A comparison of the impact of isotope ((125)I vs. (103)Pd) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer Journal Article

Authors: Kollmeier, M. A.; Pei, X.; Algur, E.; Yamada, Y.; Cox, B. W.; Cohen, G. N.; Zaider, M.; Zelefsky, M. J.
Article Title: A comparison of the impact of isotope ((125)I vs. (103)Pd) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer
Abstract: Purpose: To compare biochemical outcomes and morbidity associated with iodine-125 ( 125I) and palladium-103 ( 103Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer. Methods and Materials: Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy ( 125I prescription dose, 110Gy: n=199; 103Pd prescription dose, 100Gy: n=60) followed by external beam radiotherapy (median dose, 50.4Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires. Results: Overall, acute Grade ≥2 genitourinary toxicity occurred in 21% and 30% of patients treated with 125I and 103Pd, respectively (p=0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p=0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for 125I and 103Pd patients, respectively (p=0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p=0.046). Late Grade ≥2 gastrointestinal toxicity occurred in 7% of 125I patients and 6% of patients treated with 103Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received 103Pd (p=0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for 125I and 103Pd patients was 95.2% and 98.2% (p=0.73), respectively. Conclusion: There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between 125I and 103Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of 103Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between 103Pd and 125I. © 2012 American Brachytherapy Society.
Keywords: adult; treatment outcome; aged; middle aged; major clinical study; cancer localization; combined modality therapy; outcome assessment; follow up; radiopharmaceuticals; prostate specific antigen; quality of life; morbidity; risk factors; risk assessment; prostate cancer; prostatic neoplasms; questionnaire; gastrointestinal toxicity; iodine 125; iodine radioisotopes; comorbidity; scoring system; radiation injuries; brachytherapy; radiotherapy, conformal; external beam radiotherapy; new york; urogenital tract disease; radioisotopes; erectile dysfunction; androgen deprivation therapy; radiation dose distribution; palladium 103; palladium; recurrence free survival; international index of erectile function; external beam radiation therapy; iodine-125; palladium-103; international prostate symptom score
Journal Title: Brachytherapy
Volume: 11
Issue: 4
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2012-07-01
Start Page: 271
End Page: 276
Language: English
DOI: 10.1016/j.brachy.2011.11.002
PROVIDER: scopus
PUBMED: 22192495
Notes: --- - "Export Date: 2 July 2012" - "CODEN: BRACC" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brett Wayne Cox
    62 Cox
  2. Michael J Zelefsky
    619 Zelefsky
  3. Yoshiya Yamada
    359 Yamada
  4. Gilad N Cohen
    132 Cohen
  5. Marisa A Kollmeier
    144 Kollmeier
  6. Marco Zaider
    169 Zaider
  7. Ece Algur
    2 Algur
  8. Xin Pei
    98 Pei