Five-year effectiveness of low-dose-rate brachytherapy: comparisons with nomogram predictions in patients with non-metastatic prostate cancer presenting significant control of intra- and periprostatic disease

Abstract

PurposeTo assess the effectiveness of low-dose-rate (LDR) brachytherapy in patients with localized prostate cancer and to compare the outcome with predictions from Kattan and Partin nomograms at 60 months after seed implantation.Material and methodsOne thousand, one hundred and eighty-seven patients with localized prostate cancer at low-, intermediate-, or high-risk of progression received LDR brachytherapy using iodine-125 seeds with curative intent, applied as monotherapy or in combination with external beam radiation therapy (EBRT), and/or androgen deprivation therapy (ADT). At 60 months after seed implantation, data of 1,064 patients (1,058 alive + 6 who died of prostate cancer) were analyzed for biochemical progression-free survival (bPFS) based on prostate-specific antigen (PSA) levels using the Phoenix definition. Five-year bPFS probabilities were determined for various risk group classifications (d’Amico, Mt. Sinai, MSKCC/Seattle, NCCN). Outcomes were also compared to patient-individualized nomogram predictions of 5-year bPFS (Kattan 2002) and probability of organ-confined disease (Kattan 2002, Partin 2007).ResultsOverall, 93.3% (993/1,064) of the patients were free of biochemical progression within 5 years, while the average 5-year bPFS probability according to the Kattan nomogram was significantly lower (85%, p < 0.001). Outcomes were significantly better than Kattan nomogram predictions in the subgroup of patients with monotherapy as well as in patients additionally treated with EBRT. Comparison of the overall outcome with nomogram predictions for organ-confined disease (Kattan nomogram: 50%; Partin nomogram: 65%) revealed a significant probability of LDR brachytherapy to destroy periprostatic tumor spread (p < 0.001) in all risk group constellations, even in high-risk patients.ConclusionsThe results indicate high effectiveness of LDR brachytherapy in all risk groups, significantly better than predicted with the Kattan nomogram in most subgroups. The significant superiority of LDR brachytherapy compared to nomogram predictions of organ-confined disease suggests that LDR brachytherapy effectively controls both intra- and periprostatic disease.

Acute and late toxicities in localized prostate cancer patients treated with low-dose 125I brachytherapy (110 Gy) in combination with external beam radiation therapy versus brachytherapy alone (160 Gy)

“…There have been several reports to compare the treatment outcomes and GU or GI toxicities [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, they included a variety of LDR-BT modalities or sources, or different prescribed doses such as mixed 125 I and 103 Pb [ 8 , 15 , 16 ].…”

“…Higher dose can deliver to prostate with lower exposure to organs at risks; 2. The treatment time became remarkably shorter than EBRT because usually the insertion was completed within one day [ 14 , 19 , 27 ]. In comparison with EBRT, LDR-BT can deliver a higher dose with lower exposure to organs at risk.…”

A survivin-driven tumour-activatable minicircle system for prostate cancer theranostics

“…Once patients with aggressive, high-risk PCa have been identified, therapeutic MCs may be used sequentially for tumour therapy and these MCs could even be delivered intraprostatically during a standard 12-core biopsy. Therapeutic MCs would act as an intermediate treatment post-diagnosis to prevent cancer spreading prior to patients receiving more radical procedures such as prostatectomy or brachytherapy, as these procedures are considerably more effective for early-stage disease [44]. A dual-MC theranostic system allows for separate administration of MCs pre-and post-diagnosis to match their clinical usage, whereas the same would not be possible for an all-in-one theranostic MC as both genes would be administered together.…”

Biochemical outcomes and predictive factors by risk group after permanent iodine-125 seed implantation: Prospective cohort study in 2,316 patients

“…The 5-year bFFF or bRFS rates using the Phoenix definition were reported to be 92. (12,16,18,19,(24)(25)(26)(27)(28)(29), respectively. In our study, for the low-risk patients, 98.35% of the patients were treated with PI monotherapy and 39.40% of the patients received HT, and their 5-year bFFF rate was 94.9%.…”

“…The rate of high-risk patients who received HT was 80.45% in our study. Zimmermann et al reported that the rate of high-risk patients who received HT was 60.4%, and their 5-year bFFF rate was 79.2% in high-risk patients (12). Ohashi et al reported that the rate of high-risk patients who received HT was 49.0%, and their 5-year bFFF rate was 84.8% in high-risk patients (27).…”