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

Abstract

PurposeTo perform a comparative study of 500 consecutive 125I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning.Material and methodsFrom 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%.ResultsMedian 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.ConclusionsThe outcome of patients with low risk prostate carcinoma treated with 125I 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.

Prostate brachytherapy in Ghana: our initial experience

“…Biochemical failure is often used as a reliable marker for treatment efficacy and prostate cancer survival. Several studies have shown that the primary pre-treatment factors associated with PSA control are pre-treatment PSA, the Gleason score, and the clinical stage [4, 5, 21]. This makes PSA control comparisons across single-institution series problematic because case selection will have a significant impact on the outcome of treatment.…”

“…Many reports with long term follow-ups are now available, which confirm good outcomes in selected patients with prostate specific antigen (PSA), relapse-free survival rates equivalent to those achieved by surgery [2, 3]. However, the excellent results achieved with both low and high dose rate brachytherapy mostly come from single institutions in developed countries with significant experience in prostate brachytherapy [4, 5]. Setting up of a prostate brachytherapy service requires expensive equipment [6] and well trained personnel; therefore not surprisingly there have been relatively few reports from Africa [7].…”

Plan reproducibility of intraoperatively custom-built linked seeds compared to loose seeds for prostate brachytherapy

“…With this approach, the user can create intraoperatively built custom linked seeds, using a combination of seeds, connectors, and spacers. The advantages of linked seeds include intraoperative customization, less migration, and increased stabilization due to linking, indicating the benefits of loose plus stranded seeds [ 18 ].…”

Y-configured metallic stent combined with 125 I seed strands cavity brachytherapy for a patient with type IV Klatskin tumor

“…Firstly, the seeds can deliver a high radiation dose to the target tissues that drops rapidly with the distance from the seeds, thereby resulting in low radiation doses to the surrounding tissues. As a result, the use of 125 I seeds enables the delivery of a high radiation dose to tumor tissues while minimizing injury to normal tissues, which requires less shield [ 9 ]. For example, cumulative absorbed dose at the 5 mm from the source axis was 97.2 Gy and it dropped rapidly to 28.8 Gy at the 10 mm from the source axis in this patient.…”