Long-Term Efficacy and Toxicity of Low-Dose-Rate 125 I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer

Kittel, J. A.; Reddy, Chandana A.; Smith, Kristin L.; Stephans, Kevin L.; Tendulkar, Rahul D.; Ulchaker, James; Angermeier, Kenneth W.; Campbell, Steven; Stephenson, Andrew J.; Klein, Eric A.; Wilkinson, Dominic; Ciezki, Jay P.

doi:10.1016/j.ijrobp.2015.02.047

Cited by 63 publications

(35 citation statements)

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“…Although we had previously reported very low rates of radiation cystitis based on this approach 25 , a subsequent publication with a median 5-year follow-up concluded that this approach did not appear to be adequate for men with intermediate risk disease based on poor biochemical control 16 . Our updated results corroborated these findings, with 10-year estimates of biochemical progression free survival (combined low: 65.4%, intermediate: 28.4%) and modified biochemical progression free survival (combined low: 78.7%, intermediate: 49.7%) that were inferior to long-term rates associated with whole-gland prostate brachytherapy from series with adequate postimplant quality assessment 2–5 . In fact, the reported biochemical control rates from these series were more comparable with our reported 10-year rates of biopsy-proven local recurrences (combined low: 11.0%, intermediate: 22.5%).…”

Section: Discussionsupporting

confidence: 80%

“…Although the 10-year rates of metastasis for combined low (2.1%) and intermediate (8.2%) risk disease were comparable to respective rates of 5.4% (low) and 12% (low-intermediate) from a recent whole-gland brachytherapy monotherapy series with or without ADT by Kittel et al 5 , our 12-year metastasis rates (low: 4.6%, intermediate: 15.7%) were inferior to respective rates (2% and 5%) from another institutional series by Marshall et al 4 . In this series, low risk patients were treated with brachytherapy monotherapy, and intermediate risk patients were treated with ADT plus brachytherapy with or without EBRT.…”

Section: Discussionmentioning

confidence: 57%

“…1 Brachytherapy monotherapy can yield excellent outcomes for patients with National Comprehensive Cancer Network (NCCN) lowrisk, intermediate-risk, and even high-risk disease. [2][3][4][5][6] NCCN guidelines include brachytherapy as monotherapy for patients with low-risk and low-volume intermediate-risk disease. Furthermore, brachytherapy is included as an optional boost after external beam radiotherapy (EBRT) for patients with intermediate-risk and high-risk disease.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of partial prostate treatment with magnetic resonance imaging‐guided brachytherapy for patients with favorable‐risk prostate cancer

King

Nguyen

Boldbaatar

et al. 2018

Cancer

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of partial prostate treatment with magnetic resonance imaging‐guided brachytherapy for patients with favorable‐risk prostate cancer

King

Nguyen

Boldbaatar

et al. 2018

Cancer

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“…The fact that they did have similar outcomes to patients with lower risk or fewer risk factors may indicate overall ADT benefit. It has been reported that patients with unfavourable IR and favourable HR have relatively poor outcomes with PB alone (69,99,124), however, some have speculated that with high quality brachytherapy with sufficient margins, this difference may be less significant (123). …”

