Combined brachytherapy with external beam radiotherapy for localized prostate cancer: Reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy Journal Article


Authors: Zelefsky, M. J.; Nedelka, M. A.; Arican, Z. L.; Yamada, Y.; Cohen, G. N.; Shippy, A. M.; Park, J. J.; Zaider, M.
Article Title: Combined brachytherapy with external beam radiotherapy for localized prostate cancer: Reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy
Abstract: Purpose: To report the acute and late treatment-related toxicities of combined permanent interstitial 125I implantation delivered via real-time intraoperative planning and supplemental intensity-modulated radiotherapy (IMRT) for patients with clinically localized prostate cancer. Methods and materials: One hundred twenty-seven patients were treated with a combined modality (CM) regimen consisting of 125I implantation (110 Gy) using a transrectal ultrasound-guided approach followed 2 months later by 50.4 Gy of IMRT directed to the prostate and seminal vesicles. Late toxicity was scored according to the NCI Common Terminology Criteria for Adverse Events toxicity scale. The acute and late toxicities were compared to a contemporaneously treated cohort of 216 patients treated with 125I alone to a prescribed dose of 144 Gy. Results: The incidence of Grade 2 acute rectal and urinary side effects was 1% and 10%, respectively, and 2 patients developed Grade 3 acute urinary toxicities. The 4-year incidence of late Grade 2 gastrointestinal toxicity was 9%, and no Grade 3 or 4 complications have been observed. The 4-year incidence of late Grade 2 gastrourinary toxicities was 15% and 1 patient developed a Grade 3 urethral stricture, which was corrected with urethral dilatation. The percentage of patients who experienced resolution of late rectal and urinary symptoms was 92% and 65%, respectively. Multivariate analysis revealed that in addition to higher baseline International Prostate Symptom Score, those patients treated with implant alone compared to CM were more likely to experience Grade 2 acute urinary symptoms. Increased Grade 2 late rectal toxicities were noted for CM patients (9% vs. 1%; p = 0.001) as well as a significant increase for late Grade 2 urinary toxicities (15% vs. 9%; p = 0.004). Conclusions: Adherence to dose constraints with combination real-time brachytherapy using real-time intraoperative planning and IMRT is associated with a low incidence of acute and late toxicities. Acute urinary side effects were signficantly less common for CM patients compared to those treated with implantation alone. Late Grade 2 rectal and urinary toxicities were more common for patients treated with CM compared to implant alone. © 2008 American Brachytherapy Society.
Keywords: adult; aged; middle aged; major clinical study; treatment planning; comparative study; combined modality therapy; follow-up studies; adenocarcinoma; nephrotoxicity; radiotherapy dosage; incidence; morbidity; dose-response relationship, radiation; prostate cancer; prostatic neoplasms; gastrointestinal toxicity; iodine 125; iodine radioisotopes; imrt; radiation injuries; brachytherapy; radiation therapy; multivariate analysis; radiotherapy, conformal; external beam radiotherapy; toxicity; gastrointestinal tract; transrectal ultrasonography; intraoperative radiotherapy; urethra stricture; rectum disease; urinary tract disease
Journal Title: Brachytherapy
Volume: 7
Issue: 1
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2008-01-01
Start Page: 1
End Page: 6
Language: English
DOI: 10.1016/j.brachy.2007.12.002
PUBMED: 18299108
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 16" - "Export Date: 17 November 2011" - "CODEN: BRACC" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    655 Zelefsky
  2. Yoshiya Yamada
    374 Yamada
  3. Alison Maureen Shippy
    16 Shippy
  4. Gilad N Cohen
    139 Cohen
  5. Marco Zaider
    169 Zaider
  6. Jessica Park
    12 Park