放射性^125I粒子植入联合内分泌治疗早期前列腺癌

目的：探讨经会阴超声引导放射性^125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应。方法：39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性^125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗。粒子治疗的匹配周边剂量（matched peripheral doses,MPD）为145—160Gy,尿道剂量低于400Gy。^125I粒子活度0．35—0．50mCi,中位植入69颗（19—97颗）。结果：失败标准为前列腺特异抗原（prostate specific antigen,PSA）治疗后升高〉4ng／ml,≤〈4ng／ml为生物化学无进展生存（biochemical disease—free survival,BDFS）。全部患者顺利完成粒子植入术。36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗。2年和3年BDFS分别为94．8％（37／39）和92．3％（36／39）。粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5．1％（2／39）和7．7％（3／39）,没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53．8％（20／39）、17．9％（7／39）和2．6％（1／39）,对症处理好转。2例粒子移位,没有相关并发症。结论：经会阴超声引导放射性^125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点。     

放射性125I粒子植入联合内分泌治疗早期前列腺癌

目的:探讨经会阴超声引导放射性125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应.方法: 39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗.粒子治疗的匹配周边剂量(matched peripheral doses,MPD)为145-160Gy,尿道剂量低于400Gy.125I粒子活度0.35-0.50mCi,中位植入69颗(19-97颗).结果: 失败标准为前列腺特异抗原(prostate specific antigen,PSA)治疗后升高>4ng/ml,≤4ng/ml为生物化学无进展生存(biochemical disease-free survival,BDFS).全部患者顺利完成粒子植入术.36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗.2年和3年BDFS分别为94.8%(37/39)和92.3%(36/39).粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5.1%(2/39)和7.7%(3/39),没有Ⅲ级和Ⅳ级直肠反应.粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53.8%(20/39)、17.9%(7/39)和2.6%(1/39),对症处理好转.2例粒子移位,没有相关并发症.结论: 经会阴超声引导放射性125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

联合间歇性内分泌与125I放射性粒子植入术治疗局部晚期前列腺癌(附20例报告)

目的:探讨联合125I放射性粒子植入术和间歇性内分泌治疗局部进展期前列腺癌的临床价值.方法:前列腺癌患者20例,年龄52～80岁,中位年龄74岁,PSA:6.83～643.8ng/mL,Gleason Score:7～9分,临床分期T3NOM0.连续硬膜外麻醉,截石位,直肠超声从前列腺基底到尖部进行扫描,图像传送至计算机计划系统进行三维重建和术中计划,根据计划行直肠超声引导下经会阴125I放射性粒子植入术,术后结合雄激素全阻断疗法.当PSA达到0ng/mL,并稳定2个月后停止内分泌治疗,当PSA连续3次上升,则重新开始内分泌治疗.结果:所有患者手术均顺利,术中使用穿刺针26～36根,植入粒子57～99粒,平均73粒.术后随访8～51个月,平均22月.1例术后16个月发生骨转移,1例术后22个月死亡.术后3～5个月所有患者的PSA都降到正常范围,其中3例PSA未达到0ng/mL,未停药.4例术后5～26个月,出现PSA反弹,再次用药3～5个月PSA值达到0ng/mL:目前12例未出现PSA反弹,第一周期脱离治疗时间2～44个月,平均16.9个月.近期出现的并发症有轻至中度尿路刺激症30%(6/20),急性尿潴留5%(1/20),直肠刺激症和血便25%(5/20),多数患者症状随访1年后缓解.目前18例患者的PSA值在0～1.2ng/mL之间,其中17患者PSA≤0.17ng/mL.结论:对于局部晚期前列腺癌,125I放射粒子植入术结合间歇性内分泌是一种安全有效的治疗方法.     

