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Long-term outcomes in patients younger than 60 years of age treated with brachytherapy for prostate cancer

Langzeitergebnisse einer Brachytherapie des Prostatakarzinoms bei Patienten unter 60 Jahren

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Abstract

Purpose

The purpose of the study was to report the outcomes and late toxicities in patients younger than 60 years of age with long-term follow-up treated with low dose rate (LDR) brachytherapy for localized prostate cancer.

Methods

Between January 2000 and December 2009, 270 consecutive patients were treated with favourable localized prostate cancer; the median follow-up was 111 months (range 21–206). All patients received one implant of LDR brachytherapy. Toxicity was reported according to the Common Toxicity Criteria for Adverse Events, Version 4.0 (CTAE v4.02) by the National Cancer Institute.

Results

The overall survival according to Kaplan–Meier estimates was 99 (±1%) at 17 years. The 17-year rate for failure in tumour-free survival (TFS) was 97% (±1%), whereas for biochemical control it was 95% (±1%) at 17 years, 97% (±1%) of patients being free of local recurrence. No intraoperative or perioperative complications occurred. Acute genitourinary (GU) grade II toxicity was 4% at 12 months. No other chronic toxicity was observed after treatment. At 6 months, 94% of patients reported no change in bowel function.

Conclusions

LDR brachytherapy provides patients younger than 60 years of age with low and intermediate-risk prostate cancer excellent outcomes and has a low risk of significant long-term GU or gastrointestinal morbidity.

Zusammenfassung

Zielsetzung

Ziel der Studie war es, im Langzeit-Follow-up die Behandlungsergebnisse und die Spättoxizität bei Patienten unter 60 Jahren, die eine niedrig dosierte Brachytherapie („low dose rate“ [LDR]) bei lokal begrenztem Prostatakarzinom erhielten, zu erfassen.

Methoden

Von Januar 2000 bis Dezember 2009 wurden 270 konsekutive Patienten mit günstig lokalisiertem Prostatakarzinom behandelt; die Follow-up-Dauer betrug im Median 111 Monate (Spanne 21–206 Monate). Jeder Patient erhielt ein Implantat für die LDR-Brachytherapie. Die Toxizität wurde gemäß den Common Toxicity Criteria for Adverse Events, Version 4.0 (CTCAE v4.02), des National Cancer Institute erfasst.

Ergebnisse

Das Gesamtüberleben nach einer Kaplan-Meier-Schätzung betrug 99 % (±1 %) nach 17 Jahren. Die 17-Jahres-Rate für das Versagen im tumorfreien Überleben lag bei 97 % (±1 %), die für die biochemische Kontrolle bei 95 % (±1 %) nach 17 Jahren, 97 % (±1 %) der Patienten hatten kein lokales Rezidiv. Intraoperative oder perioperative Komplikationen ereigneten sich nicht. Die urogenitale Grad-II-Toxizität betrug nach 12 Monaten 4 %. Eine anderweitige chronische Toxizität wurde nach der Behandlung nicht beobachtet. Nach 6 Monaten gaben 94% der Patienten keine Veränderungen in der Darmfunktion an.

Schlussfolgerungen

Mit der LDR-Brachytherapie werden bei Patienten unter 60 Jahren mit Low-risk- oder Intermediate-risk-Prostatakarzinom hervorragende Ergebnisse erzielt. Das Risiko einer signifikanten langfristigen Morbidität im urogenitalen oder gastrointestinalen Bereich ist gering.

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Abbreviations

AJCC:

American Joint Committee on Cancer

BT:

Brachytherapy

EBRT:

External beam radiotherapy

CTAE v4.02:

Common Toxicity Criteria for Adverse Event, version 4.02

D90:

The dose that covers 90% volume of CTV

GI:

Gastrointestinal

GU:

Genitourinary

LDR:

Low dose rate

PSA:

Serum prostate-specific antigen

SPSS:

Statistical analysis SPSS

SD:

Standard deviations

TFS:

Tumor-free survival

TG-43:

Task group 43 (American Association of Physicist in Medicine)

TRUS:

Transrectal ultrasound

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Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain

    Pedro J. Prada M.D., Ph.D., Juan Cardenal M.D., Ana García Blanco M.D., Javier Anchuelo M.D., María Ferri M.D. & Ivan Diaz de Cerio M.D.

  2. Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

    Andrés Vázquez Ph.D., Maite Pacheco Ph.D. & Samuel Ruiz Arrebola Ph.D.

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  1. Pedro J. Prada M.D., Ph.D.
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  2. Juan Cardenal M.D.
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  3. Ana García Blanco M.D.
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  4. Javier Anchuelo M.D.
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  5. María Ferri M.D.
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  6. Ivan Diaz de Cerio M.D.
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  8. Maite Pacheco Ph.D.
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Correspondence to Pedro J. Prada M.D., Ph.D..

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Conflict of interest

P.J. Prada, J. Cardenal, A. García Blanco, J. Anchuelo, M. Ferri, I. Diaz de Cerio, A. Vázquez, M. Pacheco and S. Ruiz Arrebola declare that they have no competing interests.

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Prada, P.J., Cardenal, J., García Blanco, A. et al. Long-term outcomes in patients younger than 60 years of age treated with brachytherapy for prostate cancer. Strahlenther Onkol 194, 311–317 (2018). https://doi.org/10.1007/s00066-017-1238-2

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  • DOI: https://doi.org/10.1007/s00066-017-1238-2

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