Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

Ohashi, Toshio; Yorozu, Atsunori; Saito, Shiro; Tanaka, Nobumichi; Katayama, Norihisa; Kojima, Shinsuke; Maruo, Shinichiro; Kikuchi, Takashi; Dokiya, Takushi; Fukushima, Masanori; Yamanaka, Hidetoshi

doi:10.1016/j.ijrobp.2015.05.014

Cited by 40 publications

(24 citation statements)

References 38 publications

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“…The percentages of Grade 2 or 3 GU toxicities we found were similar to reports from the MD Anderson Cancer Center (RTOG-Grade 2: 6.5%, Grade 3: 1.7%, Grade 4: 0.5%) [ 40 ] and other institutions in Japan. Ohashi et al [ 41 ] reported in the urinary toxicity profiles of J-POPS, analyses of 2339 patients, Grade 2+ late urinary toxicities developed in 5.75% of the patients. Yorozu et al [ 42 ] reported the outcomes for 1313 men treated with 125 I brachytherapy at a single institution in Japan: the 7-year Grade 3+ GU toxicity was 2%; patients who experienced Grade 2 or greater urinary toxicity had a larger prostate volume and needed a larger number of needles and seeds in this study, but no significant risk factors were detected in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan

Maki

Itoh

Kubota

et al. 2017

Journal of Radiation Research

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The aim of this study was to determine the outcomes and adverse events for 300 men with prostate cancer treated with 125iodine (125I) brachytherapy with and without external-beam radiation therapy (EBRT) at a single institution in Japan. Between February 2005 and November 2011, 300 consecutive patients with clinically localized prostate cancer were treated with 125I brachytherapy at the Nagoya University Hospital. A total of 271 men were treated with implants with doses of 145 Gy, and 29 men were treated with implants with doses of 110 Gy combined with EBRT (40–50 Gy/20–25 fractions). The median patient age was 69 years (range, 53–83 years). The median follow-up period was 53 months (range, 5–99 months). According to the National Comprehensive Cancer Network risk classification, 132 men (44%) had low-risk, 147 men (29%) had intermediate-risk and 21 men (7%) had high-risk disease. The 5-year overall survival rate, biochemical relapse–free survival rate, and disease-specific survival rates were 93.5%, 97.3% and 98.5%, respectively. Two men (0.6%) died of prostate cancer and 10 men (3.3%) died of other causes. Seventeen men (5.6%) experienced Grade 2 rectal bleeding in all: 12 (41.4%) of 29 in brachytherapy with EBRT, and 5 (1.8%) of 271 in brachytherapy alone. The rates of Grade 2 and 3 genitourinary toxicity were 1.0% and 1.7%, respectively. Excellent local control was achieved at our hospital for localized prostate cancer with 125I brachytherapy with and without EBRT. Gastrointestinal and genitourinary toxicities were acceptable.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan

Maki

Itoh

Kubota

et al. 2017

Journal of Radiation Research

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“…Seed implantation may result in chronic inflammation, which has been reported to be significantly associated with higher IPSS and larger prostate volume (14). In a multi-institutional cohort study, it was reported that grade 2 acute urinary toxicities developed within 3 months in 7.36%, while grade 2 late urinary toxicities developed in 5.75% (1). A study investigating LUTS after low-dose rate PBT reported IPSS to be greatest from 1 to 3 months after seed implantation and gradually return to almost baseline levels after 12 to 24 months (10,15,16).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Prolonged Urination Disorder After Permanent 125I Brachytherapy for Localized Prostate Cancer

