Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-year Canadian experience.

PURPOSE To report outcomes and toxicity of the first Canadian permanent prostate implant program. METHODS AND MATERIALS 396 consecutive patients (Gleason < or =6, initial prostate specific antigen (PSA) < or =10 and stage T1-T2a disease) were implanted between June 1994 and December 2001. The median follow-up is of 60 months (maximum, 136 months). All patients were planned with fast-simulated annealing inverse planning algorithm with high activity seeds ([gt] 0.76 U). Acute and late toxicity is reported for the first 213 patients using a modified RTOG toxicity scale. The Kaplan-Meier biochemical failure-free survival (bFFS) is reported according to the ASTRO and Houston definitions. RESULTS The bFFS at 60 months was of 88.5% (90.5%) according to the ASTRO (Houston) definition and, of 91.4% (94.6%) in the low risk group (initial PSA < or =10 and Gleason < or =6 and Stage < or =T2a). Risk factors statistically associated with bFFS were: initial PSA >10, a Gleason score of 7-8, and stage T2b-T3. The mean D90 was of 151 +/- 36.1 Gy. The mean V100 was of 85.4 +/- 8.5% with a mean V150 of 60.1 +/- 12.3%. Overall, the implants were well tolerated. In the first 6 months, 31.5% of the patients were free of genitourinary symptoms (GUs), 12.7% had Grade 3 GUs; 91.6% were free of gastrointestinal symptoms (GIs). After 6 months, 54.0% were GUs free, 1.4% had Grade 3 GUs; 95.8% were GIs free. CONCLUSION The inverse planning with fast simulated annealing and high activity seeds gives a 5-year bFFS, which is comparable with the best published series with a low toxicity profile.

[1]  Jean Pouliot,et al.  The robustness of dose distributions to displacement and migration of 125I permanent seed implants over a wide range of seed number, activity, and designs. , 2004, International journal of radiation oncology, biology, physics.

[2]  J. Pouliot,et al.  Optimization of permanent 125I prostate implants using fast simulated annealing. , 1996, International journal of radiation oncology, biology, physics.

[3]  R. Sloboda,et al.  Dosimetric consequences of increased seed strength for I-125 prostate implants. , 2003, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[4]  H. Holm,et al.  Transperineal 125iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. , 1983, The Journal of urology.

[5]  Patrick W McLaughlin,et al.  Randomized trial of high- and low-source strength (125)I prostate seed implants. , 2005, International journal of radiation oncology, biology, physics.

[6]  J. Battermann,et al.  Results of permanent prostate brachytherapy, 13 years of experience at a single institution. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[7]  R. Stock,et al.  Urinary symptom flare following I-125 prostate brachytherapy. , 2003, International journal of radiation oncology, biology, physics.

[8]  J Pouliot,et al.  Monte Carlo simulations of prostate implants to improve dosimetry and compare planning methods. , 1999, Medical physics.

[9]  J. Roy,et al.  Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy. , 1995, International journal of radiation oncology, biology, physics.

[10]  S. K. Kang,et al.  Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method. , 2001, International journal of radiation oncology, biology, physics.

[11]  R. Stock,et al.  Biochemical outcomes after prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. , 2003, International journal of radiation oncology, biology, physics.

[12]  D. Kuban,et al.  Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995. , 2003, International journal of radiation oncology, biology, physics.

[13]  L. Potters,et al.  Urinary morbidity following ultrasound-guided transperineal prostate seed implantation. , 1999, International journal of radiation oncology, biology, physics.

[14]  Y. Yu,et al.  Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society. , 2001, International journal of radiation oncology, biology, physics.

[15]  R. Taschereau,et al.  Seed misplacement and stabilizing needles in transperineal permanent prostate implants. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[16]  R. Stock,et al.  A dose-response study for I-125 prostate implants. , 1998, International journal of radiation oncology, biology, physics.

[17]  K. Wallner,et al.  Dysuria after permanent prostate brachytherapy. , 2003, International journal of radiation oncology, biology, physics.

[18]  D. Beyer,et al.  Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. , 2003, Brachytherapy.

[19]  D. Brachman,et al.  Failure-free survival following brachytherapy alone or external beam irradiation alone for T1-2 prostate tumors in 2222 patients: results from a single practice. , 2000, International journal of radiation oncology, biology, physics.

[20]  L. Potters,et al.  Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. , 2002, International journal of radiation oncology, biology, physics.

[21]  W Cavanagh,et al.  Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow-up. , 1997, Seminars in surgical oncology.

[22]  Blasko,et al.  10-year biochemical (prostate-specific antigen) control of prostate cancer with (125)I brachytherapy. , 2001, International journal of radiation oncology, biology, physics.

[23]  Roy Jean,et al.  Permanent transperineal prostate implants performed under local anesthesia , 1998 .

[24]  L. Potters,et al.  Is pelvic radiation necessary in patients undergoing prostate brachytherapy , 1998 .

[25]  Stone,et al.  Neoadjuvant Hormonal Therapy Improves the Outcomes of Patients Undergoing Radioactive Seed Implantation for Localized Prostate Cancer. , 1999, Molecular urology.

[26]  Ross Halperin,et al.  Is there a preferred strength for regularly spaced 125I seeds in inverse-planned prostate implants? , 2003, International journal of radiation oncology, biology, physics.

[27]  Kent Wallner,et al.  Prostate brachytherapy under local anesthesia; lessons from the first 600 patients. , 2002, Brachytherapy.

[28]  K. Wallner,et al.  Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer. , 2000, International journal of radiation oncology, biology, physics.

[29]  R. Stock,et al.  Role of hormonal therapy in the management of intermediate- to high-risk prostate cancer treated with permanent radioactive seed implantation. , 2002, International journal of radiation oncology, biology, physics.

[30]  J. Battermann,et al.  Randomized trial of high- and low-source strength (125)I prostate seed implants: In regard to Narayana et al. (Int J Radiat Oncol Biol Phys 2005;61:44-51). , 2005, International journal of radiation oncology, biology, physics.