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. 2020 Dec;12(6):547-553.
doi: 10.5114/jcb.2020.101687. Epub 2020 Dec 16.

Toxicity in patients treated with permanent prostate brachytherapy using intraoperatively built custom-linked seeds versus loose seeds

Luc Ollivier  1   2 , Francois Lucia  1   2   3 , Truongan Nguyen  4 , Caroline Lucas  4 , Vincent Bourbonne  1   2   3 , Nicolas Boussion  1   3 , Gaelle Goasduff  1 , Georges Fournier  2   3   4 , Olivier Pradier  1   2   3 , Gurvan Dissaux  1   2   3 , Antoine Valeri  2   3   4 , Ulrike Schick  1   2   3
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Toxicity in patients treated with permanent prostate brachytherapy using intraoperatively built custom-linked seeds versus loose seeds

Luc Ollivier et al. J Contemp Brachytherapy. 2020 Dec.

Abstract

Purpose: Low-dose-rate brachytherapy (BT) with permanent iodine-125 radioactive seeds is a highly effective treatment option for low- and favorable intermediate-risk prostate cancer. However, optimal implantation is not always achieved due to edema or seeds loss. One way to improve seed placement is the use of stranded seeds called "intraoperatively built custom-linked seeds (IBCLS)" in an opposition to loose seeds (LS). To date, there are few data comparing toxicity rates between these two techniques. The aim of this study was to compare dosimetric parameters and toxicity rates at 2 years between both procedures in a matched-paired population.

Material and methods: Patients were considered for BT according to European guidelines. Among 548 patients treated at our institution, 105 patients in the loose seeds cohort were individually matched to 105 patients in the IBCLS group according to age, prostate volume, pre-operative international prostate symptom score (IPSS), clinical stage, and Gleason score. Erectile function was scored using the five-item international index of erectile function (IIEF-5) score. A multivariable linear mixed-effects model was applied to examine the association between total and individual scores (repeated measures) and covariates.

Results: Overall, 61 (29%) patients presented with a favorable intermediate-risk prostate cancer. There were no significant changes in IPSS over time (p = 0.57). During follow-up, the IIEF-5 was similar in the two groups, except at one month, where it was lower in the IBCLS group (10.9 vs. 6.9, p = 0.029). Also, there was no difference in grade ≥ 2 rectal toxicity. At 1 month, D90Gy, V150%, and V100% were higher in the LS group compared to the IBCLS group.

Conclusions: Low-dose-rate prostate brachytherapy using IBCLS is a safe technique, with comparable toxicity profiles at 2 years compared to LS brachytherapy.

Keywords: LDR; brachytherapy; linked seed; loose seed; prostate cancer.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Average value of IPSS (international prostate symptom score) in the IBCLS (intraoperatively built custom- linked seeds, blue bars) group and the LS (loose seeds, orange bars) group before brachytherapy and during follow- up. Errors bars display the range of values. Data are normally distributed (according to Shapiro-Wilk test)
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