Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan–Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
Low Dose Rate Brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy : Practice and outcome analysis in a series of 2237 patients from 11 Institutions / G. Fellin, M.A. Mirri, L. Santoro, B.A. Jereczek-Fossa, C. Divan, S. Mussari, F. Ziglio, B. La Face, F. Barbera, M. Buglione, L. Bandera, B. Ghedi, N.G. Di Muzio, A. Losa, P. Mangili, L. Nava, R. Chiarlone, N. Ciscognetti, E. Gastaldi, F. Cattani, R. Spoto, A. Vavassori, F.R. Giglioli, A. Guarneri, V. Cerboneschi, M. Mignogna, M. Paoluzzi, V. Ravaglia, C. Chiumento, S. Clemente, V. Fusco, R. Santini, M. Stefanacci, F.P. Mangiacotti, M. Martini, T. Palloni, G. Schinaia, G. Lazzari, G. Silvano, S. Magrini, U. Ricardi, R. Santoni, R. Orecchia. - In: BRITISH JOURNAL OF RADIOLOGY. - ISSN 0007-1285. - 89:1065(2016 Jul 25), pp. 20150981.1-20150981.11. [10.1259/bjr.20150981]
Low Dose Rate Brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy : Practice and outcome analysis in a series of 2237 patients from 11 Institutions
B.A. Jereczek-Fossa;R. Spoto;R. OrecchiaUltimo
2016
Abstract
Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan–Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.File | Dimensione | Formato | |
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