To evaluate the long-term oncological, functional and toxicity outcomes of LDR-BT in relation to risk factors and radiation dose in a prospective multicenter cohort.
Data of patients from 12 Swiss centers undergoing LDR-BT from 09/2004 - 03/2018 were prospectively collected. Patients with a follow-up ≥ 3 months were analyzed. Functional and oncologic outcomes were assessed at approximately 6 weeks, 6 and 12 months post-implantation and annually thereafter. LDR-BT was performed with 125-Iodine seeds. Dosimetry was done 6 weeks after implantation based on the European Society for Radiotherapy and Oncology recommendations. Kaplan-Meier method was used for biochemical recurrence free survival (BRFS). A PSA rise above the PSA nadir + 2 was defined as biochemical failure. Functional outcomes were assessed by urodynamic measurement parameters and questionnaires.
Of 1580 patients in the database, 1291 (81.7%) were evaluable for therapy outcome. Median follow up was 37.1 months (range 3.0 - 141.6). Better BRFS was found for Gleason score ≤ 3+4 (p=0.03, log rank test) and initial PSA level of < 10ng/ml (p<0.001). D'Amico Risk groups were significantly associated with BRFS (p<0.001), with a hazard ratio (HR) of 2.38 for intermediate and high-risk patients vs low risk patients. D90 after 6 weeks was significantly lower in patients with recurrence. Functional outcomes returned close to baseline levels after 2-3 years. A major limitation of these findings is a substantial loss to follow-up.
Our results are in line with other studies showing that LDR-BT is associated with good oncological outcomes together with good functional results.
BJU international. 2020 Jan 21 [Epub ahead of print]
Pascal Viktorin, Paul Martin Putora, Hans-Peter Schmid, Ludwig Plasswilm, Christoph Schwab, Armin Thoeni, Werner Hochreiter, Ladislav Prikler, Stefan Suter, Patrick Stucki, Michael Müntener, Nadja Blick, Hans Schiefer, Sabine Güsewell, Karin Zürn, Daniel Engeler
Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland., Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland., Clinic for Radiation-Oncology, Lindenhof Hospital Berne, Berne, Switzerland., Urology Clinic, Hirslanden Clinic Aarau, Aarau, Switzerland., Urology Clinic, Uroviva Clinic Buelach, Buelach, Switzerland., Urology Clinic Zug, Zug, Switzerland., Urology Clinic, Cantonal Hospital Lucerne, Lucerne, Switzerland., Urology Clinic, Triemli Hospital, Zurich, Switzerland., Clinical Trial Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland.