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. 2021 Aug;13(4):373-386.
doi: 10.5114/jcb.2021.108592. Epub 2021 Aug 24.

Eligibility criteria according to EAU/ESTRO/SIOG guidelines for exclusive iodine-125 brachytherapy for intermediate-risk prostate adenocarcinoma patients: impact on relapse-free survival

Sophie Robin  1 , Sylvie Chabaud  2 , Anne-Agathe Serre  1 , Béatrice Bringeon  3 , Sébastien Clippe  4 , François Rocher  5 , Olivier Desmettre  6 , Gabriel Bringeon  6 , Frédéric Gassa  1 , Pascal Pommier  1
Affiliations

Eligibility criteria according to EAU/ESTRO/SIOG guidelines for exclusive iodine-125 brachytherapy for intermediate-risk prostate adenocarcinoma patients: impact on relapse-free survival

Sophie Robin et al. J Contemp Brachytherapy. 2021 Aug.

Abstract

Purpose: Iodine-125 (125I) brachytherapy (BT) alone for intermediate-risk (IR) prostate adenocarcinoma (PCA) is controversial. The purpose of the study was to investigate potential predictive factors in selected IR-PCA patients treated with BT.

Material and methods: Among 547 patients treated with 125I BT between 2003 and 2013, 149 IR-PCA cases were selected according to NCCN classification after an additional exclusion of patients with prostate specific antigen (PSA) > 15 ng/ml and ISUP group 3. A relapse was defined as a biochemical failure, using ASTRO Phoenix definition, or a relapse identified on imaging. Survival curves were estimated with Kaplan-Meier method. Potential prognostic variables including EAU/ESTRO/SIOG guidelines eligibility criteria were analyzed using univariate and Cox's proportional hazards regression analysis.

Results: Of the 149 IR patients, 112 were classified as favorable, with 69 cases eligible to BT according to EAU/ESTRO/SIOG guidelines, and 37 patients were identified as unfavorable as per NCCN. Androgen deprivation therapy (ADT) was applied in 6 patients only. Percentage of positive biopsy cores were ≤ 33% and ≥ 50% for 119 and 11 patients, respectively. With a median follow-up of 8.5 years, 30 patients experienced a relapse. 10-year overall survival, progression-free survival (PFS), and relapse-free survival (RFS) were 84% (95% CI: 75-90%), 66% (95% CI: 56-75%), and 77% (95% CI: 67-84%), respectively. Failure to meet EAU/ESTRO/SIOG criteria was significantly associated with a lower RFS (p = 0.0267, HR = 2.37 [95% CI: 1.10-5.08%]).

Conclusions: Brachytherapy is an effective treatment for selected IR-PCA cases. Patients who were not eligible according to EAU/ESTRO/SIOG guidelines demonstrated a lower RFS.

Keywords: brachytherapy; guidelines; intermediate-risk; prognostic criteria; prostate.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimate of overall survival for the entire cohort (A); for eligible FIR vs. not eligible FIR vs. UIR (B); for FIR vs. UIR (C); and for FIR eligible vs. FIR not eligible or UIR (D) FIR – favorable intermediate-risk, eligible – eligible for brachytherapy according to the EAU guidelines, UIR – unfavorable intermediate-risk
Fig. 2
Fig. 2
Kaplan-Meier estimate of relapse-free survival for the entire cohort (A); for eligible FIR vs. not eligible FIR vs. UIR (B); for FIR vs. UIR (C); and for FIR eligible vs. FIR not eligible or UIR (D) FIR – favorable intermediate-risk, eligible – eligible for brachytherapy according to the EAU guidelines, UIR – unfavorable intermediate-risk
Fig. 3
Fig. 3
Venn diagram of relapses for patients with imaging
Fig. 4
Fig. 4
Kaplan-Meier estimate of progression-free survival for the entire cohort (A); for eligible FIR vs. not eligible FIR vs. UIR (B); for FIR vs. UIR (C); and for FIR eligible vs. FIR not eligible or UIR (D) FIR – favorable intermediate-risk, eligible – eligible for brachytherapy according to the EAU guidelines, UIR – unfavorable intermediate-risk
See this image and copyright information in PMC

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