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:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.

ADVANCES IN KNOWLEDGE:

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.

• Authors: Giovanni Fellin, Maria A Mirri, Luigi Santoro, Barbara A Jereczek-Fossa, Claudio Divan, Salvatore Mussari, Francesco Ziglio, Beniamino La Face, Fernando Barbera, Michela Buglione, Laura Bandera, Barbara Ghedi, Nadia G Di Muzio, Andrea Losa, Paola Mangili, Luciano Nava, Renato Chiarlone, Nunzia Ciscognetti, Emilio Gastaldi, Federica Cattani, Ruggero Spoto, Andrea Vavassori, Francesca R Giglioli, Alessia Guarneri, Valentina Cerboneschi, Marcello Mignogna, Mauro Paoluzzi, Valentina Ravaglia, Costanza Chiumento, Stefania Clemente, Vincenzo Fusco, Roberto Santini, Marco Stefanacci, Francesco P Mangiacotti, Marco Martini, Tiziana Palloni, Giuseppe Schinaia, Grazia Lazzari, Giovanni Silvano, Stefano Magrini, Umberto Ricardi, Riccardo Santoni, Roberto Orecchia
• Journal: The British journal of radiology (Br J Radiol) Vol. 89 Issue 1065 Pg. 20150981 (Sep 2016) ISSN: 1748-880X [Electronic] England
• PMID: 27384381 (Publication Type: Evaluation Study, Journal Article, Meta-Analysis)

Chemical References

• Prostate-Specific Antigen

Topics

• Adult
• Aged
• Aged, 80 and over
• Brachytherapy (methods, mortality)
• Dose-Response Relationship, Radiation
• Humans
• Italy (epidemiology)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Recurrence, Local (mortality)
• Practice Patterns, Physicians'
• Prostate-Specific Antigen
• Prostatic Neoplasms (mortality, radiotherapy)
• Radiotherapy Dosage
• Treatment Outcome
• Ultrasonography, Interventional (methods)