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Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients

Vergleich von Seeds-Brachytherapie und externer Strahlentherapie (70 bzw. 74 Gy) bei 919 Niedrigrisiko-Prostatakarzinompatienten

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Abstract

Purpose

The aim of this analysis was to compare the biochemical no evidence of disease (bNED) rates in low-risk prostate cancer patients treated at two centers of excellence using different approaches: seed brachytherapy (BT) and external beam radiotherapy (EBRT).

Materials and methods

A total of 919 low-risk prostate cancer patients, treated from 1998–2008, were identified in the two databases. In Utrecht, 667 patients received I-125 BT applying a dose of 144 Gy. In Vienna, 252 patients were treated with EBRT, applying a local dose of 70 Gy in 82 patients and 74 Gy in 170 patients. bNED rates (Phoenix definition) were assessed.

Results

The median follow-up was 46 months (range 1–148 months). The 5-year actuarial bNED rates were 94% for BT patients and 88% for EBRT patients (p = 0.002)—84% for patients receiving 70 Gy and 91% for patients receiving 74 Gy, respectively. In the univariate analysis, patients receiving 70 Gy showed significantly worse outcome compared to BT (p = 0.001) and a difference close to significance compared to 74 Gy (p = 0.06). In the multivariate analysis including tumor stage, Gleason score, initial PSA, hormonal therapy, and dose, patients receiving 70 Gy EBRT showed significantly worse bNED rates compared to BT patients.

Conclusion

Low-risk prostate cancer patients receiving 74 Gy by EBRT show comparable biochemical control rates to patients receiving seed brachytherapy, whereas patients receiving 70 Gy show significantly worse outcome.

Zusammenfassung

Ziel

Das Ziel der Studie war der Vergleich der biochemischen Kontrollrate („biochemical no evidence of disease“, bNED) bei Niedrigrisiko-Prostatakarzinompatienten, die an zwei Kompetenzzentren unterschiedlich behandelt wurden: mit der Seeds-Brachytherapie (BT) und mit externer Strahlentherapie (EBRT, mit 70 bzw. 74 Gy).

Material und Methoden

Zwischen 1998 und 2008 wurden 919 Patienten mit einem Niedrigrisiko-Prostatakarzinom behandelt und eingeschlossen. In Utrecht erhielten 667 Patienten eine Jod-125 Seeds-Brachytherapie mit einer Dosis von 144 Gy. In Wien wurden 252 Patienten mittels EBRT behandelt, wobei 82 Patienten mit 70 Gy und 170 Patienten mit 74 Gy bestrahlt wurden. Die biochemischen Kontrollraten wurden entsprechend der Phönix-Definition ermittelt.

Ergebnisse

Die mittlere Nachsorge betrug 46 Monate (1–148 Monate). Die biochemischen 5-Jahres-Kontrollraten lagen bei 94% für die BT- und bei 88% für alle EBRT-Patienten (p = 0,002) mit jeweils 84% für die 70-Gy-Patienten und 91% für die 74-Gy-Patienten. In der univariaten Analyse zeigten die 70-Gy-Patienten im Vergleich zu den BT-Patienten signifikant schlechtere Resultate (p = 0,001) und im Vergleich zu den 74-Gy-Patienten beinahe signifikante Unterschiede (p = 0,06; Fig. 1). In der multivariaten Analyse mit Einschluss von Tumor-Stadium, Gleason-Score, initialem PSA, Hormontherapie und Dosis zeigten Patienten bei EBRT mit 70 Gy signifikant schlechtere bNED-Raten (Tab. 2).

Schlussfolgerung

Niedrig-Risiko Prostatakarzinompatienten, die mittels EBRT mit 74 Gy behandelt wurden zeigen vergleichbare Resultate zu Seeds Brachytherapie Patienten. Patienten, die mit einer Dosis von 70 Gy mittels EBRT behandelt werden zeigen signifikant schlechtere Tumorkontrollraten.

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Fig. 1
Fig. 2

References

  1. Alicikus ZA, Yamada Y, Zhang Z et al (2011) Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. Cancer 117:1429–1437

    Article  PubMed  Google Scholar 

  2. Al-Mamgani A, Heemsbergen W, Levendag PC et al (2010) Subgroup analysis of patients with localized prostate cancer treated within the Dutch-randomized dose escalation trial. Radiother Oncol 96:13–18

    Article  PubMed  Google Scholar 

  3. Ash D, Flynn A, Battermann J et al (2000) ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 57:315–321

    Article  PubMed  CAS  Google Scholar 

  4. Battermann JJ (2000) I-125 implantation for localized prostate cancer: the Utrecht University experience. Radiother Oncol 57:269–272

    Article  PubMed  CAS  Google Scholar 

  5. Battermann JJ, Boon TA, Moerland MA (2004) Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiother Oncol 71:23–28

    Article  PubMed  Google Scholar 

  6. Chism DB, Hanlon AL, Horwitz EM et al (2004) A comparison of the single and double factor high-risk models for risk assignment of prostate cancer treated with 3D conformal radiotherapy. Int J Radiat Oncol Biol Phys 59:380–385

