A history of transurethral resection of the prostate should not be a contra-indication for low-dose-rate  125 I prostate brachytherapy: results of a prospective Uro-GEC phase-II trial

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Abstract

Purpose

Early reports suggested that transurethral resection (TURP) prior to permanent seed brachytherapy (BT) results in high incontinence rates. Guidelines consider prior TURP as a contra-indication to treatment, but improvements in imaging and treatment planning may reduce this risk, and are investigated in this prospective study.

Material and methods

99 men with histologically proven low- to intermediate-risk, localized prostate cancer, with a history of TURP performed at least 3 months before BT procedure were enrolled. All patients received a permanent seed implant between March 2009 and June 2015. Intra-operative interactive planning was recommended to ensure optimal accuracy of seed placement during the procedure. No supplemental external beam was allowed. Target and organ at risk contouring, definition of clinical target volume (CTV), and dosimetric parameters followed the modified GEC-ESTRO guidelines for permanent seed implants, as described an earlier report of our group. Follow-up was scheduled every 3 months for the first year, and every 6 months afterwards, with minimum follow-up of 2 years.

Study endpoints

The primary endpoint was the incidence of post-implant urinary incontinence. Secondary endpoints were the incidence of urinary and gastro-intestinal toxicity, the eventual impact on the sexual function, and the freedom from biochemical failure.

Results

The median follow-up time for these 99 patients was 49 months (min. 24, max. 96). In this series, the incontinence rate was 2% after TURP + BT and 2% in case of TURP + BT + re-TURP, ending up with a total urinary incontinence rate of 4%. Acute and late urinary toxicities were extremely low. No significant late gastro-intestinal toxicity was seen, and the 5-year biochemical non-evidence of disease (bNED) was 93%.

Conclusions

The excellent long-term results and low morbidity presented as well as many advantages of prostate brachytherapy over other treatments demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and organ-confined prostate cancer.

Related collections

Most cited references 24

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American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy.

Brian J. Davis, Eric Horwitz, W Robert Lee … (2012)

To provide updated American Brachytherapy Society (ABS) guidelines for transrectal ultrasound-guided transperineal interstitial permanent prostate brachytherapy (PPB). The ABS formed a committee of brachytherapists and researchers experienced in the clinical practice of PPB to formulate updated guidelines for this technique. Sources of input for these guidelines included prior published guidelines, clinical trials, published literature, and experience of the committee. The recommendations of the committee were reviewed and approved by the Board of Directors of the ABS. Patients with high probability of organ-confined disease or limited extraprostatic extension are considered appropriate candidates for PPB monotherapy. Low-risk patients may be treated with PPB alone without the need for supplemental external beam radiotherapy. High-risk patients should receive supplemental external beam radiotherapy if PPB is used. Intermediate-risk patients should be considered on an individual case basis. Intermediate-risk patients with favorable features may appropriately be treated with PPB monotherapy but results from confirmatory clinical trials are pending. Computed tomography-based postimplant dosimetry performed within 60 days of the implant is considered essential for maintenance of a satisfactory quality assurance program. Postimplant computed tomography-magnetic resonance image fusion is viewed as useful, but not mandatory. Updated guidelines for patient selection, workup, treatment, postimplant dosimetry, and followup are provided. These recommendations are intended to be advisory in nature with the ultimate responsibility for the care of the patients resting with the treating physicians. Copyright © 2012. Published by Elsevier Inc.

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American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer.

Lekshmi Nath, P Grimm, S Nag … (1999)

To develop and disseminate the American Brachytherapy Society (ABS) recommendations for the clinical quality assurance and guidelines of permanent transperineal prostate brachytherapy with 125I or 103Pd. The ABS formed a committee of experts in prostate brachytherapy to develop consensus guidelines through a critical analysis of published data supplemented by their clinical experience. The recommendations of the panels were reviewed and approved by the Board of Directors of the ABS. Patients with high probability of organ-confined disease are appropriately treated with brachytherapy alone. Brachytherapy candidates with a significant risk of extraprostatic extension should be treated with supplemental external beam radiation therapy (EBRT). Patient selection guidelines were developed. Dosimetric planning of the implant should be carried out for all patients before seed insertion. A modified peripheral loading is preferred. The AAPM TG-43 recommendations requiring a change in prescription dose for 125I sources should be universally implemented. The recommended prescription doses for monotherapy are 145 Gy for 125I and 115-120 Gy for 103Pd. The corresponding boost doses (after 40-50 Gy EBRT) are 100-110 Gy and 80-90 Gy, respectively. Clinical evidence to guide selection of radionuclide (103Pd or 125I) is lacking. Post implant dosimetry and evaluation must be performed on all patients. It is suggested that the dose that covers 90% (D90) and 100% (D100) of the prostate volume and the percentage of the prostate volume receiving the prescribed dose (V100) be obtained from a dose-volume histogram (DVH) and reported. Guidelines for appropriate patient selection, dose reporting, and improved quality of permanent prostate brachytherapy are presented. These broad recommendations are intended to be technical and advisory in nature, but the ultimate responsibility for the medical decisions rests with the treating physician. This is a constantly evolving field, and the recommendations are subject to modifications as new data becomes available.

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Daniel Ash, Anthony Flynn, Jan Battermann … (2000)

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Author and article information

Contributors

Peter Hoskin: On behalf of : for the Uro-GEC working group of ESTRO

Journal

Journal ID (nlm-ta): J Contemp Brachytherapy

Journal ID (iso-abbrev): J Contemp Brachytherapy

Journal ID (publisher-id): JCB

Title: Journal of Contemporary Brachytherapy

Publisher: Termedia Publishing House

ISSN (Print): 1689-832X

ISSN (Electronic): 2081-2841

Publication date (Electronic): 28 February 2020

Publication date (Print): February 2020

Volume: 12

Issue: 1

Pages: 1-5

Affiliations

[1 ]Department of Radiotherapy, Europe Hospitals Brussels, Belgium,

[2 ]University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,

[3 ]Department of Radiation Oncology, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands,

[4 ]Mount Vernon Cancer Centre, Northwood, United Kingdom

Author notes

Address for correspondence: Carl Salembier, MD, Department of Radiotherapy, Europe Hospitals Brussels, Belgium, e-mail: c.salembier@ 123456europehospitals.be

Article

Publisher ID: 39843

DOI: 10.5114/jcb.2020.92913

PMC ID: 7073343

SO-VID: fe3df882-b0b0-4b53-9823-d504e1b0fa06

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)