放射性 125 I粒子植入治疗睾丸切除术后复发性前列腺癌

目的探讨超声引导放射性 125 I粒子植入治疗复发前列腺癌.方法8例前列腺癌去势术后复发实施超声引导放射性 125 I粒子植入治疗.2例单纯粒子植入治疗,肿瘤匹配周边剂量为(matched peripheral dose,MPD)90～145 Gy,2例先行外放疗,外放疗剂量为40～45 Gy.粒子活度0.35～0.40 mCi.随访3～29个月,连续3次前列腺特异抗原(prostate specific antigen,PSA)升高即为生物化学失败(biochemical failure).结果粒子治疗前后PSA分别为(7.53±7.64)ng/mL 和(1.25±1.19)ng/mL,统计学处理明显下降,t=2.297,P=0.038.2例生物化学失败,生物化学控制率(biochemical control rate)为6/8例,1例出现1级泌尿道并发症,1例出现2级泌尿道并发症.1/8例患者粒子发生移位,但是并没有引起临床相关并发症,没有粒子移位到肺.结论超声引导经会阴放射性 125 I粒子植入治疗复发前列腺癌具有安全、微创、并发症发生率低和疗效肯定,是一种较理想的补救治疗手段.     

联合间歇性内分泌与^125Ⅰ放射性粒子植入术治疗局部晚期前列腺癌（附20例报告）

目的：探讨联合^125Ⅰ放射性粒子植入术和间歇性内分泌治疗局部进展期前列腺癌的临床价值。方法：前列腺癌患者20例,年龄52～80岁,中位年龄74岁,PSA：6．83～643．8ng／mL,Gleason Score：7～9分,临床分期T3NOMO.连续硬膜外麻醉,截石位,直肠超声从前列腺基底到尖部进行扫描,图像传送至计算机计划系统进行三维重建和术中计划,根据计划行直肠超声引导下经会阴^125Ⅰ放射性粒子植入术,术后结合雄激素全阻断疗法。当PSA达到0ng／mL,并稳定2个月后停止内分泌治疗,当PSA连续3次上升,则重新开始内分泌治疗。结果：所有患者手术均顺利,术中使用穿刺针26～36根,植入粒子57～99粒,平均73粒。术后随访8～51个月,平均22月。1例术后16个月发生骨转移,1例术后22个月死亡。术后3～5个月所有患者的PSA都降到正常范围,其中3例PSA未达到0ng／mL,未停药。4例术后5～26个月,出现PSA反弹,再次用药3～5个月PSA值达到0ng／mL。目前12例未出现PSA反弹,第一周期脱离治疗时间2～44个月,平均16．9个月。近期出现的并发症有轻至中度尿路刺激症30％（6／20）,急性尿潴留5％（1／20）,直肠刺激症和血便25％（5／20）,多数患者症状随访1年后缓解。目前18例患者的PSA值在0～1．2ng/mL之间,其中17患者PSA≤0．17ng／mL。结论：对于局部晚期前列腺癌,^125Ⅰ放射粒子植入术结合间歇性内分泌是一种安全有效的治疗方法。     

前列腺~(125)Ⅰ射粒子植入结合去势治疗C期前列腺癌(附10例报告)

目的　探讨前列腺12 5I放射粒子植入内放疗在前列腺癌治疗中的意义。方法　依据治疗计划 ,在直肠B超引导下 ,经会阴穿刺植入前列腺12 5I放射粒子对 10例C期前列腺癌行三维适形内放疗并结合手术去势治疗。结果　全组手术顺利 ,平均植入12 5I放射粒子 5 8粒 ,平均手术时间 80分钟 ,术后平均住院时间 5 .9天 ,随访 9例术后 3个月结果 :前列腺体积及PSA均有不同程度降低 ,前列腺平均体积由35 .2cm3 降至 2 4 .7cm3 ,平均PSA由 19.8ng/ml降至0 .74ng/ml,随访 6例术后 6个月结果 :5例PSA进一步降低 ,平均 0 .11ng/ml,1例升高 ,由 0 .5 1ng/ml升高至 1.6 5ng/ml,无一例出现严重的并发症。结论　采用永久性放射粒子植入前列腺三维适形内放疗是一种有效、微创的治疗前列腺癌的方法。     

前列腺~(125)Ⅰ射粒子植入结合去势治疗C期前列腺癌(附10例报告)

