Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Journal Article
| Authors: | Zelefsky, M. J.; Yamada, Y.; Cohen, G. N.; Shippy, A.; Chan, H.; Fridman, D.; Zaider, M. |
| Article Title: | Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer |
| Abstract: | Purpose: To report the 5-year tumor control and toxicity outcomes for patients with localized prostate treated with I-125 permanent implantation using an intraoperative real-time conformal planning technique. Methods and Materials: Between January 1998 and June 2002, 367 patients with prostate cancer were treated with I-125 permanent interstitial implantation using a transrectal ultrasound-guided approach. Real-time intraoperative treatment planning which incorporated inverse planning optimization was used. The median follow-up time was 63 months. Results: The median V100 and D90 were 96% and 173 Gy, respectively. In 96% of cases a D90 of >140 Gy was achieved. The median urethral and rectal doses were 100% and 33% of the prescription doses, respectively. The 5-year PSA relapse-free survival outcomes for favorable and intermediate risk patients according to the ASTRO definition were 96% and 89%, respectively. In these patients no dosimetric parameter was identified which influenced the biochemical outcome. Of 38% who developed acute Grade 2 urinary symptoms, 63% had resolution of their symptoms within a median time of 6 months. The incidence of late rectal and urinary Grade 3 or higher toxicities were 1% and 4%, respectively. Seven percent (n = 27) developed late rectal bleeding (Grade 2) and 19% experienced late Grade 2 urinary symptoms. Conclusion: Real-time intraoperative planning consistently achieved optimal coverage of the prostate with the prescription dose with concomitant low doses delivered to the urethra and rectum. Biochemical control outcomes were excellent at 5 years and late toxicity was unusual. These data demonstrate that real-time planning methods can consistently and reliably deliver the intended dose distribution to achieve an optimal therapeutic ratio between the target and normal tissue structures. © 2007 Elsevier Inc. All rights reserved. |
| Keywords: | human tissue; treatment outcome; human cell; major clinical study; cancer localization; treatment planning; radiotherapy dosage; oncology; prostate cancer; prostate-specific antigen; prostatic neoplasms; iodine 125; iodine radioisotopes; tumors; dosimetry; intraoperative period; brachytherapy; radiotherapy planning, computer-assisted; radiotherapy, conformal; patient treatment; computer assisted radiotherapy; biochemistry; radiation dose distribution; transrectal ultrasonography; tissue; ultrasonography, interventional; rectum; rectum hemorrhage; ultrasonics; interstitial radiation; peroperative echography; i-125; real time systems; implants (surgical); urinary tract disease; real-time planning |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 67 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2007-01-01 |
| Start Page: | 65 |
| End Page: | 70 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2006.08.030 |
| PUBMED: | 17189063 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 46" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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