Section: Discussionmentioning

confidence: 99%

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

et al. 2017

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Introduction Prostate Brachytherapy (PB) has well-documented excellent long-term outcomes in all risk groups. There are significant uncertainties regarding the role of Androgen Deprivation Therapy (ADT) with brachytherapy. The purpose of this report is to review systemically the published literature and summarize present knowledge regarding the impact of ADT on Biochemical Progression Free Survival (bPFS), Cause Specific Survival (CSS) and Overall Survival (OS). Material and Methods A literature search was conducted in Medline and Embase covering the years 1996-2016. Selected were articles with >100 patients, minimum follow-up 3 years, defined risk stratification and directly examining the role and impact of ADT on bPFS, CSS and OS. The studies were grouped to reflect disease risk stratification. We also reviewed the impact of ADT on OS, cardiovascular morbidity, mortality, and ongoing brachytherapy Randomized Controlled Trials (RCTs). Results 52 selected studies (43,303 patients) were included in this review; 7 HDR (High Dose Rate), and 45 LDR (Low Dose Rate). Twenty-five studies were multi-institutional and 27 single institution, (retrospective review or prospective data collection) and two were RCTs. The studies were heterogeneous in patient population, risk categories, risk factors, follow-up time, and treatment administered, including ADT administration and duration (median 3-12 months). Seventy one percent of the studies reported a lack of benefit, while 28% show improvement in bPFS with addition of ADT to PB. The lack of benefit was seen in LR and favourable IR disease, as well as the majority of HDR studies. A bPFS benefit of up to 15% was seen with ADT use in: patients with suboptimal dosimetry, those with multiple adverse risk factors (unfavourable IR) and most HR studies. Four studies reported very small benefit to CSS (2%). None of the studies showed OS advantage, however 3 studies reported an absolute 5-20% OS detriment with ADT. Literature suggests OS detriment is more likely in older patients or those with pre-existing cardiovascular disease (CVD). Four RCTs with an adequate number of patients and well defined risk stratification are in progress. One RTC will answer the question regarding the role of ADT with PB in favourable IR patients, and the other 3 RTCs will focus on optimal duration of ADT in the unfavourable IR and favourable HR population. Conclusions Patients treated with brachytherapy have excellent long-term disease outcomes. Existing evidence shows no benefit of adding ADT to PB in LR and favourable IR patients. Unfavourable IR, HR patients and those with suboptimal dosimetry may have up to 15% improvement in bPFS with addition of 3-12 months of ADT, with uncertain impact on CSS and a potential detriment on OS. In order to minimize morbidity one should exercise caution in prescribing ADT together with PB, in particular to older men and those with existing CVD. Due to the retrospective nature of this evidence, significant selection and treatment bias, no definitive conclusions a...

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“…Lower urinary tract symptoms (LUTS) are major complications for men following PBT (5)(6)(7)(8)(9)(10). For some patients, International Prostate Symptom Scores (IPSS) quickly return to pretreatment levels, while others require more time.…”

mentioning

confidence: 99%

Predictive Factors for Prolonged Urination Disorder After Permanent 125I Brachytherapy for Localized Prostate Cancer

Mori

Fukumori

Daizumoto

et al. 2017

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The use of permanent radioactive implants to treat clinicallylocalized prostate cancer patients has been increasing rapidly all over the world for the past 20 years. In Japan, prostate brachytherapy (PBT) became an insurance adaptation in 2003 and has become one of the most common treatments for clinically-localized prostate cancer (1) National Comprehensive Cancer Network Clinical Practice Guidelines recommend PBT not only for low-and intermediate-risk groups but also for high-and very high-risk groups in combination with androgen deprivation therapy (ADT) and external beam radiotherapy (EBRT) (2). It is reported that high-dose radiotherapy using low-dose-rate PBT in combination with EBRT and short-term ADT has shown excellent outcomes in high-risk and very highrisk cancer (3, 4).PBT can cause some adverse events. Lower urinary tract symptoms (LUTS) are major complications for men following PBT (5-10). For some patients, International Prostate Symptom Scores (IPSS) quickly return to pretreatment levels, while others require more time. We assessed the change in LUTS after brachytherapy to reveal predictive factors for prolonged urination disorder.To our knowledge, no study has analyzed predictive factors using time-dependent multivariate analysis. Patients and MethodsPatient characteristics. Between July 2004 and December 2014, 404 patients received low-dose-rate PBT at Tokushima University Hospital in Japan and were followed-up for at least 2 years. Clinical characteristics of patients are shown in Table I.Brachytherapy procedure. Pre-planning involved analyzing the prostate in detail by transrectal ultrasonography about 4 weeks before brachytherapy to calculate prostate volume (PV) and plan seed implantation. Brachytherapy was performed using ultrasoundguided, transperineal prostate implantation planned using Interplant software (CMS, St. Louis, MO, USA). For post-planning, about 4 weeks after seed implantation, computed tomography, and radiography of the chest kidneys, ureters, and bladder were performed to calculate the radiation dose to 90% of the prostate volume (D90) and to evaluate seed migration in all patients.Follow-up. All patients were asked to return at 1, 3, and 6 months after seed implantation, and every 6 months thereafter. Patient IPSS was assessed at each visit. PV was measured every 12 months using 755

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Long-Term Efficacy and Toxicity of Low-Dose-Rate 125 I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer

Cited by 63 publications

References 40 publications

Long‐term outcomes of partial prostate treatment with magnetic resonance imaging‐guided brachytherapy for patients with favorable‐risk prostate cancer

Long‐term outcomes of partial prostate treatment with magnetic resonance imaging‐guided brachytherapy for patients with favorable‐risk prostate cancer

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

Predictive Factors for Prolonged Urination Disorder After Permanent 125I Brachytherapy for Localized Prostate Cancer

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