 目的　探讨前列腺12 5I放射粒子植入内放疗在前列腺癌治疗中的意义。方法　依据治疗计划 ,在直肠B超引导下 ,经会阴穿刺植入前列腺12 5I放射粒子对 10例C期前列腺癌行三维适形内放疗并结合手术去势治疗。结果　全组手术顺利 ,平均植入12 5I放射粒子 5 8粒 ,平均手术时间 80分钟 ,术后平均住院时间 5 .9天 ,随访 9例术后 3个月结果 :前列腺体积及PSA均有不同程度降低 ,前列腺平均体积由35 .2cm3 降至 2 4 .7cm3 ,平均PSA由 19.8ng/ml降至0 .74ng/ml,随访 6例术后 6个月结果 :5例PSA进一步降低 ,平均 0 .11ng/ml,1例升高 ,由 0 .5 1ng/ml升高至 1.6 5ng/ml,无一例出现严重的并发症。结论　采用永久性放射粒子植入前列腺三维适形内放疗是一种有效、微创的治疗前列腺癌的方法。     

放射性~(125)I粒子植入治疗前列腺癌的研究进展

随着放射性~(125)I粒子植入技术的迅速发展,该项技术已逐渐成为治疗前列腺癌的重要方法。文章检索了近10年来有关放射性~(125)I粒子植入治疗前列腺癌的文献报道,主要从~(125)I粒子植入治疗前列腺癌的作用机制、适应证、处方剂量推荐、临床应用优势、应用现状及疗效评价、相关尿路不良反应治疗建议、粒子辐射防护等7个方面进行综述,并分析了目前~(125)I粒子植入治疗前列腺癌相关研究及辐射防护方面存在的一些不足,旨在为临床安全应用~(125)I粒子治疗前列腺癌提供更有力的依据和借鉴,丰富前列腺癌的治疗方法。     

超声引导^125I粒子植入治疗前列腺癌方法的建立与近期疗效

目的探讨超声引导放射性^125I粒子治疗前列腺癌方法建立和近期疗效。方法26例前列腺癌全身或硬膜外麻醉下行经直肠超声引导粒子植入治疗。经直肠超声获取前列腺图像,将图像直接传输到计算机治疗计划系统,术中适时计算机计划,肿瘤周边匹配剂量（matched peripheral doses,MPD）145～160Gy。根据治疗计划插植粒子针,利用Mick植入器植入粒子,粒子植入总数为19—90颗,粒子活度0．35～0．4mCi。术后1个月行盆腔CT扫描,质量验证。结果26例患者成功实施会阴超声和模板引导放射性^125I粒子组织间近距离治疗前列腺癌手术。手术历时1—1．5h。术后验MPD为（137．73±36．5014）Gy。26例前列腺癌患者^125I粒子治疗后生物化学控制率92．3％,2例患者术后6个月出现骨转移。^125I粒子植入治疗,34．6％无尿道副反应,Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级尿道副反应分别为38．5％、11．5％、11．5％、0和0。Ⅰ级直肠副反应发生率为3．9％。1例患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺。结论经会阴超声引导放射性粒子治疗前列腺癌具有微创、精确度高和副反应发生率低等优势。     

I 125放射性粒子植入在口腔颌面部恶性肿瘤治疗中的应用

  目的  研究I125放射性粒子组织间近距离植入治疗口腔颌面部恶性肿瘤的近期疗效及副反应, 探讨其在恶性肿瘤综合治疗中的应用价值。   方法  根据制定的相应放射性粒子植入治疗计划, 对38例口腔颌面部恶性肿瘤患者应用手术配合I125粒子植入治疗或单纯粒子植入治疗, 术后随访观察疗效及副反应。   结果  所有病例随访12~28个月, 平均20个月, 其中23例手术配合粒子植入者局部未见明显新生肿物, 15例单纯粒子植入病例均见病灶不同程度缩小, 不适症状有所减轻。除2例患者出现局部皮肤色素沉着, 1例患者咽部不适1周后缓解, 余病例均未出现明显粒子植入后副反应。   结论  放射性粒子植入治疗对口腔颌面部恶性肿瘤的近期疗效显著, 为综合治疗口腔颌面部恶性肿瘤提供了新的发展方向。      

Brachytherapy with transperineal (125)Iodine seeds for localized prostate cancer.

