Acute urinary morbidity following I‐125 interstitial implantation of the prostate gland

Desai, Jigna; Stock, Richard G.; Stone, Nelson N.; Iannuzzi, Christopher; DeWyngaert, J. Keith

doi:10.1002/(sici)1520-6823(1998)6:3<135::aid-roi4>3.3.co;2-j

Cited by 28 publications

(43 citation statements)

References 13 publications

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“…Many series have shown that the pre-implant IPSS represents a robust predictor for the time to IPSS resolution [3,5,6,10], while time to IPSS resolution also appears to be directly correlated with prophylactic and prolonged α-blocker usage [3,8,10,20,21]. Consistent with the present study (Fig.…”

Section: Discussionsupporting

confidence: 91%

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Gutman¹,

Merrick²,

Butler³

et al. 2005

BJU International

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OBJECTIVE To determine if the International Prostate Symptom Score (IPSS) before seed implantation, stratified into mild (0–7), moderate (8–19) and severe (>20) categories, predicts brachytherapy‐related morbidity in terms of IPSS resolution, catheter dependency and the need for surgical intervention after brachytherapy. PATIENTS AND METHODS From January 1998 to September 2003, 1034 consecutive patients had permanent interstitial brachytherapy for clinical stage T1b‐T3a NXM0 (2002 system) prostate cancer. Of the 1034 patients, 739 (71.5%) presented with an IPSS of 0–7, 287 (27.7%) of 8–19, and eight (0.8%) of ≥ 20. The IPSS 8–19 cohort was further stratified into 8–14 (237 men) and 15–19 (50 men) subgroups. The median follow‐up was 38.2 months. In all patients, an α‐blocker was initiated before brachytherapy and continued at least until the IPSS normalized, the latter defined as a return to within 1 point of that before implantation. A median of 21 IPSS questionnaires were obtained per patient. Several clinical, treatment and dosimetric variables were evaluated as predictors of urinary morbidity. RESULTS For the entire cohort, the IPSS peaked at a mean of 0.5 months after implantation and resolved at a mean of 1.7 months. At 5 years after brachytherapy, 90.1% of patients at risk (88.8%, 95.5%, and four of eight patients with a pre‐implant IPSS of 0–7, 8–19 and ≥ 20, respectively) were within the IPSS 0–7 category. Compared to the pre‐implant IPSS, 13 patients (8%) were assigned to a higher IPSS severity category. Neither prolonged urinary catheter dependency (>5 days; 16 patients, 1.5%) or transurethral resection of the prostate (TURP, 17 patients, 1.6%) depended on the pre‐implant IPSS subgroup. In Cox regression analysis, IPSS resolution was best predicted by pre‐implant IPSS, prolonged catheter dependency by patient age, and TURP by any catheter dependency, the maximum IPSS increase and the maximum urethral dose. CONCLUSIONS The IPSS before implantation predicted the resolution of IPSS after brachytherapy, but did not correlate with substantial urinary morbidity, including catheter dependency or the need for TURP. At 5 years after brachytherapy, 90.1% of patients at risk were assigned to the IPSS 0–7 category.

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Section: Discussionsupporting

confidence: 91%

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Gutman¹,

Merrick²,

Butler³

et al. 2005

BJU International

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“…In our series, we noted a mean urethral D 10 of 159% with a range of 127-192% for 52 implants. These data demonstrate lower doses to the urethra compared to published results of permanent seed implants [7,32]. When examining rectal morbidity of permanent seed brachytherapy, Wallner et al found that in patients developing RTOG grade 1-2 rectal toxicity, an average of 17 mm 2 of the rectal wall was irradiated to doses > 100 Gy, compared to 11 mm 2 for patients experiencing no rectal morbidity [32].…”

Section: Discussionmentioning

confidence: 75%

3-D Conformal HDR Brachytherapy as Monotherapy for Localized Prostate Cancer

et al. 2004

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“…Based on the study by Wallner et al, 38 it appears that the maximum urethral dose and the length of the urethra that receives greater than 360 Gy ͑converted from 400 Gy of pre-TG43 dose for 125 I͒ are significantly correlated with RTOG grade 2-3 urinary morbidity. In another study, Desai et al 43 reported that acute urinary morbidity in 117 patients treated with 125 I implants correlated with the dose-volume histogram of the prostate as well as doses delivered to 5 cm 2 of the urethra as measured by the dose-surface histogram. Additional studies incorporating more patients, different radionuclides and various seed loading patterns will aid the determination of the dose tolerance to the urethra.…”

Section: Urethramentioning

confidence: 99%

Permanent prostate seed implant brachytherapy: Report of the American Association of Physicists in Medicine Task Group No. 64

et al. 1999

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There is now considerable evidence to suggest that technical innovations, 3D image-based planning, template guidance, computerized dosimetry analysis and improved quality assurance practice have converged in synergy in modern prostate brachytherapy, which promise to lead to increased tumor control and decreased toxicity. A substantial part of the medical physicist's contribution to this multi-disciplinary modality has a direct impact on the factors that may singly or jointly determine the treatment outcome. It is therefore of paramount importance for the medical physics community to establish a uniform standard of practice for prostate brachytherapy physics, so that the therapeutic potential of the modality can be maximally and consistently realized in the wider healthcare community. A recent survey in the U.S. for prostate brachytherapy revealed alarming variance in the pattern of practice in physics and dosimetry, particularly in regard to dose calculation, seed assay and time/method of postimplant imaging. Because of the large number of start-up programs at this time, it is essential that the roles and responsibilities of the medical physicist be clearly defined, consistent with the pivotal nature of the clinical physics component in assuring the ultimate success of prostate brachytherapy. It was against this background that the Radiation Therapy Committee of the American Association of Physicists in Medicine formed Task Group No. 64, which was charged ͑1͒ to review the current techniques in prostate seed implant brachytherapy, ͑2͒ to summarize the present knowledge in treatment planning, dose specification and reporting, ͑3͒ to recommend practical guidelines for the clinical medical physicist, and ͑4͒ to identify issues for future investigation.

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Acute urinary morbidity following I‐125 interstitial implantation of the prostate gland

Cited by 28 publications

References 13 publications

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

3-D Conformal HDR Brachytherapy as Monotherapy for Localized Prostate Cancer

Permanent prostate seed implant brachytherapy: Report of the American Association of Physicists in Medicine Task Group No. 64

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