Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer

Zeléfsky, Michael J.; Yamada, Yoshiya; Cohen, Gilad; Shippy, Alison M.; Chan, Heather; Fridman, David; Zaider, Marco

doi:10.1016/j.ijrobp.2006.08.030

Cited by 120 publications

(57 citation statements)

References 19 publications

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“…Because institutions with the most experience are likely to have fewer complications, the rate of morbidity from brachytherapy across all institutions may be greater than that published. Likewise, advances in imaging, seed placement, and planning are likely to result in a decrease in the current rate of toxicity compared with older published series (25).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Eade

Horwitz

Ruth

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To compare the toxicity and biochemical outcomes of intensity-modulated radiation therapy (IMRT) and 125 I transperineal permanent prostate seed implant ( 125 I) for patients with lowrisk prostate cancer.Methods and Materials-Between 1998 and 2004, a total of 374 low-risk patients (prostatespecific antigen < 10 ng/ml, T1c-T2b, Gleason score of 6 or less, and no neoadjuvant hormones) were treated at Fox Chase Cancer Center (216 IMRT and 158 125 I patients). Median follow-up was 43 months for IMRT and 48 months for 125 I. The IMRT prescription dose ranged from 74-78 Gy, and 125 I prescription was 145 Gy. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was recorded by using a modified Radiation Therapy Oncology Group scale. Freedom from biochemical failure was defined by using the Phoenix definition (prostate-specific antigen nadir + 2.0 ng/ml).Results-Patients treated by using IMRT were more likely to be older and have a higher baseline American Urological Association symptom index score, history of previous transurethral resection of the prostate, and larger prostate volumes. On multivariate analysis, IMRT was an independent predictor of lower acute and late Grade 2 or higher GU toxicity and late Grade 2 or higher GI toxicity. Three-year actuarial estimates of late Grade 2 or higher toxicity were 2.4% for GI and 3.5% for GU by using IMRT compared with 7.7% for GI and 19.2% for GU for 125 I, respectively. Four-year actuarial estimates of freedom from biochemical failure were 99.5% for IMRT and 93.5% for 125 I (p = 0.09).Conclusions-The IMRT and 125 I produce similar outcomes, although IMRT appears to have less acute and late toxicity.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Eade

Horwitz

Ruth

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…12,13 Many studies define chronic radiation proctitis as persistent or new-onset rectal symptoms that occur from 6 months to 1 year after radioactive seed implantation. [14][15][16][17] The common symptoms of chronic radiation proctitis are rectal urgency, incontinence, pain, strictures, mucous discharge, and rectal bleeding. Rarely, rectal fistula or perforation can occur, necessitating surgical intervention.…”

Section: Clinical Manifestations Of Chronic Radiation Proctitismentioning

confidence: 99%

“…In more contemporary series, the rates of rectal fistula have been between 0% and 1%. 15,[37][38][39] The lower rates most likely are because of both technical improvements and a better understanding by nonbrachytherapists in managing postimplantation rectal bleeding. Improvements in brachytherapy techniques also have lowered nonlife-threatening but more common FIGURE 2.…”

Section: Incidence Of Late Rectal Complicationsmentioning

confidence: 99%

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Late rectal complications after prostate brachytherapy for localized prostate cancer

Phan¹,

Swanson²,

Levy³

et al. 2009

Cancer

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This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Prostate cancer is the leading cause of cancer in men and accounts for approximately 33% of cancer deaths among men in the US.1,2 Management options for organ-confined, low-to intermediate-risk prostate cancer include watchful waiting, radical prostatectomy, external-beam radiation therapy, and prostate brachytherapy with permanent interstitial implants. Recent improvements in radioactive seed implantation techniques have established prostate brachytherapy as a highly effective treatment modality for localized prostate cancer, with long-term local and biochemical control similar to outcomes observed after radical prostatectomy and external-beam radiation therapy. 3,4 Because prostate cancer is diagnosed

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“…The main limitation of contemporary brachytherapy is faulty seed placement that may result in insufficient dose to the cancer and/or inadvertent radiation to the rectum, urethra, and bladder. Intra-operative implant optimization promises a major clinical breakthrough, but for this technique to succeed the implanted seeds must be reconstructed and registered with the anatomy [1]. This work concentrates on the first problem, reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Prostate Implant Reconstruction with Discrete Tomography

Liu

Jain

Fichtinger

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2007

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Abstract. We developed a discrete tomography method for prostate implant reconstructions using only a limited number of X-ray projection images. A 3D voxel volume is reconstructed by back-projection and using distance maps generated from the projection images. The true seed locations are extracted from the voxel volume while false positive seeds are eliminated using a novel optimal geometry coverage model. The attractive feature of our method is that it does not require exact seed segmentation of the X-ray images and it yields near 100% correct reconstruction from only six images with an average reconstruction accuracy of 0.86 mm (std=0.46mm).

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Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer

Cited by 120 publications

References 19 publications

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Late rectal complications after prostate brachytherapy for localized prostate cancer

Prostate Implant Reconstruction with Discrete Tomography

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