BACKGROUND AND PURPOSE: To analyze the treatment results of transperineal (125)Iodine seeds in localized prostate cancer. PATIENTS AND METHODS: Between 1985 and 1996, 102 patients with T1-T2 N0 prostate cancer were treated with transperineal (125)Iodine seed implants at the Academic Medical Centre in Amsterdam. Tumours were classified as T1c in four patients, T2a in 73 patients and T2b in 25 patients. The mean pre-treatment PSA was 17 ng/ml. The (125)Iodine seeds were implanted transperineally under transrectal ultrasound guidance. The mean prostate volume was 31 ml (range 15-48 ml). An average of 49 seeds (range 29-74) was implanted. The dose to the periphery of the prostate was 160 Gy. Until 1988, 27 patients had additional external pelvic irradiation to a dose of 40 Gy in 20 daily fractions of 2 Gy. RESULTS: The 5- and 7-year actuarial survival rates were 77 and 63%, respectively (median 102 months). Ten patients (9.5%) died from prostate cancer. The 5- and 7-year clinical progression rates were 12 and 17%, respectively. Biochemical failure rates at 5 and 7 years were 39 and 44%, respectively. Age, alkaline phosphatase, creatinine, differentiation grade, additional treatment, staging procedure, number of seeds, prostate volume, treatment period and PSA were analyzed as prognostic factors. Only pre-treatment PSA was a prognosticator of clinical and biochemical outcome but not of survival. Biochemical control at 6 years varied from 30% for pre-treatment PSA values higher than 20 ng/ml to 95% for values < or =8 ng/ml. Forty-one out of 49 patients who were sexually active before brachytherapy maintained sexual function during the follow-up. Complete urinary incontinence occurred in one patient. No rectal complications were seen in patients receiving brachytherapy alone. CONCLUSIONS: Transperineal (125)Iodine seeds brachytherapy in localized prostate cancer achieves a good clinical control and overall survival with acceptable late toxicity. Biochemical failure was strongly correlated to the pre-treatment PSA value.     

Four-year biochemical outcome after radioimmunoguided transperineal brachytherapy for patients with prostate adenocarcinoma

PURPOSE: To evaluate 4-year biochemical outcomes for patients with prostate adenocarcinoma who underwent radioimmunoguided (Prostascint) permanent prostate brachytherapy. METHODS AND MATERIALS: Eighty patients with clinical T1C-T3A NxM0 prostate cancer underwent ProstaScint-guided prostate brachytherapy using either (103)Pd or (125)I between February 1997 and December 2000. Sixty-seven patients underwent prostate brachytherapy alone, whereas 13 patients received neoadjuvant hormonal manipulation before implantation. Risk factors (RF) included PSA >10, Stage >or=T2b, and Gleason grade >or=7. Sixty patients had low-risk disease (0 RF), 17 were intermediate risk (1 RF), and 3 were high risk (2 RF). Biochemical disease-free survival (bDFS) was calculated using the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria, a PSA cutoff of 1.0 ng/mL, and a PSA cutoff of 0.5 ng/mL. RESULTS: Four-year bDFS for the entire cohort was 97.4% using the ASTRO consensus criteria. Low-risk patients (60) had a 4-year bDFS of 100%; intermediate- and high-risk patients (20 patients) were 89.2%. The hormonally na?ve group (67 patients) had a 4-year bDFS of 96.9% and a median PSA nadir of 0.2 ng/mL. Median time to nadir was 19.8 months (range: 1.9-53.2 months). For the neoadjuvant hormonal therapy group (13 patients), ASTRO-defined bDFS was 100%. Overall, 85.2% of patients had a posttreatment PSA 相似文献   

Three-dimensional computed tomography-guided monotherapeutic pararectal brachytherapy of prostate cancer with seminal vesicle invasion.

