Customized dose prescription for permanent prostate brachytherapy: Insights from a multicenter analysis of dosimetry outcomes Journal Article
| Authors: | Stone, N. N.; Potters, L.; Davis, B. J.; Ciezki, J. P.; Zelefsky, M. J.; Roach, M.; Fearn, P. A.; Kattan, M. W.; Stock, R. G. |
| Article Title: | Customized dose prescription for permanent prostate brachytherapy: Insights from a multicenter analysis of dosimetry outcomes |
| Abstract: | Purpose: To investigate the biochemical control rate in patients undergoing permanent prostate brachytherapy as a function of the biologically effective dose (BED) and risk group. Methods and Materials: Six centers provided data on 3,928 permanent brachytherapy patients with postimplant dosimetry results. The mean prostate-specific antigen level was 8.9 ng/mL. 125I was used in 2,293 (58%), 103Pd in 1,635, and supplemental external beam radiotherapy in 882 (22.5%) patients. The patients were stratified into low- (n = 2,188), intermediate- (n = 1,188), and high- (n = 552) risk groups and into three BED groups of < 140 Gy (n = 524), 140-200 Gy (n = 2284), and >200 Gy (n = 1,115). Freedom from biochemical disease progression (biochemical freedom from failure [bFFF]) was determined using the American Society for Therapeutic Radiology Oncology and Phoenix definitions and calculated using the Kaplan-Meier method, with factors compared using the log-rank test. Results: The 10-year prostate-specific antigen bFFF rate for the American Society for Therapeutic Radiology Oncology and Phoenix definitions was 79.2% and 70%, respectively. The corresponding bFFF rates for the low-, intermediate-, and high-risk groups was 84.1% and 78.1%, 76.8% and 63.6%, and 64.4% and 58.2%, respectively (p < 0.0001). The corresponding bFFF rate for the three BED groups was 56.1% and 41.4%, 80% and 77.9%, and 91.1% and 82.9% (p < 0.0001). The corresponding bFFF rate for the low-risk patients by dose group was 69.8% and 49.8%, 86% and 85.2%, and 88.1% and 88.3% for the low-, intermediate, and high-dose group, respectively (p <0.0001). The corresponding bFFF rate for the intermediate-risk patients by dose group was 52.9% and 23.1%, 74.1% and 77.7%, and 94.3% and 88.8% for the low-, intermediate-, and high-dose group, respectively (p < 0.0001). The corresponding bFFF rate for high-risk patients by dose group was 19.2% and 41.7%, 61.8% and 53.2%, and 90% and 69.6% for the low-, intermediate-, and high-dose group, respectively (p < 0.0001). Conclusions: These data suggest that permanent brachytherapy dose prescriptions can be customized to risk status. In low-risk patients, achieving a BED of ≥140 Gy might be adequate for prostate-specific antigen control. However, high-risk disease might require a BED dose of ≥200 Gy. © 2007 Elsevier Inc. All rights reserved. |
| Keywords: | controlled study; treatment outcome; major clinical study; clinical trial; cancer risk; cancer patient; treatment indication; prostate specific antigen; radiotherapy dosage; radiotherapy; patient monitoring; risk; prostate cancer; prostate-specific antigen; prostatic neoplasms; antigens; iodine 125; iodine radioisotopes; tumors; dosimetry; multicenter study; reference values; brachytherapy; relative biological effectiveness; external beam radiotherapy; high risk population; kaplan meier method; cancer control; radioisotopes; biochemistry; palladium 103; palladium |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 69 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2007-12-01 |
| Start Page: | 1472 |
| End Page: | 1477 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2007.05.002 |
| PUBMED: | 17689026 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 33" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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