A multicenter evaluation of biochemical relapse free survival outcomes for intra-operatively planned prostate brachytherapy using an automated delivery system

Publication date: Available online 6 June 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Kevin Martell, Siraj Husain, Daniel Taussky, Steve Angyalfi, Guila Delouya, Philippe Després, Luc Beaulieu, Andre-Guy Martin, Eric Vigneault
PurposeTo report biochemical recurrence in prostate cancer treated with intraoperatively planned low dose rate prostate brachytherapy using an automated delivery system (IO-LDRB).MethodsBetween 2003 and 2013, 2608 patients from 3 centers were treated with IO-LDRB as single modality treatment for low or low-tier intermediate risk prostate cancer. Databases from the three centers have been analyzed. These independent databases were collected prospectively. Patient, tumor and treatment characteristics were then compared and Kaplan-Meier survival estimates of biochemical relapse free survival (bRFS) were generated and the Cox Proportional Hazards model was used to determine factors predicting for relapse.Results2608 patients with a median follow-up of 4.7 (IQR: 3.1-6.9) years were analyzed. Median age was 64 (Range: 42-84) years. In these patients, median initial PSA was 5.5 ng/mL, 74% were T1 and 26% were T2. 73% were Gleason 6 and 25% Gleason 7. Median % of biopsy cores positive was 33%, and median gland volume was 34.2cc. 11% of patients received hormones for a median of 3.0 months prior to implantation. Median seed activity was 0.437 mCi, D90 was 186.7 Gy and V100 was 99.37%.Biochemical relapse was observed in 124 patients (4.8%) and median time to failure was 4.0 years. Predicted bRFS was 93% at 7 years. On cox regression bRFS was dependent only on D90 at the time of implantation and PSA density.ConclusionsIO-LDRB is an effective treatment option for patients with low and low-tier intermediate risk prostate cancer. Rates of biochemical relapse remain low several years post treatment. These results compared favorably with manual preplan technique results published.

Teaser

This multicentre analysis shows evidence for efficacy in brachytherapy treatments for prostate cancer when delivered using an automated delivery system. Results with this technique do not appear inferior to other published series on preplanned techniques.


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