PURPOSE: To treat patients with prostate cancer and seminal vesicle invasion with monotherapeutic three dimensional computed tomography (3-DCT)-guided posterior pararectal brachytherapy. METHODS AND MATERIALS: Three hundred and sixty two patients with clinical stage T1 a,b or T2 a,b of prostate cancer were referred for 3-DCT-guided brachytherapy. Each underwent ftirther staging with 3-D CT-guided pararectal biopsy of the seminal vesicles under local anesthesia during the pre-treatment CT-planning. Forty-three patients (12%) were upstaged to T3 cNoMo disease. In the set of 43 patients, Eight had Gleason's score< or =6, 24 Gleason's score=7, and 11 patients > or =8. Initial PSA was <10 ng/ml in 14 patients, 10-20 ng/ml in 11 patients, and >20 in 18 patients. Of the 43 patients, 37 patients were treated monotherapeutically with 3-D CT-guided brachytherapy. No patients received hormone therapy after the implant. The prescribed dosage to the seminal vesicles and prostate is 120 Gy with Pd-103 seeds and 144 Gy with 1-125 seeds. RESULTS: The prescribed dosage was achieved in all 37 patient's throughout the seminal vesicles whose range of target radiation extended 5-10 mm outside the target in the adjacent fat as calculated with post-implant CT-dosimetry with Varian Brachy Vision or MMS software. Prostate Specific Antigen (PSA) outcome data were available in 34 patients treated with monotherapy and follow up ranged from 12-56 months (median, 24 months). Decreased PSA levels were stratified into six groups based on the presenting Gleason's score and initial PSA. In the first group (with Gleason's score< or =6 and initial PSA <20 ng/ml), PSA levels decreased to less than 0.5 ng/ml in all seven patients (100%) after brachytherapy. In the second group (with Gleason's=7 and initial PSA<20 ng/ml), PSA levels decreased to less than 1 ng/ml in 11 of 13 patients (85%); additionally PSA levels decreased to less than 0.5 ng/ml in ten patients (77% in this group). In the third group (with Gleason's score=7 and initial PSA> 20 ng/ml), PSA decreased to less than 0.5 ng/ml in four out of eight patients (50%). All of the patients in the fourth group (with Gleason's score> or =8 and initial PSA<20 ng/ml) decreased their PSA levels to less than 0.5 ng/ml in three of three patients. PSA decreased less than 0.5 ng/ml in two out of three patients (67% in the last group with Gleason's score> or =8 and initial PSA> 20 ng/ml). There were no patients with Gleason's score of 1-6 and greater than 20 ng/ml initial PSA. Patients, irrespective of the Gleason's score and PSA, had an overall response of decreased PSA (less than 1 ng/ml) of 79%. CONCLUSION: 3-D CT-guided brachytherapy delivers adequate dosage to the seminal vesicles. Clinical and biochemical results are encouraging in patients with low initial PSA levels regardless of their Gleason's scores, but longer-term data in a greater number of patients is necessary.     

Permanent interstitial brachytherapy for clinically organ-confined high-grade prostate cancer with a pretreatment PSA < 20 ng/mL

The objective of this study was to determine the effect of biopsy Gleason score 8 and 9 histology on biochemical outcome following a permanent prostate brachytherapy approach that includes multiple periprostatic seeds and supplemental external beam radiation. Forty-six consecutive T1c-T2b (1997 AJCC) patients with Gleason score 8 and 9 prostate cancer who were either hormone naive (33 patients) or received cytoreductive (< or =6 months) hormonal therapy (13 patients) underwent brachytherapy from June 1995 to November 2000. The median patient age was 69.7 years, with a median pretreatment prostate-specific antigen (PSA) of 7.7 ng/mL. The median follow-up was 58 months (range 27-93 months). Forty-five of the patients were implanted with Pd-103 and 44 received supplemental external beam radiation therapy (45 Gy). Biochemical success was defined by either a PSA < or = 0.4 ng/mL after a nadir or by the ASTRO consensus definition. The actuarial 7-year biochemical disease-free survival was 84.8% using either a PSA < or = 0.4 ng/mL or the ASTRO consensus definition. The median postimplant PSA was less than 0.1 ng/mL for both the hormone naive and hormonally manipulated patients. The utilization of hormonal therapy for 6 months or less duration resulted in a statistically nonsignificant improvement in biochemical outcome (92.3% versus 81.8%, P = 0.393). When stratified by pretreatment PSA, 87.9% of patients with a pretreatment PSA < or = 10 ng/mL and 76.9% with a pretreatment PSA > 10 ng/mL (P = 0.377) remained biochemically free of disease. In multivariate analysis, none of the clinical, treatment, or dosimetric parameters predicted for outcome. Following a permanent prostate brachytherapy approach that used multiple periprostatic seeds, the majority of patients with clinically organ-confined Gleason score 8 and 9 prostate cancer remain biochemically free of disease with identical outcomes for both biochemical definitions of success.     

Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer

PURPOSE: To evaluate 5-year biochemical disease-free outcome for men with clinical T1b-T3a NxM0 1977 American Joint Committee on Cancer (1997 AJCC) adenocarcinoma of the prostate gland who underwent transperineal ultrasound-guided permanent prostate brachytherapy. METHODS AND MATERIALS: Four hundred twenty-five patients underwent transperineal ultrasound-guided prostate brachytherapy using either 103Pd or 125I, for clinical T1b-T3a NxM0 (1997 AJCC) adenocarcinoma of the prostate gland, from April 1995 to October 1999. No patient underwent pathologic lymph-node staging. One hundred ninety patients were implanted with either 103Pd or 125I monotherapy; 235 patients received moderate-dose external beam radiation therapy (EBRT), followed by a prostate brachytherapy boost; 163 patients received neoadjuvant hormonal manipulation, in conjunction with either 103Pd or 125I monotherapy (77 patients) or in conjunction with moderate-dose EBRT and a prostate brachytherapy boost (86 patients). The median patient age was 68.0 years (range, 48.2-81.3 years). The median follow-up was 31 months (range, 11-69 months). Follow-up was calculated from the day of implantation. No patient was lost to follow-up. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiation and Oncology (ASTRO) consensus definition. RESULTS: For the entire cohort, the 5-year actuarial biochemical no evidence of disease (bNED) survival rate was 94%. For patients with low-, intermediate-, and high-risk disease, the 5-year biochemical disease-free rates were 97.1%, 97.5%, and 84.4%, respectively. For hormone-naive patients, 95.7%, 96.4%, and 79.9% of patients with low-, intermediate-, and high-risk disease were free of biochemical failure. Clinical and treatment parameters predictive of biochemical outcome included: clinical stage, pretreatment prostate-specific antigen (PSA), Gleason score, risk group, age > 65 years, and neoadjuvant hormonal therapy. Isotope choice was not a statistically significant predictor of disease-free survival for any risk group. The median postimplant PSA was < or = 0.2 for all risk groups, regardless of hormonal status. The mean posttreatment PSA, however, was significantly lower for men implanted with 103Pd (0.14 ng/mL) than for those implanted with 125I (0.25 ng/mL), p < or = 0.001. CONCLUSION: With a median follow-up of 31 months, permanent prostate brachytherapy results in a high probability of actuarial 5-year biochemical disease-free survival (DFS) for patients with clinical T1b-T3a (1997 AJCC) adenocarcinoma of the prostate gland, with an apparent plateau on the PSA survival curve.     

Transperineal 125iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity

PURPOSE: To evaluate the efficacy and toxicity of transperineal 125I implants for clinically localized prostate cancer in elderly men in a community cancer setting. METHODS AND MATERIALS: From 1988 to 1993, 206 patients, median age 77 years, with localized (Stage T1 and T2), low-grade (Gleason score < or = 7) prostate cancer were treated using pre-planned 125I transperineal implants. Patients were followed for biochemical freedom from disease, overall survival, and treatment-associated morbidity. RESULTS: The 5-year actuarial biochemical freedom from failure rate for all patients available for follow-up was 63%. Specifically, biochemical freedom from failure was 76% in patients with pretreatment PSA < or = 10 ng/ml, compared to 51% of patients with values > 10 ng/ml (median observation time 35 months). Actuarial freedom from failure for patients with PSA < or = 4 ng/ml was 84%. Stage and Gleason score did not predict outcome. PSA nadir was the strongest predictor of long-term biochemical disease-free survival (p < 0.001) with only 2 failures in 62 patients who achieved a posttreatment PSA nadir < or = 0.5 ng/ml. CONCLUSION: Transperineal 125I implants for early prostate cancer are efficacious and feasible for certain populations of elderly patients with favorable prognostic indicators in the community cancer setting. Patients with poor prognostic indicators at diagnosis do not appear to be candidates for treatment with implant alone. ( 1999 El.vit r 'Cio;noo lnc     

Analysis of prostate-specific antigen bounce after I permanent seed implant for localised prostate cancer

