Giovanni Fellin1, Maria A Mirri2, Luigi Santoro3, Barbara A Jereczek-Fossa4,5, Claudio Divan6, Salvatore Mussari1, Francesco Ziglio7, Beniamino La Face8, Fernando Barbera8, Michela Buglione8,9, Laura Bandera8,9, Barbara Ghedi10, Nadia G Di Muzio11, Andrea Losa12, Paola Mangili13, Luciano Nava12, Renato Chiarlone14, Nunzia Ciscognetti15, Emilio Gastaldi16, Federica Cattani17, Ruggero Spoto4, Andrea Vavassori4, Francesca R Giglioli18, Alessia Guarneri18, Valentina Cerboneschi19, Marcello Mignogna19, Mauro Paoluzzi20, Valentina Ravaglia21, Costanza Chiumento22, Stefania Clemente22, Vincenzo Fusco22, Roberto Santini23, Marco Stefanacci23, Francesco P Mangiacotti24, Marco Martini25, Tiziana Palloni2, Giuseppe Schinaia26, Grazia Lazzari27, Giovanni Silvano26, Stefano Magrini8,9, Umberto Ricardi18, Riccardo Santoni28, Roberto Orecchia4,5. 1. 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy. 2. 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy. 3. 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. 4. 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy. 5. 5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 6. 6 Division of Urology, Santa Chiara Hospital, Trento, Italy. 7. 7 Service of Health Physics, Santa Chiara Hospital, Trento, Italy. 8. 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy. 9. 9 Brescia University, Brescia, Italy. 10. 10 Department of Health Physics, Spedali Civili Hospital, Brescia, Italy. 11. 11 Department of Radiotherapy, San Raffaele Turro Hospital, Milan, Italy. 12. 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy. 13. 13 Service of Health Physics, San Raffaele Turro Hospital, Milan, Italy. 14. 14 Department of Radiotherapy, ASL2 Savonese, San Paolo Hospital, Savona, Italy. 15. 15 Service of Health Physics, ASL2 Savonese, San Paolo Hospital, Savona, Italy. 16. 16 Department of Urology, ASL2 Savonese, San Paolo Hospital, Savona, Italy. 17. 17 Service of Health Physics, European Institute of Oncology, Milan, Italy. 18. 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy. 19. 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy. 20. 20 Operative Unit of Urology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy. 21. 21 Department of Medical Physics, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy. 22. 22 Department of Radiation Oncology, IRCCS CROB, Italy. 23. 23 Unit of Radiotherapy, Pistoia Hospital, USL3, Pistoia, Italy. 24. 24 Service of Health Physics, San Filippo Neri Hospital, ASL RME, Rome, Italy. 25. 25 Department of Urology, San Filippo Neri Hospital, ASL RME, Rome, Italy. 26. 26 MEMOTEF Department, "La Sapienza" University, Rome, Italy. 27. 27 Division of Radiation Oncology, Azienda USL, Taranto, Italy. 28. 28 University of Rome "Tor Vergata", Rome, Italy.
Abstract
OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
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