    Article  PubMed  Google Scholar 

  7. Dearnaley DP, Sydes MR, Graham JD et al (2007) Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 8:475–487

    Article  PubMed  Google Scholar 

  8. Dolezel M, Odrazka K, Vaculikova M et al (2010) Dose escalation in prostate radiotherapy up to 82 Gy using simultaneous integrated boost: direct comparison of acute and late toxicity with 3D-CRT 74 Gy and IMRT 78 Gy. Strahlenther Onkol 186:197–202

    Article  PubMed  Google Scholar 

  9. Ghadjar P, Gwerder N, Manser P et al (2010) High-dose (80 Gy) intensity-modulated radiation therapy with daily image-guidance as primary treatment for localized prostate cancer. Strahlenther Onkol 186:687–692

    Article  PubMed  Google Scholar 

  10. Goldner G, Bombosch V, Geinitz H et al (2009) Moderate risk adapted dose escalation with three-dimensional conformal radiotherapy of localized prostate cancer from 70 to 74 Gy. Strahlenther Onkol 185:94–100

    Article  PubMed  Google Scholar 

  11. Goldner G, Dimopoulos J, Kirisits C et al (2009) Moderate dose escalation in three-dimensional conformal localized prostate cancer radiotherapy single-institutional experience in 398 patients comparing 66 Gy versus 70 Gy versus 74 Gy. Strahlenther Onkol 185:438–445

    Article  PubMed  Google Scholar 

  12. Goldner G, Sljivic S, Oismueller R et al (2011) Prostate cancer radiotherapy in Austria: overview on number of patients, intention to treat and treatment techniques based on the year 2007. Strahlenther Onkol 187:279–283

    Article  PubMed  Google Scholar 

  13. Guckenberger M, Ok S, Polat B et al (2010) Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer. Strahlenther Onkol 186:535–543

    Article  PubMed  Google Scholar 

  14. Hinnen KA, Battermann JJ, Roermund JGH van et al (2010) Long-term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 76:1433–1438

    Article  PubMed  Google Scholar 

  15. ICRU (1999) Report 62: prescribing, recording and reporting photon beam therapy (supplement to ICRU report 50). Bethesda: International Commission on Radiation Units and Measurements

  16. Kuban DA, Tucker SL, Dong L et al (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74

    Article  PubMed  Google Scholar 

  17. Kupelian PA, Potters L, Khuntia D et al (2004) Radical prostatectomy, external beam radiotherapy < 72 Gy, external beam radiotherapy > or = 72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 58:25–33

    Article  PubMed  Google Scholar 

  18. Leitlinienprogramm Onkologie, S3-Leitlinie Prostatakarzinom, Version 2.0, 1. Aktualisierung 09.2011; http://www.degro.org/dav/html/leitlinien/LLPCA.pdf, accessed 13 February 2012

  19. Nag S, Beyer D, Friedland J et al (1999) American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 44:789–799

    Article  PubMed  CAS  Google Scholar 

  20. Nath R, Anderson LL, Luxton G et al (1995) Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM radiation therapy committee task group no. 43. Med Phys 22:209–223

    Article  PubMed  CAS  Google Scholar 

  21. National Comprehensive Cancer Network Website http://www.nccn.org/professionals/physician_gls/f_guidelines.asp, accessed 13 February 2012

  22. Peeters ST, Heemsbergen WD, Koper PC et al (2006) Dose-response in radiotherapy for localized prostate cancer: resultsof the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with78 Gy. J Clin Oncol 24:1990–1996

    Article  PubMed  Google Scholar 

  23. Pieters BR, Back DZ de, Koning CC et al (2009) Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: a systematic review. Radiother Oncol 93:168–173

    Article  PubMed  Google Scholar 

  24. Pinkawa M, Piroth MD, Holy R et al (2011) Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer. Strahlenther Onkol 187:479–484

    Article  PubMed  Google Scholar 

  25. Roach M III, Hanks G, Thames H Jr et al (2006) Defining biochemical failurefollowing radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO phoenix consensus conference. Int J Radiat Oncol Biol Phys 65:965–974

    Article  PubMed  Google Scholar 

  26. Salembier C, Lavagnini P, Nickers P et al (2007) Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol 83:3–10

    Article  PubMed  Google Scholar 

  27. Sylvester JE, Blasko JC, Grimm PD et al (2003) Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys 57:944–952

    Article  PubMed  Google Scholar 

  28. Zelefsky MJ, Kuban DA, Levy LB et al (2007) Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 67:327–333

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors want to thank Mag. Alexander Iro for his support regarding statistical analyses.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiobiology, University Hospital of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    G. Goldner M.D., R. Pötter, M.P. Schmid & C. Kirisits

  2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    J.J. Battermann, S. Sljivic & M. van Vulpen

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  1. G. Goldner M.D.
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  2. R. Pötter
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  7. M. van Vulpen
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Correspondence to G. Goldner M.D..

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Goldner, G., Pötter, R., Battermann, J. et al. Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients. Strahlenther Onkol 188, 305–310 (2012). https://doi.org/10.1007/s00066-012-0078-3

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