1. Biochemical control and toxicity for favorable- and intermediate-risk patients using real-time intraoperative inverse optimization prostate seed implant: Less is more!
- Author
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A.L. Hanlon, E. Crockett, Adam Raben, Bruce Benge, M. Lobis, T. Desperito, Firas Mourtada, D. Cozzolino, Abrihup Sarkar, J. Martelli-Raben, H Chen, S. Terranova, E. Kemmerer, Andrew Glick, and Gaurav Shukla
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Brachytherapy ,Urology ,Adenocarcinoma ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,Iodine Radioisotopes ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Risk Factors ,Prostate ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Seed Implant ,Aged ,Prostatectomy ,Radioisotopes ,Intraoperative Care ,Genitourinary system ,business.industry ,Prostatic Neoplasms ,Androgen Antagonists ,Radiotherapy Dosage ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,Androgen ,Surgery ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Toxicity ,Inverse optimization ,Neoplasm Grading ,business ,Palladium ,Follow-Up Studies - Abstract
Purpose To report the biochemical control rate and clinical outcomes with real-time inverse planning (inverse optimization prostate seed implant [IO-PSI]) for favorable-risk (FR) and intermediate-risk (IR) prostate adenocarcinoma in a community practice setting. This analysis is an extended followup of our initial report, with favorable early biochemical control rate (biochemical nonevidence of disease) of 97% at 4 years. Methods and Materials Three hundred fifty-seven evaluable patients with FR and IR prostate cancer underwent real-time IO-PSI (iodine-125/145 Gy or palladium-103/120 Gy) between 2001 and 2013. Results With a median followup of 54 months (range, 24–110 months), the absolute biochemical failure free survival of disease was 96%. The 8-year actuarial probability of prostate-specific antigen failure-free survival for FR and IR cohorts was 92.4% and 87%, respectively. Late genitourinary and gastrointestinal toxicity remained low. Late Grade 2 and Grade 3 genitourinary toxicity was 19% and 1%, respectively. Late Grade 2 and 3 rectal bleeding rates were 1% and 0%, respectively. No difference in biochemical control was observed with preimplant short course androgen deprivation or between Gleason score 3 + 4 vs. 4 + 3 patients. No dosimetric parameter was predictive of biochemical failure. Patients with FR had a significantly decreased risk of failure (hazard ratio = 0.26; 95% confidence interval = 0.09–0.78; p = 0.02) compared with those with IR. Patients with a prostate-specific antigen nadir >0.4 ng/mL had an increased risk of failure (hazard ratio = 1.37; 95% confidence interval = 1.27–1.47; p Conclusions Our initial biochemical and clinical outcomes using real-time IO-PSI persisted with extended followup and support our original hypothesis for use of a reduced number of sources, needles, and total activity, suggesting that with IO, less is more.
- Published
- 2017