Long-Term Efficacy and Toxicity of Low Dose Rate 125I Prostate Brachytherapy as Monotherapy in Low, Intermediate, and High-Risk Prostate Cancer
Menée à partir de données portant sur 1 989 patients atteints d'un cancer de la prostate à risque faible, intermédiaire ou élevé de récidive et traités entre 1996 et 2007 (âge médian : 67 ans), cette étude évalue l'efficacité, du point de vue de la mortalité spécifique et des taux de survie sans récidive biochimique, de survie sans métastases distantes ou de survie globale à 5 ans, et la toxicité génito-urinaire ou gastro-intestinale d'une curiethérapie à faible débit de dose par iode 125
Purpose/Objectives : To report long-term efficacy and toxicity for a single-institution cohort of patients treated with low dose-rate prostate brachytherapy (PI) monotherapy. Methods and Materials : From 1996-2007, 1,989 patients with low (61.3%), low-intermediate (29.8%), high-intermediate (4.5%), and high-risk prostate cancer (4.4%) were treated with PI and followed prospectively in a registry. All patients were treated with 125I monotherapy to 144 Gy. Late toxicity was coded retrospectively according to a modified Common Terminology Criteria for Adverse Events (CTCAE) 4.0 scale. The rates of biochemical relapse-free survival (bRFS), distant metastases free survival (DMFS), overall survival (OS), and prostate cancer specific mortality (PCSM) were calculated. We identified factors associated with late grade ≥ 3 genitourinary (GU) and gastrointestinal (GI) toxicity, bRFS, DMFS, OS, PCSM, and incontinence. Results : Median age was 67 years, and median overall and PSA follow-up were 6.8 years and 5.8 years, respectively. The overall 5-year rates for bRFS, DMFS, OS, and PCSM were 90.5%, 97.0%, 92.6%, and 0.71%, respectively. The 10-year rates were 81.5%, 91.5%, 76.1%, and 2.5%, respectively. The overall rates of late grade ≥ 3 GU and GI toxicity were 7.6% and 0.8%, respectively. On multivariable analysis, age and prostate length were significantly associated with increased risk of late grade ≥ 3 GU toxicity. The risk of incontinence was highly correlated with both pre- and post-PI transurethral resection of the prostate (TURP). Conclusions : Prostate brachytherapy as monotherapy is an effective treatment for low and low-intermediate risk prostate cancer and appears promising as a treatment for high-intermediate and high risk prostate cancer. Significant long-term toxicities are rare when brachytherapy is performed as monotherapy.
http://www.redjournal.org/article/S0360-3016(15)00253-9/abstract