Treatment results of brachytherapy vs. external beam radiation therapy for intermediate-risk prostate cancer with 10-year followup

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• 作者：Barry W. Goy^a ; ^{barry.w.goy@kp.org} ; Margaret S. Soper^a ; Tangel Chang^b ; Jeff M. Slezak^c ; Harry A. Cosmatos^a ; Michael Tome^a
• 关键词：Brachytherapy ; Radiation therapy ; Prostate cancer ; Intermediate risk
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：15
• 期：6
• 页码：687-694
• 全文大小：204 K
• 卷排序：15

文摘

To compare 10-year treatment outcomes of brachytherapy vs. external beam radiation therapy for patients with intermediate-risk prostate cancer (IRPC).Methods and MaterialsBetween 2004 and 2007, 93 IRPC patients underwent brachytherapy using iodine-125 to a dose of 145 Gy without supplemental external radiation. A retrospective comparison was performed to a contemporary cohort of 597 patients treated with external beam radiation therapy to a median dose of 75.3 Gy using a propensity score-matched analysis.ResultsMedian followup was 7.8 years. With brachytherapy, 51.6% had Gleason score 7 vs. 72.0% for external radiation (p < 0.001). Median initial prostate-specific antigen was 8.3 for brachytherapy vs. 9.4 for external radiation (p = 0.01). Neoadjuvant androgen deprivation therapy was given in 59.5% of external radiation vs. 10.8% of brachytherapy patients (p < 0.001). The 10-year freedom from biochemical failure (FFBF) for brachytherapy was 81.7% vs. 54.5% for external radiation (p = 0.002). Unfavorable intermediate-risk patients experienced borderline significant improved FFBF with brachytherapy (p = 0.08). The 10-year freedom from salvage therapy for brachytherapy was 93.2% vs. 72.2% for external radiation (p = 0.006). There were no significant differences in distant metastases-free survival, prostate cancer-specific survival, or overall survival after adjusting for age. Multivariate analysis with propensity score matching showed that brachytherapy remained an independent predictor for improved FFBF (p = 0.007). Grade 1 and 2 late rectal complication rate was 6.5% for brachytherapy vs. 15.2% for external radiation (p = 0.02).ConclusionsBrachytherapy using iodine-125 without supplemental external radiation is a reasonable treatment option for selected IRPC patients.