Vol. 42 (5): 906-917, September – October, 2016
Pieter Logghe 1, Rolf Verlinde 1, Frank Bouttens 2, Caroline Van den Broecke 3, Nathalie Deman 4, Koen Verboven 4, Dirk Maes 1, Luc Merckx 1
1 Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 2 Department of Radiotherapy-Oncology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 3 Department of Pathology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 4 Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
Objectives: To retrospectively evaluate the disease free survival (DFS),disease specific survival (DSS),overall survival (OS) and side effects in patients who received low-dose rate (LDR) brachytherapy with I125 stranded seeds.
Materials and methods: Between july 2003 and august 2012, 274 patients with organ confined prostate cancer were treated with permanent I125 brachytherapy. The median follow-up, age and pretreatment prostate specific antigen (iPSA) was 84 months (12-120), 67 years (50-83) and 7.8 ng/mL (1.14-38), respectively. Median Gleason score was 6 (3-9). 219 patients (80%) had stage cT1c, 42 patients (15.3%) had stage cT2a, 3 (1.1%) had stage cT2b and 3 (1.1%) had stage cT2c. The median D90 was 154.3 Gy (102.7-190.2).
Results: DSS was 98.5%.OS was 93.5%. 13 patients (4.7%) developed systemic disease, 7 patients (2.55%) had local progression. In 139 low risk patients, the 5 year biochemical freedom from failure rate (BFFF) was 85% and 9 patients (6.4%) developed clinical progression. In the intermediate risk group, the 5 year BFFF rate was 70% and 5 patients (7.1%) developed clinical progression. Median nPSA in patients with biochemical relapse was 1.58 ng/mL (0.21 – 10.46), median nPSA in patients in remission was 0.51 ng/mL (0.01 – 8.5). Patients attaining a low PSA nadir had a significant higher BFFF (p<0.05). Median D90 in patients with biochemical relapse was 87.2 Gy (51 – 143,1). Patients receiving a high D90 had a significant higher BFFF (p<0.05).
Conclusion: In a well selected patient population, LDR brachytherapy offers excelente outcomes. Reaching a low PSA nadir and attaining high D90 values are significant predictors for a higher DFS.
Keywords: Brachytherapy; Survival; Prostate-Specific Antigen; Prostatic Neoplasms