Long-term results of treatment for prostate carcinoma by staging pelvic lymph node dissection and definitive irradiation using low-dose rate temporary iridium-192 interstitial implant and external beam radiotherapy

Abstract

BACKGROUND The objective of this study was to evaluate long‐term treatment outcome of definitive irradiation by using temporary interstitial implant and limited dose of external beam radiotherapy in treatment of localized prostate carcinoma. METHODS In total, 536 patients with biopsy‐proven adenocarcinoma of the prostate, classification T1–T3, underwent staging pelvic lymph node dissection and brachytherapy delivering an average tumor dose of 30 grays (Gy), supplemented by external beam radiation therapy for an additional dose of 36 Gy delivered over 4 weeks. One hundred of 536 (18%) patients had pathologic D1 disease. A total of 181 patients had undergone transurethral prostatectomy before the treatment. Repeat prostate biopsy was performed on 132 patients 18 or more months after treatment. None of the patients received neoadjuvant or adjuvant hormone therapy. RESULTS Cumulative disease free survival (DFS) including biochemical DFS at 10 and 15 years for classification T1B,C was 78% and 72%; for T2A, 78% and 78%; for T2B,C, 68% and 66%; and for T3A–C, 45% and 45%, respectively. Cause specific survival for the entire group at 10 and 15 years was 89% and 87%, respectively. Severe complications occurred only in the early developmental phase of the study. CONCLUSIONS In univariate analysis, the clinical stage, histologic grade, pretreatment PSA level, lymph node status, and results of repeat posttreatment biopsy were all independently significant prognostic factors. However, the authors' study indicates that in multivariate analysis, only two factors emerged with statistical significance—the status of pelvic lymph nodes and the results of posttreatment biopsy. This signifies the importance of local tumor control to achieve ultimate cure and the importance of assessment of pelvic lymph nodes before definitive local therapy other than radical prostatectomy, especially in the high‐risk group. Cancer 2001;92:2084–94. © 2001 American Cancer Society.

High-Dose Rate Brachytherapy of Prostatic Adenocarcinoma in Combination with External Beam Radiotherapy

“…In the study by Puthawala et al[22] the span is for T3 (45%) to T1 (78%).Tabelle 3. Therapieergebnisse von vier größeren Studien in Bezug aufkrankheitsfreies Überleben (DFS) bzw.…”

“…Gesamtüberleben (OS) sowie fünf Studien bezüglich der lokalen Kontrolle anhand von Biopsiedaten 4-24 Monate nach Therapie. In der Studie von Puthawala et al[22] wurden T3-Tumoren (45%) bis T1-Tumoren (78%) integriert.…”

Long-term outcome for lymph node-positive prostate cancer

“…In more contemporary series utilizing biochemical follow-up, the best results 10 report a 5-year biochemical disease-free survival of 77% with radiation alone. A second study utilizing a brachytherapy boost 11 showed a 5-year biochemical failure-free survival rate of 64%. Although the results of these two more recent series seem favorable, the perception of most practitioners, as confirmed by our small group of patients, is that radiation alone is not likely to result in a durable response.…”

Laparoscopic Seminal Vesicle and Pelvic Lymph Node Resection before High-Dose Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer

“…In case of three-dimensional conformal radiation therapy (3D-CRT), if the risk of PLN involvement is ≥ 10%, some advocated PLN dissection prior to radiation therapy [7,9,23]. Laparoscopy is now frequently used for this end, providing better preradiation staging and prognosis.…”