eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2022
vol. 14
 
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abstract:
Original paper

Long-term results with custom-linked iodine-125 seeds and real-time brachytherapy in low- and intermediate-risk prostate cancer

Jose Luis Guinot
1
,
Juan Casanova
2
,
Victor Gonzalez-Perez
3
,
Miguel Angel Santos
1
,
Victor De los Dolores
3
,
Maria Isabel Tortajada
1
,
Carmen Guardino
3
,
Vicente Crispin
3
,
Jose Rubio-Briones
2
,
Leoncio Arribas
1

1.
Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia (I.V.O.) Valencia, Spain
2.
Department of Urology, Fundacion Instituto Valenciano de Oncologia (I.V.O.) Valencia, Spain
3.
Department of Radiation Physics, Fundacion Instituto Valenciano de Oncologia (I.V.O.) Valencia, Spain
J Contemp Brachytherapy 2022; 14, 3: 215-221
Online publish date: 2022/05/12
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Purpose
Brachytherapy (BT) with iodine-125 (125I) seeds is effective in low- and intermediate-risk prostate carcinoma, with fewer side effects compared to other techniques, but relapses increase in long-term. In the present paper, 10-year biochemical relapse-free survival (BRFS) results are presented.

Material and methods
Between 2007 and 2016, 706 patients were treated with real-time technique using Bard-ProLink™ system. 145 Gy was administered to the prostate with exclusive BT and 108 Gy after 46 Gy of external radiotherapy (EBRT). Androgen deprivation therapy was applied in 19.3% of patients.

Results
Median follow-up was 96 months (range, 24-163 months). BRFS at 5 and 10 years was 95% and 91.1%, respectively. For 480 low-risk cases, BRFS at 5 and 10 years was 95.7% and 92.7%, and for 226 intermediate-risk cases, it was 92.7% and 88%, respectively (p < 0.05). With combined treatment of EBRT + BT, 133 cases (59%) of intermediate-risk were treated without differences with exclusive BT. Gleason score 4 + 3 cases dropped to 72.8% at 10 years (p < 0.001), with androgen deprivation therapy (ADT) to 90.9% and without ADT to 66.8%; it was worse if patients had exclusive BT. 10-year BRFS for T1c was 95% compared to 84% for T2 (p < 0.001). Initial prostate specific antigen (PSA) > or < 10 showed no differences. With > 50% biopsy cores positive, it fell to 80% at 10 years (p < 0.001). In 154 patients up to 60 years of age, 10-year BRFS was 97.6%. Urinary complications appeared in 16.9% of cases in exclusive BT vs. 26.1% in EBRT + BT. Grade 2+ urinary late complications were observed in 19.1% and grade 3+ in 5.8% of patients. Rectal toxicity was 4% (2.5% in BT alone and 10.1% in RT + BT), while G3+ was seen in 0.1%.

Conclusions
Real-time BT with custom-linked 125I seeds is a very effective long-term treatment in low- and intermediate-risk prostate carcinoma. With Gleason score 4 + 3 or > 50% biopsy cores positive, we recommend combined treatment with additional ADT for 6 months.

keywords:

prostate, brachytherapy, 125I seeds, low-risk, intermediate-risk, long-term, custom-linked seeds

 
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