To perform a comparative study of 500 consecutive (125)I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning.
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From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system.
Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7. 3 and 7. 2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%.
Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90. 2% to 97. 2% (low risk from 91. 3% to 97. 2%, intermediate risk from 84. 2% to 97. 1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1. 2% and 5. 2%, respectively. A urinary catheter was necessary in 6. 9% and 9. 6%, and urethral resection in 1. 9% and 4. 4%. Genitourinary toxicity was G1-2 in 4. 6% and 12%, G3-4 in 1. 9% and 4. 8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy.
The outcome of patients with low risk prostate carcinoma treated with (125)I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.
Journal of contemporary brachytherapy. 2015 Aug 18 [Epub]
Jose Luis Guinot, Jose Vicente Ricós, Maria Isabel Tortajada, Miguel Angel Santos, Juan Casanova, Jose Clemente, Josefa Samper, Paula Santamaría, Leoncio Arribas
Department of Radiation Oncology. , Department of Urology, Fundacion Instituto Valenciano de Oncologia (I. V. O. ), Valencia, Spain. , Department of Radiation Oncology. , Department of Radiation Oncology. , Department of Urology, Fundacion Instituto Valenciano de Oncologia (I. V. O. ), Valencia, Spain. , Department of Radiation Oncology. , Department of Radiation Oncology. , Department of Radiation Oncology. , Department of Radiation Oncology.