Palladium-103 brachytherapy for prostate carcinoma

• Published in: International journal of radiation oncology, biology, physics Vol. 46; no. 4; pp. 839 - 850
• Main Authors: Blasko, John C, Grimm, Peter D, Sylvester, John E, Badiozamani, Kas Ray, Hoak, David, Cavanagh, William
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2000; Elsevier
• Subjects: Aged; Analysis of Variance; Biological and medical sciences; Brachytherapy; Brachytherapy - methods; Cohort Studies; Disease-Free Survival; Follow-Up Studies; Genital system. Mammary gland; Half-Life; Humans; Male; Medical sciences; Neoplasm Staging; Nephrology. Urinary tract diseases; Palladium - therapeutic use; Prospective Studies; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radioisotopes - therapeutic use; Radiopharmaceuticals - therapeutic use; Radiotherapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Failure; Tumors of the urinary system; Ultrasonography, Interventional; Urinary tract. Prostate gland; Brachytherapy; Radiotherapy; Prostate-specific antigen; Prostate cancer; Human; Correlation; Kaplan Meier estimator; Urinary system disease; Carcinoma; Prostate disease; Treatment efficiency; Male; Tumoral marker; Palladium; Malignant tumor; Prostate specific antigen; Time interval; Male genital diseases; Curietherapy; Prostate
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(99)00499-X

Purpose: A report of biochemical outcomes for patients treated with palladium-103 (Pd-103) brachytherapy over a fixed time interval. Methods and Materials: Two hundred thirty patients with clinical stage T1–T2 prostate cancer were treated with Pd-103 brachytherapy and followed with prostate-specific antigen (PSA) determinations. Kaplan-Meier estimates of biochemical failure on the basis of two consecutive elevations of PSA were utilized. Multivariate risk groups were constructed. Aggregate PSA response by time interval was assessed. Results: The overall biochemical control rate achieved at 9 years was 83.5%. Failures were local 3.0%; distant 6.1%; PSA progression only 4.3%. Significant risk factors contributing to failure were serum PSA greater than 10 ng/ml and Gleason sum of 7 or greater. Five-year biochemical control for those exhibiting neither risk factor was 94%; one risk factor, 82%; both risk factors, 65%. When all 1354 PSA determinations obtained for this cohort were considered, the patients with a proportion of PSAs ≤ 0.5 ng/ml continued to increase until at least 48 months post-therapy. These data conformed to a median PSA half-life of 96.2 days. Conclusions: Prostate brachytherapy with Pd-103 achieves a high rate of biochemical and clinical control in patients with clinically organ-confined disease. PSA response following brachytherapy with low-dose-rate isotopes is protracted.