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Mid‐term outcome of permanent prostate iodine‐125 brachytherapy in J apanese patients
Author(s) -
Kimura Takahiro,
Kido Masahito,
Miki Kenta,
Yamamoto Toshihiro,
Sasaki Hiroshi,
Kuruma Hidetoshi,
Hayashi Norihiro,
Takahashi Hiroyuki,
Aoki Manabu,
Egawa Shin
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12347
Subject(s) - medicine , brachytherapy , biochemical recurrence , prostate cancer , hormonal therapy , radiation therapy , urology , prostate specific antigen , adjuvant , hormone therapy , multivariate analysis , stage (stratigraphy) , prostate , oncology , adjuvant therapy , gastroenterology , cancer , prostatectomy , breast cancer , paleontology , biology
Objectives To analyze mid‐term oncological outcomes of low‐dose rate brachytherapy in J apanese patients. Methods Between 2003 and 2010, 604 consecutive patients with clinically localized prostate cancer were treated with low‐dose rate brachytherapy at J ikei U niversity H ospital in Tokyo, Japan. Median follow up was 48 months. Of these patients, 260 (43%) were treated with neoadjuvant therapy, 45 (7.5%) with adjuvant hormonal therapy and 75 (12.4%) with supplemental external beam radiation therapy. Biochemical recurrence was defined as the prostate‐specific antigen nadir plus 2 ng/mL. Results Of the 604 patients, 219 (36.2%) were low risk, 361 (59.8%) were intermediate risk and 24 (4.0%) had high‐risk disease. The median biologically effective dose was 174.4 G y2. At 8 years, biochemical recurrence‐free survival, cancer‐specific survival, and overall survival were 82.2%, 100% and 95.6%, respectively. Biochemical recurrence‐free survival at 8 years was 89.9%, 79.4% and 52.5%, for the low‐, intermediate‐, and high‐risk groups, respectively. Biochemical recurrence‐free survival for the high‐risk group was significantly lower than the low‐ and intermediate‐risk groups ( P < 0.001). Biochemical recurrence‐free survival did not differ significantly by biologically effective dose stratification. In multivariate analysis, younger age ( P = 0.045), higher prostate‐specific antigen ( P = 0.004), higher G leason score ( P = 0.006) and higher clinical T stage ( P = 0.008) were significant covariates associated with biochemical recurrence. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than low‐dose rate brachytherapy monotherapy ( P = 0.0021 and 0.010). Just four patients experienced G 3 genitourinary or gastrointestinal toxicity. Conclusions Low‐dose rate brachytherapy results in excellent mid‐term oncological outcomes and acceptable toxicity in J apanese patients. In our experience, biologically effective dose does not represent a significant predictor for biochemical recurrence.