Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

• Published in: British journal of radiology Vol. 89; no. 1065; p. 20150981
• Main Authors: Fellin, Giovanni, Mirri, Maria A, Santoro, Luigi, Jereczek-Fossa, Barbara A, Divan, Claudio, Mussari, Salvatore, Ziglio, Francesco, La Face, Beniamino, Barbera, Fernando, Buglione, Michela, Bandera, Laura, Ghedi, Barbara, Di Muzio, Nadia G, Losa, Andrea, Mangili, Paola, Nava, Luciano, Chiarlone, Renato, Ciscognetti, Nunzia, Gastaldi, Emilio, Cattani, Federica, Spoto, Ruggero, Vavassori, Andrea, Giglioli, Francesca R, Guarneri, Alessia, Cerboneschi, Valentina, Mignogna, Marcello, Paoluzzi, Mauro, Ravaglia, Valentina, Chiumento, Costanza, Clemente, Stefania, Fusco, Vincenzo, Santini, Roberto, Stefanacci, Marco, Mangiacotti, Francesco P, Martini, Marco, Palloni, Tiziana, Schinaia, Giuseppe, Lazzari, Grazia, Silvano, Giovanni, Magrini, Stefano, Ricardi, Umberto, Santoni, Riccardo, Orecchia, Roberto
• Format: Journal Article
• Language: English
• Published: England The British Institute of Radiology 01.09.2016
• Subjects: Adult; Aged; Aged, 80 and over; Brachytherapy - methods; Brachytherapy - mortality; Dose-Response Relationship, Radiation; Genitourinary tract; Humans; Italy - epidemiology; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local - mortality; Practice Patterns, Physicians; Prostate-Specific Antigen; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; Radiotherapy and Oncology; Radiotherapy Dosage; Treatment Outcome; Ultrasonography, Interventional - methods
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr.20150981

Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.