Long-term results of Iodine-125 seed brachytherapy in low and intermediate risk prostate carcinoma
PD-0568
Abstract
Long-term results of Iodine-125 seed brachytherapy in low and intermediate risk prostate carcinoma
Authors: Jose-Luis Guinot1, Victor Gonzalez-Perez2, Juan Casanova3, Miguel Angel Santos4, Victor De los Dolores2, Alonso La Rosa4, Alba Sanchez-Rodriguez2, Ana Laborda4, Sandra Canos1, Veronica Cotanda2, Carmen Guardino2, Maria Isabel Tortajada4, Leoncio Arribas4
1Foundation Instituto Valenciano de Oncologia (IVO), Radiation oncology, Valencia, Spain; 2Foundation Instituto Valenciano de Oncologia (IVO), Radiation Physics, Valencia, Spain; 3Foundation Instituto Valenciano de Oncologia (IVO), Urology, Valencia, Spain; 4Foundation Instituto Valenciano de Oncologia (IVO), Radiation Oncology, Valencia, Spain
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Purpose or Objective
Brachytherapy (BT) with Iodine-125 seeds is effective in low-risk
prostate carcinoma, similar to other techniques, but with fewer side effects.
In intermediate risk there are variable results and relapses increase in the
long term. The 10-year biochemical relapse-free survival (BRFS) results are
presented.
Material and Methods
Between 2007 and 2016, 706 patients were treated with the real-time
technique with the ProLink (BARD) © system. 145 Gy was administered to the
prostate with exclusive BT and 108 Gy after 46 Gy of external radiotherapy
(EBRT). Hormonal blocking was used in 19.3%.
Results
With a median follow-up
of 96 months (24-163), the BRFS at 5 years and 10 years is 95% and 91.1%. In
the 480 low risk cases it is 95.7% and 92.7% and in the 226 intermediate risk
cases 92.7% and 88% (p <0.05). With combined treatment EBRT + BT, 133 cases
(59%) of intermediate risk were treated, without differences with the cases of
exclusive BT. Gleason 4 + 3 cases dropped to 72.8% at 10 years (p <0.001),
with hormonal blockade 90.9% and without hormones 66.8%, and it was worse if
they had exclusive BT. The BRFS at 10 years in T1c was 95%, compared to 84% in
T2 (p <0.001). The initial PSA> or <10 showed no differences. With
involvement of> 50% of the cylinders, it fell to 80% at 10 years (p
<0.001). In 154 patients up to 60 years of age, the BRFS at 10 years was
97.6%. There were complications in 18'3% with exclusive BT and 33.3% in
combined. Urological toxicity was 18.7% (16.9% in exclusive BT vs 26.1% in EBRT
+ BT), ≥ G2 in 13.3% and ≥ G3 in 5.8%. Rectal toxicity was very low, 4% (2.5%
in BT alone and 10.1% in RT + BT), ≥ G2 in 1.6% and ≥ G3 in 0.1%.
Conclusion
BT with I-125 seeds is
a very effective long-term treatment in low and intermediate risk prostate
carcinoma. In cases with Gleason 4 + 3 or> 50% affected cylinders, there are
more relapses, and we recommend triple treatment with EBRT + BT + hormonal
blockade for 6 months. Toxicity is limited in cases with combined treatment and
very low with exclusive BT. BT with I-125 seeds should be offered to selected
patients as the first therapeutic option, especially in young patients.