BACKGROUND AND PURPOSE: To report on the incidence of benign prostate-specific antigen bounce following permanent I(125) prostate brachytherapy, to describe the associations in our population and review the relationship of bounce to subsequent biochemical failure. MATERIALS AND METHODS: From February 2000 to May 2005, 374 patients with localised prostate cancer were treated with I(125) permanent prostate brachytherapy at a single institution. A prospectively collected database was used to identify cases of prostate-specific antigen (PSA) bounce, defined as a rise of 0.2 ng/ml above an initial PSA nadir with subsequent decline to or below that nadir without treatment. The patients who received neo-adjuvant or adjuvant hormone manipulation were excluded. Biochemical failure was determined using the both the ASTRO consensus definition and Phoenix (nadir +2 ng/mL) definition. RESULTS: Two hundred and five patients were identified with a median follow-up of 45 months (24-85). PSA bounce was noted in 79 (37%) men, occurring at a median of 14.8 months (1.7-40.6) following implant. The median peak PSA was 1.8 ng/ml (0.4-7.4) with a bounce magnitude of 0.91 ng/ml (0.2-5.8). When pre- and post-implant factors were assessed for association to bounce, only younger age was statistically significant (p=0.002). The threshold for biochemical failure as defined by the ASTRO consensus definition (1997) was met in 4 (5%) patients after experiencing bounce as opposed to 19 (15%) non-bounce patients (p=0.01). The threshold for Phoenix (nadir +2 ng/mL) was met in 6 (7.5%) patients following bounce versus 22 (17%) of non-bounce patients (p=0.003). Both definitions are prone to false positive calls during bounce. Median PSA velocity during the bounce was 0.08 ng/mL/month (0.02-0.98) and was statistically significantly lower than the median velocity prior to the Phoenix biochemical failure at 0.28 ng/mL/month (0.07-2.04) (p=0.0005). CONCLUSION: PSA bounce is a common finding in our population and is associated with a lower rate of subsequent biochemical failure. The noted differences in PSA velocity will require verification in a future analysis to reduce the influence of median follow-up on this finding. Patients should be advised of the potential of bounce in PSA follow-up after permanent I(125) prostate brachytherapy and physicians involved in follow-up of prostate brachytherapy patients should be aware of this phenomenon, allowing them to commit to appropriate PSA surveillance, avoiding the premature and inappropriate initiation of salvage therapy during PSA bounce.     

Estudio retrospectivo de pacientes tratados con braquiterapia prostática con I-125 en el Instituto Catalán de Oncología

Introduction. Prostate brachytherapy is indicated in patients with initial-stage prostate cancer. Our objective is to describe, in a series of patients treated in our institution with permanent implants of¹²⁵I seeds, the dosimetric characteristics of the technique and the preliminary results together with the toxicity profile, biological relapse and survival. Material and methods. Between May 2000 and September 2003, we treated 153 patients using permanent transperineal¹²⁵I seed implants (target dose of 145 Gy), of whom 130 were included in the analysis for having a minimum of 6 months follow-up. Distribution by stage was: 73.85% (n=96) Tlc and 26.15% (n=34) T2a. Gleason <6,97% (n=127); median prostate specific antigen (PSA) pre-treatment was 6.24 ng/ml. The median prostate volume was 28 cc; 34 patients had received previous hormonal therapy prior to the implants. Median age was 65 years. Results. There were 130 patients with >6 months follow-up in the analysis (median age = 65 years) of whom 18.46% (n=24) had attended the Radiotherapy Service for the first time and who had previously been prescribed hormonal therapy. Technical characteristics of the implants: median number of needles = 24 (range 14–35); median number of seeds = 76 (range 46–111); median activity = 14.46 MBq/seed; total activity implanted (median) = 1,121.1 MBq. The median follow-up was 20 months (6–42 months). Survival free of disease at 1 and 2 years was 99.1 % and 89.9%, respectively. Based on the stratification of risk groups, 99% and 92.1% of the patients of low risk continued free of the disease at 1 and 2 years, respectively while for those patients of intermediate risk these values were 100% and 77.8% respectively. Frequency of relevant secondary effects were rectitis G1 5.38% and G2 of 1.54%; haematuria G2 44.62% and G3 1.54%. A probe was necessary to resolve acute urine retention in 3.85%. Conclusions. Prostate brachytherapy is a complex procedure that requires the participation of a multi-disciplinary team, it precludes prolonged hospitalisation and allows the patient to resume normal activity within a short period. Although the mean follow-up time is short, the results with respect to survival free of biochemical relapse and toxicity are comparable to those described in the literature. The patient tolerance of the implant has been good. Longer follow-up is necessary to confirm the long-term conclusions.     

