with prostate cancer: A systematic review and meta-analysis

“…Finally, 15 studies were included in the meta-analysis (Fig. 1 ): four prospective cohort studies and 11 retrospective cohort studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…A meta-analysis of 11 studies [ 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 ] revealed that the RR of late GI toxic complications from LDR-BT was significantly lower than that from LDR-BT EBRT (3.96; 95% CI, 1.23–12.70; 0.02) (Fig. 2 b).…”

Efficacy and safety of CT‑guided 125I brachytherapy in elderly patients with non‑small cell lung cancer

“…In addition, SBRT is contraindicated for lesions within 2 cm from the bronchial tree, and a marked prevalence of complications such as pulmonary toxicity and rib toxicity have been reported (24,25). 125 I seed implantation is a minimally invasive treatment for tumors that has been rapidly developed in the past decade and has been listed as a treatment for prostate cancer (26). 125 I seeds are implanted into tumors and continuously generate low-energy gamma-rays to kill tumor cells in a similar manner to multiple hyperfractionated radiotherapy, which can prevent the accelerated repopulation of tumor cells (27,28).…”