The phylogeny of permanent prostate brachytherapy

Aronowitz, Jesse N.; Rivard, Mark J.

doi:10.5114/jcb.2013.35562

Cited by 25 publications

(17 citation statements)

References 34 publications

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“…However, the excellent results achieved with both low and high dose rate brachytherapy mostly come from single institutions in developed countries with significant experience in prostate brachytherapy [4, 5]. Setting up of a prostate brachytherapy service requires expensive equipment [6] and well trained personnel; therefore not surprisingly there have been relatively few reports from Africa [7]. …”

Section: Purposementioning

confidence: 99%

Prostate brachytherapy in Ghana: our initial experience

Mensah¹,

Yarney²,

Vanderpuye³

et al. 2016

jcb

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PurposeThis study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa.Material and methodsA total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN) criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy.ResultsThe median patient age was 64.0 years (range 46-78 years). The median follow-up was 58 months (range 18-74 months). Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA) was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6%) experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2). One patient developed a recto urethral fistula (grade 3) following banding for hemorrhoids.ConclusionsOur results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively performed in a resource challenged environment if adequate training and proctoring is provided.

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Section: Purposementioning

confidence: 99%

Prostate brachytherapy in Ghana: our initial experience

Mensah¹,

Yarney²,

Vanderpuye³

et al. 2016

jcb

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“…Despite favorable long term biochemical control rates in patients treated with permanent prostate brachytherapy, the definition of a technically adequate implant including periprostatic dose distributions remains somewhat unclear [14, 15]. However, data suggests that permanent cancer control is related to intraprostatic radiation dose and periprostatic treatment margins [3–6].…”

Section: Discussionmentioning

confidence: 99%

Permanent prostate brachytherapy extracapsular radiation dose distributions: analysis of a multi-institutional database

Merrick

Butler²,

Grimm³

et al. 2013

jcb

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PurposePeriprostatic brachytherapy doses impact biochemical control. In this study, we evaluate extracapsular volumetric dosimetry following permanent prostate brachytherapy in patients entered in a multi-institutional community database.Material and methodsIn the database, 4547 patients underwent brachytherapy (3094 – 125I, 1437 – 103Pd and 16 – 131Cs). Using the originally determined prostate volume, a 5 mm, 3-dimensional peri-prostatic anulus was constructed around the prostate (except for a 2 mm posterior margin), and evaluated in its entirety and in 90° segments. Prostate dosimetric parameters consisted of a V100 and D90 while the annular dosimetry was reported as a V100.ResultsThe intraprostatic V100 and D90 for 103Pd, and 125I were statistically comparable when stratified by isotope and/or monotherapy vs. boost. The overall mean V100 for the periprostatic annulus was 62.8%. The mean V100 at the base (51.6%) was substantially less than the apex (73.5%) and midgland (65.9%). In addition, for all patients, the anterior V100 (45.7%) was less than the lateral (68.8%) and the posterior (75.0%). The geometric V100 annular differences were consistent when evaluated by isotope. Overall, the V100 was higher in the 125I cohort.ConclusionsThe optimal extracapsular brachytherapy dose and radial extent remains unknown, but will prove increasingly important with reductions and/or elimination of supplemental external beam radiation therapy. The large multi-institutional community database demonstrates periprostatic annular doses that are not as robust as those in selected high volume brachytherapy centers, and may be inadequate for optimal biochemical control following monotherapeutic brachytherapy, especially in higher risk patients.

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“…In conclusion, dose distribution within the prostate can be heterogeneous and standard whole prostate dosimetric parameters based on a prescription dose may not be fully representative of implant quality [30]. Acceptable clinical outcomes can be obtained even when the TZ systematically receives a lower radiation dose than the rest of the prostate to spare the urethra.…”

Section: Discussionmentioning

confidence: 99%