Pulmonary Metastases After Low-Dose-Rate Brachytherapy for Localized Prostate Cancer

Abstract

PurposeTo analyze unusual events and focus discussion on pulmonary metastasis in particular after low-dose-rate brachytherapy (LDR-BT) for prostate cancer (PCa).Materials and MethodsA total of 616 consecutive patients who had undergone LDR-BT for clinically localized PCa at Jikei University Hospital between October 2003 and April 2010 were enrolled in this study. Follow-up information was summarized, and patterns of biochemical recurrence and clinical outcome were investigated.ResultsDisease risk was stratified as low-risk in 231 patients, intermediate-risk in 365, and high-risk in 20, respectively. Of these patients, 269 (43.7%) had received hormonal therapy (HT) in combination with LDR-BT, and 80 (13.0%) had received external beam radiotherapy (EBRT). Average dosimetric parameter values with and without EBRT were 95.3% and 94.2% for V100, 132.8 Gy and 164.2 Gy for D90, and 180.6 Gy2 and 173.7 Gy2 for the biologically effective dose. Biochemical recurrence was noted in 14 patients (6.1%) in the low-risk group, 25 patients (6.8%) in the intermediate-risk group, and 6 patients (30.0%) in the high-risk group, respectively. In these cases of biochemical recurrence, 9 (64.3%), 13 (52.0%), and 4 patients (66.7%) in each respective risk group showed signs of clinical recurrence. Five patients (19.2%) with clinical recurrence developed pulmonary metastases, of which 4 were isolated lesions. All tumors responded favorably to subsequent HT.ConclusionsLDR-BT for biologically aggressive PCa may be linked to possible pulmonary metastasis owing to tumor dissemination during seed implantation. This information is important in planning adequate treatment for these patients.

Long‐term outcomes of radical prostatectomy versus low‐dose‐rate brachytherapy in patients with intermediate‐risk prostate cancer: Propensity score matched comparison

“…All four patients had an unfavorable risk profile. Our group had previously suggested the potential for tumor dissemination during seed implantation, especially in unfavorable‐risk patients 20 . Though such tumor dissemination remains a hypothesis and thus inconclusive owing to the small number of cases, physicians should be aware of this possibility.…”

“…These findings might be attributable to the intact prostatic gland in situ after LDR-BT. 20 Though such tumor dissemination remains a hypothesis and thus inconclusive owing to the small number of cases, physicians should be aware of this possibility.…”

Solitary Lung Metastasis of Prostate Cancer with a Long Disease-Free Interval and Normal Prostate-Specific Antigen Level

“…Gleason score ≤5. In addition, physicians should note the fact that radiotherapy including brachytherapy without surgical resection induces more lung metastasis than surgical intervention [10].…”

A comparative study on the efficacies of gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist in neoadjuvant androgen deprivation therapy combined with transperineal prostate brachytherapy for localized prostate cancer

“…The implant is planned to deliver a dose of at least 144 Gy to the clinical target volume, which includes the prostatic gland and treatment margin [ 26 ]. Although individual technical aspects are institution-dependent, efforts are made to assure optimal quality control of the radiation dose based on our over 1,000 cases of experience [ 27 ]. Computed tomography images, taken at 2–5 mm intervals, are obtained 1 month after 125 I-TPPB to determine the extent of edema.…”