Comparison of the 5-Year Outcome and Morbidity of Three-Dimensional Conformal Radiotherapy Versus Transperineal Permanent Iodine-125 Implantation for Early-Stage Prostatic Cancer

Zeléfsky, Michael J.; Wallner, Kent E.; Ling, C. Clifton; Raben, Adam; Hollister, Timothy; Wolfe, Theresa; Grann, Alison; Gaudin, Paul B.; Fuks, Zvi; Leibel, Steven A.

doi:10.1200/jco.1999.17.2.517

Cited by 282 publications

(24 citation statements)

References 20 publications

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“…In general, the incidence of persistent grade 1 symptoms (>90 days after RT) is reported to be 20–43% with a follow-up of up to 10 years [16–19]. The incidence of late grade 2 AEs is reported to be 7–19% [16–18].…”

Section: Radiation Therapy and Prostate Cancermentioning

confidence: 99%

Long-term urinary adverse effects of pelvic radiotherapy

Elliott

Malaeb

2010

World J Urol

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Objective Radiation for tumors arising in the pelvis has been utilized for over a 100 years. Adverse effects (AEs) of radiotherapy (RT) continue to accumulate with time and are reported to show decades after treatment. The benefit of RT for pelvic tumors is well described as is their acute AEs. Late AEs are less well described. The burden of treatment for the late AEs is large given the high utilization of RT. Review For prostate cancer, 37% of patients will receive radiation during the first 6 months after diagnosis. Low-and high-grade AEs are reported to occur in 20–43 and 5–13%, respectively, with a median follow-up of ∼60 months. For bladder cancer, the grade 2 and grade 3 late AEs occur in 18–27 and 6–17% with a median follow-up of 29–76 months. For cervical cancer, the risk of low-grade AEs following radiation can be as high as 28%. High-grade AEs occur in about 8% at 3 years and 14.4% at 20 years or ∼0.34% per year. Radiation AEs appear to be less common or at least less well studied after radiation for rectal and endometrial cancers. Conclusion Properly delineating the rate of long-term AEs after pelvic RT is instrumental to counseling patients about their options for cancer treatment. Further studies are needed that are powered to specifically evaluate long-term AEs.

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Section: Radiation Therapy and Prostate Cancermentioning

confidence: 99%

Long-term urinary adverse effects of pelvic radiotherapy

Elliott

Malaeb

2010

World J Urol

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“…Incidence of urethral strictures as per the CaPSURE database post radiotherapy is estimated between 1.7–5.2% at median follow up of 2.7 years, depending upon treatment type, with a higher risk with combination therapy [brachytherapy (BT) + external beam radiotherapy (EBRT)] (3). The risk of stricture increases over time, with reported rates as high as 8.5% at 24–36 months (20) and 12% at 5 years (21). The incidence after ERBT is 1.7% (1–13%) for primary ERBT and 3–8.5% in the salvage setting (1,3).…”

Section: Introductionmentioning

confidence: 99%

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Nicholson

Al-Hakeem

Maldonado

et al. 2017

Transl. Androl. Urol.

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The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

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“…Over a decade ago we compared the outcomes of EBRT with low-dose-rate permanent interstitial implantation with I-125 for patients with low-risk prostate cancer 10 . In that report we noted similar biochemical control rates at 5 years for these two treatments, with a higher risk of chronic urinary-related toxicities among patients treated with brachytherapy.…”

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confidence: 99%

Comparison of Tumor Control and Toxicity Outcomes of High-dose Intensity-modulated Radiotherapy and Brachytherapy for Patients With Favorable Risk Prostate Cancer

Zeléfsky

Yamada

Pei

et al. 2011

Urology

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Objectives To compare long-term prostate-specific antigen relapse-free survival outcome and incidence of toxicity for low-risk prostate cancer treated with brachytherapy or intensity-modulated radiotherapy. Methods 729 consecutive patients were treated with BRT (n=448; prescription dose, 144 Gy) and intensity-modulated radiotherapy alone (n=281; prescription dose, 81 Gy). Prostate-specific antigen relapse-free survival using nadir +2 definitions, and late toxicity using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Seven-year prostate-specific antigen relapse-free survival for brachytherapy and intensity-modulated radiotherapy was 95% and 89% for low-risk patients (p=0.004). Cox regression analysis demonstrated that brachytherapy was associated with improved prostate-specific antigen relapse-free survival even when adjusted for other variables. Incidence of metastatic disease between treatments was low for both treatment groups. Late grade 2 gastrointestinal toxicities were observed in 5.1% and 1.4% of the brachytherapy and intensity-modulated radiotherapy groups, respectively (p=0.02). There were no significant differences between treatment groups for late grade ≥3 rectal complications (brachytherapy, 1.1%; intensity-modulated radiotherapy, 0%; p=0.19). Late grade 2 urinary toxicities were more often observed for brachytherapy than intensity-modulated radiotherapy (15.6% and 4.3%, respectively; p<0.0001). There were no significant differences between treatment groups for late grade 3 urinary toxicity (brachytherapy, 2.2%; intensity-modulated radiotherapy, 1.4%; p=0.62). Conclusions Among low risk prostate cancer patients, 7-year biochemical tumor control is superior for intraoperative-planning brachytherapy compared with high-dose intensity-modulated radiotherapy. While significant toxicities were minimal for both groups, modest but significant increases in grade 2 urinary and rectal symptoms were noted for brachytherapy compared with intensity-modulated radiotherapy.

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Comparison of the 5-Year Outcome and Morbidity of Three-Dimensional Conformal Radiotherapy Versus Transperineal Permanent Iodine-125 Implantation for Early-Stage Prostatic Cancer

Cited by 282 publications

References 20 publications

Long-term urinary adverse effects of pelvic radiotherapy

Long-term urinary adverse effects of pelvic radiotherapy

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Comparison of Tumor Control and Toxicity Outcomes of High-dose Intensity-modulated Radiotherapy and Brachytherapy for Patients With Favorable Risk Prostate Cancer

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