Long-term outcome after elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for locally advanced prostate cancer.

PURPOSE: To report the 8-year outcome of local dose escalation using high-dose-rate conformal brachytherapy combined with elective irradiation of the pelvic lymphatics for localized prostate cancer. METHODS AND MATERIALS: One hundred forty-four consecutively treated men (1986-1992) were recorded prospectively. Twenty-nine (20.14%) patients had T1b-2a tumors, and 115 (79.86%) patients had T2b-3 tumors according to, respectively, American Joint Committee on Cancer/Union Internationale Contre le Cancer 1992. All patients had a negative nodal status, proven by CT or MRI. The mean initial PSA value was 25.61 ng/mL (Initial value for 41.66% of patients was <10 ng/mL, for 21.52% was 10-20 ng/mL, and for 32.63% was >20 ng/mL). The total dose applied by external beam radiotherapy was 50 Gy in the pelvis and 40 Gy in the prostate. The high-dose-rate brachytherapy was delivered in two fractions, which were incorporated into the external beam treatment (after 20-Gy and 40-Gy external beam radiotherapy dose). The dose per fraction was 15 Gy for the PTV1 (peripheral prostate zone) and 9 Gy for the PTV2 (entire prostatic gland). Any patient free of clinical or biochemical evidence of disease was termed bNED. Actuarial rates of outcome were calculated by Kaplan-Meier and compared using the log-rank. Cox regression models were used to establish prognostic factors of the various measures of outcome. RESULTS: The median follow-up was 8 years (range 60-171 months). The overall survival rate was 71.5%, and the disease-free survival rate was 82.6%. The bNED survival rate was 72.9%. Freedom from local recurrence for T3 stage was 91.3%, whereas for G3 lesions it was 88.23%. Freedom from distant recurrence for T3 stage was 82.6% and for G3 lesions 70.59%. Univariate survival analyses revealed that low stage (T1-2), low grade (G1-2), no hormonal therapy, initial PSA value less than 40 ng/mL, and PSA normalization <1.0 ng/mL after irradiation were associated with long survival. In multivariate analyses, initial PSA value, PSA kinetics after radiation therapy, and no adjuvant hormonal treatment were independent prognostic factors. Grade 3 late radiation toxicity (according to RTOG/EORTC scoring scheme) was 2.3% for the genitourinary system in terms of cystitis and 4.10% for the gastrointestinal system in terms of proctitis. Grades 4 and 5 genitourinary/gastrointestinal morbidity was not observed. A history of transurethral resection of the prostate with a median interval of less than 6 months from radiotherapy was associated with a high risk of genitourinary toxicity. CONCLUSION: The 8-year results confirm the feasibility and effectiveness of combined elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for cure of localized and especially high-risk prostate cancer.     

PSA kinetics and PSA bounce following permanent seed prostate brachytherapy

PURPOSE: To report the incidence, timing, and magnitude of the benign prostate-specific antigen (PSA) bounce after 125I prostate brachytherapy and correlate the bounce with clinical and/or dosimetric factors. METHODS AND MATERIALS: From March 1999 to August 2003, a total of 292 men received 125I prostate brachytherapy without androgen deprivation or supplemental beam radiotherapy and have PSA follow-up >30 months. Implants were preplanned using transrectal ultrasound (TRUS) and performed under transrectal ultrasound/fluoroscopy guidance using preloaded needles. A PSA bounce is defined as an increase >or=0.2 ng/ml with spontaneous return to prebounce level or lower. RESULTS: Resolved PSA bounces were seen in 40% of men with follow-up >30 months. Median onset was 15 months, and median magnitude was 0.76 ng/ml. Magnitude >2 ng/ml was seen in 15%. The only clinical or dosimetric factor predictive of bounce in multivariate analysis was younger age. Median time to increasing PSA level indicative of failure was 30 months. CONCLUSIONS: Benign PSA bounces are common after 125I prostate brachytherapy, especially in younger men. An increase >2 ng/ml above the nadir was seen in 15%. Magnitude of increase does not distinguish bounce from failure. Time to the start of the PSA increase can be helpful, but is not absolute. The PSA bounce does not predict subsequent failure. Caution is advised in interpreting an early increasing PSA level in the first 30 months after 125I brachytherapy in favorable-risk patients.