Combined 3-dimensional conformal radiotherapy and transperineal Pd-103 permanent implantation for patients with intermediate and unfavorable risk prostate cancer Journal Article
| Authors: | Singh, A.; Zelefsky, M. J.; Raben, A.; Lombardi, D.; Leibel, S. A. |
| Article Title: | Combined 3-dimensional conformal radiotherapy and transperineal Pd-103 permanent implantation for patients with intermediate and unfavorable risk prostate cancer |
| Abstract: | Purpose: To evaluate the efficacy and morbidity of combined 3-dimensional conformal radiation therapy (3D-CRT) and brachyth0erapy for intermediate/unfavorable risk prostate cancer. Materials and Methods: Between May 1996 and November 1997, 65 patients with intermediate/unfavorable risk prostate cancer were treated with 3D-CRT (50.4 Gy) followed by a transperineal permanent Pd-103 implant. Patients with one or two adverse prognostic features (PSA > 10 and Gleason > 7) were classified as intermediate risk and unfavorable risk, respectively. Forty-seven patients (71%) had intermediate risk and 18 (29%) had unfavorable disease risk. The median age of this group was 65 years (range, 42-76 years), and the median pretreatment PSA level was 8.0 ng/ml (range, 1.7-42.0 ng/ml). The clinical stage of these patients was as follows: T1c, 36 (55%); T2a, 27 (42%); T2b/T3, 2 (3%). Fifteen patients (23%) had a Gleason ≤ 6, 41 patients (63%) were classified as Gleason 7, and 9 (14%) as Gleason ≥ 8. Fifty-two (80%) received neoadjuvant androgen deprivation (NAAD) for cytoreduction. The median follow-up was 36 months (range, 24-42 months). Results: The PSA relapse-free survival rate at 3 years was 87%, with a median PSA value at last follow-up of 0.25 ng/ml. The relapse-free survival was 90% for those who had an initial PSA ≤ 10 ng/ml and 80% for patients who had an initial PSA > 10 ng/ml (p = 0.5). No difference in outcome was observed between patients with intermediate and unfavorable risk disease. Eight patients (13%) developed late Grade 2 rectal bleeding. Twenty-three patients (42%) required medication for urinary symptoms during the first 6 months after therapy. Three patients (5%) noted rare stress incontinence at last follow-up. Of the 44. patients who were potent prior to therapy, 17 (26%) developed erectile dysfunction (ED). Conclusion: Although the follow-up is short, the early biochemical outcome of combined 3D-CRT and brachytherapy for intermediate/unfavorable risk prostate cancer is promising. While rectal toxicity is minimal, urinary side effects are more common. Further follow-up is necessary to fully evaluate the efficacy of this combined therapeutic approach. (C) 2000 Wiley-Liss, Inc. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; disease-free survival; middle aged; implant; unclassified drug; major clinical study; cancer risk; treatment planning; cancer radiotherapy; radiation dose; chemotherapy, adjuvant; cancer staging; follow up; follow-up studies; cancer grading; time factors; risk assessment; risk; prostate cancer; prostate-specific antigen; prostatic neoplasms; brachytherapy; radiotherapy, conformal; computer assisted radiotherapy; radioisotopes; erectile dysfunction; palladium 103; palladium; prostate carcinoma; rectum hemorrhage; conformal radiotherapy; stress incontinence; urinary dysfunction; palladium-103; humans; prognosis; human; male; priority journal; article |
| Journal Title: | International Journal of Cancer |
| Volume: | 90 |
| Issue: | 5 |
| ISSN: | 0020-7136 |
| Publisher: | John Wiley & Sons |
| Date Published: | 2000-10-20 |
| Start Page: | 275 |
| End Page: | 280 |
| Language: | English |
| DOI: | 10.1002/1097-0215(20001020)90:5<275::aid-ijc4>3.0.co;2-m |
| PUBMED: | 11091351 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 18 November 2015 -- Source: Scopus |
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