Mori

Fukumori

Daizumoto

et al. 2017

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The use of permanent radioactive implants to treat clinicallylocalized prostate cancer patients has been increasing rapidly all over the world for the past 20 years. In Japan, prostate brachytherapy (PBT) became an insurance adaptation in 2003 and has become one of the most common treatments for clinically-localized prostate cancer (1) National Comprehensive Cancer Network Clinical Practice Guidelines recommend PBT not only for low-and intermediate-risk groups but also for high-and very high-risk groups in combination with androgen deprivation therapy (ADT) and external beam radiotherapy (EBRT) (2). It is reported that high-dose radiotherapy using low-dose-rate PBT in combination with EBRT and short-term ADT has shown excellent outcomes in high-risk and very highrisk cancer (3, 4).PBT can cause some adverse events. Lower urinary tract symptoms (LUTS) are major complications for men following PBT (5-10). For some patients, International Prostate Symptom Scores (IPSS) quickly return to pretreatment levels, while others require more time. We assessed the change in LUTS after brachytherapy to reveal predictive factors for prolonged urination disorder.To our knowledge, no study has analyzed predictive factors using time-dependent multivariate analysis. Patients and MethodsPatient characteristics. Between July 2004 and December 2014, 404 patients received low-dose-rate PBT at Tokushima University Hospital in Japan and were followed-up for at least 2 years. Clinical characteristics of patients are shown in Table I.Brachytherapy procedure. Pre-planning involved analyzing the prostate in detail by transrectal ultrasonography about 4 weeks before brachytherapy to calculate prostate volume (PV) and plan seed implantation. Brachytherapy was performed using ultrasoundguided, transperineal prostate implantation planned using Interplant software (CMS, St. Louis, MO, USA). For post-planning, about 4 weeks after seed implantation, computed tomography, and radiography of the chest kidneys, ureters, and bladder were performed to calculate the radiation dose to 90% of the prostate volume (D90) and to evaluate seed migration in all patients.Follow-up. All patients were asked to return at 1, 3, and 6 months after seed implantation, and every 6 months thereafter. Patient IPSS was assessed at each visit. PV was measured every 12 months using 755

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“…Several studies have demonstrated that a high D 90 for the clinical target volume (CTV) improved biochemical relapse-free survival in prostate cancer patients treated with PPB [ 1 , 2 , 4 , 6 , 7 , 8 ]. However, high radiation doses to the urethra and rectum caused greater genitourinary and gastrointestinal toxicities [ 9 , 10 , 11 ].…”

Section: Purposementioning

confidence: 99%

Dosimetry advantages of intraoperatively built custom-linked seeds compared with loose seeds in permanent prostate brachytherapy

Inada¹,

Yokokawa²,

Minami

et al. 2017

jcb

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PurposeThe aim of this study was to compare the implant quality between intraoperatively built custom-linked seeds (IBCL) and loose seeds (LS) retrospectively.Material and methodsThis study included 74 prostate cancer patients who were treated with permanent prostate brachytherapy (PPB) using IBCL (n = 37) or LS (n = 37) between July 2014 and June 2016. Dose-volume histogram (DVH) parameters, seed migration, and operation time were compared between the IBCL and LS groups. In addition to the standard target volume of the whole prostate gland, DVH parameters for prostate plus a 3 mm margin (CTV) were evaluated.ResultsIn intraoperative planning, prostate V150 was lower (54.8% vs. 59.6%, p = 0.027), and CTV V100 (88.1% vs. 85.6%, p = 0.019) and D90 (98.5% vs. 92.6%, p = 0.0033) were higher in the IBCL group compared with in the LS group. In post-implant dosimetry, prostate V100 (96.9% vs. 95.2%, p = 0.020), CTV V100 (85.6% vs. 81.7%, p = 0.046), and CTV D90 (94.2% vs. 86.5%, p < 0.001) were higher, and prostate V150 (57.1% vs. 64.5%, p = 0.0051) and CTV V150 (31.5% vs. 35.7%, p = 0.046) were lower in the IBCL group compared with in the LS group. Regarding DVH changes between intraoperative planning and post-implant dosimetry, the decrease in prostate D90 was significantly lower in the IBCL group than in the LS group (–1.16% vs. –4.17%, p < 0.001). For the IBCL group, the operation time was slightly but significantly longer than that for the LS group (50.5 minutes vs. 43.7 minutes, p = 0.011). However, the seed migration rate was significantly lower in the IBCL group than in the LS group (5% vs. 41%, p < 0.001).ConclusionsIntraoperatively built custom-linked is more advantageous than LS in terms of dosimetric parameters and migration.

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Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

Cited by 40 publications

References 38 publications

Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan

Clinical outcomes of 125I brachytherapy with and without external-beam radiation therapy for localized prostate cancer: results from 300 patients at a single institution in Japan

Predictive Factors for Prolonged Urination Disorder After Permanent 125I Brachytherapy for Localized Prostate Cancer

Dosimetry advantages of intraoperatively built custom-linked seeds compared with loose seeds in permanent prostate brachytherapy

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