Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Abstract

OBJECTIVE:\ud Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.\ud METHODS:\ud Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.\ud RESULTS:\ud Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.\ud CONCLUSION:\ud This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.\ud ADVANCES IN KNOWLEDGE:\ud Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

“…The use of interventional radiotherapy (BT) has increased in the last decades, most probably due to technical improvements, allowing to deliver higher doses to the target while reducing dose and volume of organs at risk [ 9 ]. Moreover, BT in Italy has been increasingly based on a multidisciplinary approach, with a growing number of high-quality publications of excellent treatment results [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. These innovations, in the context of a rapid diffusion of 3D planning, with an increased use of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and ultrasound, favored the diffusion of image-guided brachytherapy (IGBT) [ 32 ] with related clinical benefits.…”

Treatment paths for localised prostate cancer in Italy: The results of a multidisciplinary, observational, prospective study (Pros-IT CNR)

“…However, the number of patients participating in the Pros-IT CNR study who were prescribed this therapy was very small (1%) and reflects its scarce diffusion at this moment in Italy. A recently published article, based on data from a large multicenter Italian database, has confirmed the safety and efficacy of prostate BT [42]. Despite the many advantages of BT (shorter duration, good results and cost effectiveness), the explanation for its limited diffusion may be found in the scarcity of adequately trained radiation oncologists also due to a relatively long learning curve [43].…”

Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group

“…Analyzing the international scenario in terms of cultural background, it becomes clear that there is an adequate attention and consideration towards BT, supported by the presence of dedicated guidelines, with regard to several anatomical sites issued by the main European [16,17,18,19,20,21,22,23,24,25] and American societies [26,27,28]. For this reason, it is sensible to correlate the cultural diffusion of the role and importance of BT at a national level, with its actual diffusion in the clinical practice [29,30,31,32,33,34,35,36,37,38]. In our view, scientific national associations are called to a difficult, but at the same time, fundamental role in supporting and fostering the process of re-discovery of BT through a proper and dedicated vision.…”