摘要
Purpose
To compare biochemical outcomes and morbidity associated with iodine-125 (p>125p>I) and palladium-103 (p>103p>Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer.Methods and Materials
<p>Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy (p>125p>I prescription dose, 110 Gy: n = 199; p>103p>Pd prescription dose, 100 Gy: n = 60) followed by external beam radiotherapy (median dose, 50.4 Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires.Results
<p>Overall, acute Grade 鈮? genitourinary toxicity occurred in 21%and 30%of patients treated with p>125p>I and p>103p>Pd, respectively (p = 0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p = 0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for p>125p>I and p>103p>Pd patients, respectively (p = 0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p = 0.046). Late Grade 鈮? gastrointestinal toxicity occurred in 7%of p>125p>I patients and 6%of patients treated with p>103p>Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received p>103p>Pd (p = 0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for p>125p>I and p>103p>Pd patients was 95.2%and 98.2%(p = 0.73), respectively.Conclusion
<p>There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between p>125p>I and p>103p>Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of p>103p>Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between p>103p>Pd and p>125p>I.
