Intra-operative pubic arch interference during prostate seed brachytherapy in patients with CT-based pubic arch interference of < or =1cm

• Published in: Radiotherapy and oncology Vol. 91; no. 2; pp. 249 - 254
• Main Authors: Sejpal, Samir V, Sathiaseelan, Vythialingam, Helenowski, Irene B, Kozlowski, James M, Carter, Michael F, Nadler, Robert B, Dalton, Daniel P, McVary, Kevin T, Lin, William W, Garnett, John E, Kalapurakal, John A
• Format: Journal Article
• Language: English
• Published: Ireland 01.05.2009
• Subjects: Aged; Brachytherapy; Humans; Male; Middle Aged; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; Pubic Bone - diagnostic imaging; Radiotherapy Dosage; Tomography, X-Ray Computed - methods
• ISSN: 1879-0887
• DOI: 10.1016/j.radonc.2009.02.006

There are only a few reports on the frequency of intra-operative pubic arch interference (I-PAI) during prostate seed brachytherapy (PB). Two hundred and forty-three patients with a CT-based pubic arch interference (PAI) of < or =1 cm and a prostate volume of < or =50-60 cc underwent PB. Those patients requiring needle repositioning by > or =0.5 cm on the template were scored as having I-PAI. The incidence of I-PAI and its impact on biochemical control were analyzed. Intra-operative PAI was encountered in 47 (19.3%) patients. Forty two patients (17.3%) had I-PAI in 1-2 needles, two (0.8%) had I-PAI in four needles and three patients (1.2%) had I-PAI in six needles. Overall, 1.4% of needles required repositioning due to I-PAI. BMI>27 kg/m(2) and wider (>75 mm) pubic bone separation at mid ramus (PS-ML) were associated with a lower incidence of I-PAI. At a median follow-up of 50.1 months, the 3- and 5-year bPFS was 97.3% and 95.2%, respectively. The 5-year bPFS rates for patients with and without I-PAI were 95.6% and 95%, respectively (p=0.28). The use of CT-based PAI of < or =1cm as a selection criterion for PB is a simple and reliable method for minimizing the incidence of I-PAI and maintaining excellent biochemical control rates.