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

Abstract

The objective of this paper was to evaluate the acute urinary morbidity associated with I‐125 interstitial implantation of the prostate gland. From 1991–1995, 117 patients underwent ultrasound (U/S)‐guided implantation of the prostate gland. Median dose to 90% of the gland (d90) was 14.68 Gy (range = 1.65–21.75 Gy). The patients' urinary symptoms were recorded pre‐implantation and at regular intervals after implantation using the International Prostate Symptom Score (IPSS), a self‐assessment questionnaire in which patients scored 7 symptoms: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Median follow‐up was 12 months. The natural history of implant‐related urinary symptoms was assessed in this manner. In addition, dosimetric factors including U/S prostate volume, total activity, activity per seed, dose volume histogram (DVH) values for dose to gland, and dose area histogram (DAH) values for dose to urethra and bladder were examined for correlation to the severity of each symptom as well as to total IPSS (sum of the individual symptom scores). Total IPSS peaked at 1 month post‐implant and gradually returned to approximately baseline at 24 months. Total IPSS directly correlated with total activity and DVH for the prostate. Total IPSS, however, did not correlate with bladder or urethral DAH. With the exception of frequency, individual symptoms did not correlate with dose to gland, bladder, or urethra. Frequency scores did, however, correlate not only with dose to prostate gland but also dose to urethra. The acute urinary side effects of I‐125 prostate implantation are transient and peak at 1 month post‐implant. The severity of the urinary irritative symptoms developed are closely related to total dose to the gland. Urethral dose appears to affect frequency most significantly. Urinary symptoms, therefore, may be a limiting factor when considering dose escalation with I‐125. Radiat. Oncol. Invest. 6:135–141, 1998. © 1998 Wiley‐Liss, Inc.

Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado

“…Los cambios más significativos en el IPSS suelen aparecer en la fase aguda y progresivamente se reducen en 1 ó 2 años hasta alcanzar el nivel previo 49. Los principales factores de riesgo implicados en las disfunciones de vaciado previo al implante son, un IPSS alto (>8) y la necesidad de tratamiento con α-bloqueantes previo a la braquiterapia 48 .…”

“…El uso de un α-bloqueante no reduce el riesgo de retención prolongada (más de 3 días) ni reduce la necesidad de una cirugía desobstructiva postimplante 49 . Sólo aquellos pacientes que recibieron el tratamiento con un α-bloqueante de forma profiláctica, alcanzaron antes el nivel basal de IPSS previo al implante que aquellos que no lo recibieron o lo recibieron de forma terapéutica 13 .…”

Iodine‐125 brachytherapy for prostate cancer: First published Australian experience

“…In the present series using AUA scoring, 90% of patients had experienced grade 3, 4 or 5 toxicity at some point during the first 6 months after their radiotherapy implant. What can be derived from these and other series is that peak side‐effects occur almost universally in the first few months, and then rapidly diminish after 6 months 31,32 . At 3 years, 17% of patients continued to have weak stream, and 11% continued to have frequency and urgency.…”

Scientific impact of studies published in temporarily available radiation oncology journals: a citation analysis

“…Figure 1 shows the distribution of citations. References (Seymour & Mothersill 1997; Sheridan et al 1997; Desai et al 1998; Schmidt-Ullrich et al 1999; Smith & Haffty 1999; Johnson et al 1998; Monga et al 1999; Stickle et al 1999; Merrick et al 1998; Roach et al 1997; Wazer et al 1999; Joschko et al 1997; Chidel et al 1999; Durand & Olive 1997; Peschel et al 1999; Norman et al 1997; Kramer et al 1998; Leborgne et al 1997; Epperly et al 1999; Chancy et al 1998; Prete et al 1998; Fernandez-Vicioso et al 1997; Kang & Suh 1999; Banasiak et al 1999; Nathu et al 1998; Haffty et al 1997; Gieger et al 1997) and Table 1 include the 25 most frequently cited articles (all had at least 30 citations and were published in volumes 5-7, most emanated from the USA). The most frequently cited article in the first 4 volumes achieved 23 citations (Teicher et al 1996).…”