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Permanent interstitial low-dose-rate brachytherapy for patients with low risk prostate cancer

An interim analysis of 312 cases

Permanente interstitielle Low-Dose-Rate-Brachytherapie bei Patienten mit lokalisiertem Prostatakarzinom

Eine Interimsanalyse von 312 Fällen

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Abstract

Purpose

The biochemical relapse-free survival (bRFS) rate after treatment with permanent iodine-125 seed implantation (PSI) or combined seeds and external beam radiotherapy (COMB) for clinical stage T1–T2 localized prostate cancer is a clinically relevant endpoint. The goal of this work was to evaluate the influence of relevant patient- and treatment-related factors.

Materials and methods

The study population comprised 312 consecutive patients treated with permanent seed implantation. All patients were evaluable for analysis of overall survival (OS) and disease-specific survival (DSS), 230 for bRFS, of which 192 were in the PSI group and 38 in the COMB group. The prescribed minimum peripheral dose was 145 Gy for PSI, for COMB 110 Gy implant and external beam radiotherapy of 45 Gy. The median follow-up time was 33 months (range 8–66 months). bRFS was defined as a serum prostate-specific antigen (PSA) level ≤ 0.2 ng/ml at last follow-up.

Results

Overall, the actuarial bRFS at 50 months was 88.4 %. The 50-month bRFS rate for PSI and COMB was 90.9 %, and 77.2 %, respectively. In the univariate analysis, age in the categories ≤ 63 and > 63 years (p < 0.00), PSA nadir (≤ 0.5 ng/ml and > 0.5 ng\ml) and PSA bounce (yes/no) were the significant predicting factors for bRFS. None of the other patient and treatment variables (treatment modality, stage, PSA, Gleason score, risk group, number of risk factors, D90 and various other dose parameters) were found to be a statistically significant predictor of 50-month bRFS.

Conclusion

The biochemical failure rates were low in this study. As a proof of principle, our large monocenteric analysis shows that low-dose-rate brachytherapy is an effective and safe procedure for patients with early stage prostate cancer.

Zusammenfassung

Hintergrund und Ziel

Das biochemisch rezidivfreie Überleben (bRFS) nach der Brachytherapie mit permanenter Iod-125-Seed-Implantation (PSI) oder in Kombination mit externer Radiotherapie (COMB) ist beim Patienten mit frühem Prostatakarzinom (T1/T2) ein relevanter klinischer Endpunkt. Ziel der Arbeit war es, Langzeitergebnisse und prognostische Faktoren einer großen Kohorte zu analysieren.

Patienten und Methoden

Eine Kohorte von 312 Patienten wurde mit PSI allein oder in Kombination mit einer externen Radiotherapie behandelt. Alle Patienten konnten zur Analyse der Gesamtüberlebensrate (OS) und der krankheitsfreien Überlebensrate (DFS) herangezogen werden; in 230 Fällen wurde das bRFS kalkuliert, davon 192 in der PSI- und 38 in der COMB-Gruppe. Die Dosis der Brachytherapie betrug im Monotherapie-Arm 145 Gy und bei der Kombinationstherapie 110 Gy plus 45 Gy externe Radiotherapie. Die mediane Nachbeobachtungszeit betrug 33 Monate (Spanne 8–66 Monate). Das bRFS war definiert über ein prostataspezifisches Antigen-(PSA-)Level im Serum ≤ 0,2 ng/ml beim letzten Follow-up.

Ergebnisse

Das bRFS nach 50 Monaten lag bei 88,4 %, wobei das bRFS im Monotherapie-Arm 90,9 % und im Kombinationsarm 77,2 % betrug. Die univariate Analyse ergab, dass Alter (≤ 63 vs. > 63 Jahre; p < 0,00), PSA-Nadir (≤ 0,5 ng/ml vs. > 0,5 ng/ml) und PSA-Wiederanstieg (ja/nein) signifikant den primären Studienendpunkt beeinflussten.

Schlussfolgerung

Die biochemischen Fehlerraten in dieser Studie waren gering und das bRFS ist somit gut und vergleichbar Unsere monozentrische Studie mit ausreichender Patientenzahl zeigt, dass sich die Low-Dose-Rate-Brachytherapie als eine effektive und sichere Methode für diese Patientengruppe erwiesen hat.

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Conflict of interest

H. Badakhshi, R. Graf, V. Budach, and P. Wust state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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No funding to support the research in regard to this paper was received.

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Authors and Affiliations

  1. Department for Radiation Oncology of Charité School of Medicine, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Harun Badakhshi M.D., PhD, Reinhold Graf M.D., Volker Budach M.D., Ph.D. & Peter Wust M.D., Ph.D.

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  1. Harun Badakhshi M.D., PhD
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  2. Reinhold Graf M.D.
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  3. Volker Budach M.D., Ph.D.
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Correspondence to Harun Badakhshi M.D., PhD.

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Badakhshi, H., Graf, R., Budach, V. et al. Permanent interstitial low-dose-rate brachytherapy for patients with low risk prostate cancer. Strahlenther Onkol 191, 303–309 (2015). https://doi.org/10.1007/s00066-014-0762-6

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