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Meta-Analysis
. 2016 Sep;89(1065):20150981.
doi: 10.1259/bjr.20150981. Epub 2016 Jul 7.

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Giovanni Fellin  1 , Maria A Mirri  2 , Luigi Santoro  3 , Barbara A Jereczek-Fossa  4   5 , Claudio Divan  6 , Salvatore Mussari  1 , Francesco Ziglio  7 , Beniamino La Face  8 , Fernando Barbera  8 , Michela Buglione  8   9 , Laura Bandera  8   9 , Barbara Ghedi  10 , Nadia G Di Muzio  11 , Andrea Losa  12 , Paola Mangili  13 , Luciano Nava  12 , Renato Chiarlone  14 , Nunzia Ciscognetti  15 , Emilio Gastaldi  16 , Federica Cattani  17 , Ruggero Spoto  4 , Andrea Vavassori  4 , Francesca R Giglioli  18 , Alessia Guarneri  18 , Valentina Cerboneschi  19 , Marcello Mignogna  19 , Mauro Paoluzzi  20 , Valentina Ravaglia  21 , Costanza Chiumento  22 , Stefania Clemente  22 , Vincenzo Fusco  22 , Roberto Santini  23 , Marco Stefanacci  23 , Francesco P Mangiacotti  24 , Marco Martini  25 , Tiziana Palloni  2 , Giuseppe Schinaia  26 , Grazia Lazzari  27 , Giovanni Silvano  26 , Stefano Magrini  8   9 , Umberto Ricardi  18 , Riccardo Santoni  28 , Roberto Orecchia  4   5
Affiliations
Meta-Analysis

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Giovanni Fellin et al. Br J Radiol. 2016 Sep.

Abstract

Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.

Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.

Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.

Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.

Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

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Figures

Figure 1.
Figure 1.
CONSORT flow diagram of the study. EBRT, external beam radiotherapy; LDR-BT, low-dose-rate brachytherapy.
Figure 2.
Figure 2.
Kaplan–Meier analysis of overall survival (OS) and disease-specific survival (DSS) with 95% confidence interval (CI). Pts, patients.
Figure 3.
Figure 3.
Kaplan–Meier analysis of biochemical failure-free survival (BFFS) with 95% confidence interval (CI). Pts, patients.
See this image and copyright information in PMC

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