Feasibility study combining low dose rate (192)Ir brachytherapy and external beam radiotherapy aiming at delivering 80-85 Gy to prostatic adenocarcinoma.
Nickers, Philippe; Coppens, L; Beauduin, M.et al.
2000 • In Radiotherapy and Oncology, 55 (1), p. 41-47
[en] BACKGROUND: Increasing the radiation dose to prostatic adenocarcinoma has provided higher local control rates. A total of 80 Gy seem necessary to achieve this goal but patient set-up and prostate motion remain difficult problems to solve in conformal radiotherapy. Brachytherapy which overcomes these points could be an alternative way to external beam boost fields. We wanted to transpose the irradiation models largely used in cervix cancer treatment combining external beam radiotherapy and low dose rate brachytherapy. MATERIALS AND METHODS: In 71 patients with 19.5 and 13 ng/ml mean and median PSA levels, respectively, a dose escalation from 74 to 85 Gy was performed in four groups. RESULTS: Shifting from intraoperative placement of sources vectors (Group I) to positioning under ultrasound controls (groups II-IV), improving the implantation shape and optimizing radiation delivery to urethral bed have reduced the total dose to rectal wall under 65 Gy and to urethra under 100 Gy. Rectal/prostate dose ratio was lowered from 0.7 (Groups I-II) to 0.58 (Groups III-IV) while avoiding problems resulting from pelvic bone arch interference, prostate volume or seminal vesicles location. The mean and median follow-up periods are 28 and 18 months. In Groups III and IV 85% of patients without hormonotherapy treated with 80-85 Gy normalized PSA under 1 ng/ml within 6 months. No severe late effect has been noted for patients implanted under echographic control. CONCLUSIONS: The method described allows to deliver 85 Gy. Longer follow-up is however needed but the levels of dose delivered are not expected to induce prohibitive side effects.
Disciplines :
Oncology
Author, co-author :
Nickers, Philippe ; Université de Liège - ULiège > Centre hospitalier universitaire CHU > Radiothérapie Oncologie > Chef de clinique
Coppens, L
Beauduin, M.
Darimont, M.
de Leval, Jean ; Université de Liège - ULiège > Département des sciences cliniques > Urologie
Deneufbourg, Jean-Marie ; Université de Liège - ULiège > Faculté de médecine Sciences cliniques > Radiothérapie Oncologie > Chargé de cours Chef de service CHU
Language :
English
Title :
Feasibility study combining low dose rate (192)Ir brachytherapy and external beam radiotherapy aiming at delivering 80-85 Gy to prostatic adenocarcinoma.
Consensus statement: guidelines for PSA following radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 37:1997;1035-1041.
Bagshaw M.A., Kaplan I.D., Cox R.C. American cancer society. National conference on prostate cancer. Radiation therapy for localized disease. Cancer. 71:1993;939-952.
Bergström P., Löfroth P., Widmark A. High-precision conformal radiotherapy of prostate cancer. A new technique for exact positioning of the prostate at the time of treatment. Int. J Radiat. Oncol. Biol. Phys. 42:1998;305-311.
Crook J.M., Bahadur Y.A., Bociek R.G., et al. The correlation of pretreatment prostate specific antigen and nadir prostate specific antigen with outcome as assessed by systematic biopsy and serum prostate specific antigen. Cancer. 79:1997;326-336.
Dale R.G. The use of small fraction numbers in high-dose rate gynaecological afterloading: some radiobiological considerations. Br. J. Radiol. 63:1990;290-294.
D'Amico A.V., Coleman C.N. Role of interstitial radiotherapy in the management of clinically organ-confined prostate cancer: the jury is still out. J. Clin. Oncol. 14:1996;304-315.
D'Amico A.V., Davis A., Vargas S.O., et al. Defining the implant treatment volume for patients with low risk prostate cancer: does the anterior base need to be treated? Int. J Radiat. Oncol. Biol. Phys. 43:1999;587-590.
Dinges S., Wurm R., Stuschke M., et al. Late urethral complications after combined HDR brachytherapy and conformal radiotherapy for prostate cancer. Radiother. Oncol. 47:1998;512.
Fuks Z., Leibel S.A., Wallner K.E., et al. The effect of local control on metastatic dissemination in carcinoma of the prostate: long-term results in patients treated with 125I implantation. Int. J. Radiat. Oncol. Biol. Phys. 21:1991;537-547.
Hanks G.E., Hanlon A.L., Horwitz E., et al. A relationship of local prostate dose and subsequent metastasis with 3D CRT in prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 42:1998;142.
Hanks G.E., Hanlon A.L., Schultheiss T.E., et al. Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions. Int. J. Radiat. Oncol. Biol. Phys. 41:1998;501-510.
Kovacs G., Wirth B., Bertermann H., et al. Ten years experience in organ preservation using HDR brachytherapy boost for nodal negative, locally advanced prostate cancer. Radiother. Oncol. 39:(S1):1996;4.
Laramore G.E., Krall J.M., Thomas F.J., et al. Fast neutron radiotherapy for locally advanced prostate cancer. Am. J. Clin. Oncol. 16:1993;164-167.
Lattanzi J., McNeely S., Hanlon A., et al. Daily CT localization for correcting portal errors in the treatment of prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 41:1998;1079-1086.
Martinez A.G., Stromberg G., Edmundson G., et al. Conformal prostate brachytherapy: initial experience of a phase I/II dose escalating trial. Int. J. Radiat. Oncol. Biol. Phys. 33:1995;1019-1027.
Mate T.P., Gottesman J.E., Hatton J., et al. High dose-rate afterloading 192Iridium prostate brachytherapy feasibility report. Int. J. Radiat. Oncol. Biol. Phys. 41:1998;525-533.
Pollack A., Zagars G.K. External beam radiotherapy dose response of prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 39:1997;1011-1018.
Lent soma scales for all anatomic sites. Int. J. Radiat. Oncol. Biol. Phys. 31:1995;1049-1091.
Russell K.J., Caplan R.J., Laramore G.E., et al. Photon versus fast neutron external beam radiotherapy in the treatment of locally advanced prostate cancer: results of a randomized prospective trial. Int. J. Radiat. Oncol. Biol. Phys. 28:1994;47-54.
Van de Voorde W.M. Pathology of prostatic carcinoma. Petrovich Z., Baert L., Brady L.W. Carcinoma of the prostate. 1996;27-50 Springer, Berlin.
Zelefsky M.J., Leibel S.A., Gaudin P.B., et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 41:1998;491-500.
Zelefsky M.J., Leibel S.A., Wallner K.E., et al. Significance of normal serum prostate-specific antigen in the follow-up period after definitive radiation therapy for prostatic cancer. J. Clin. Oncol. 13:1995;459-463.