T. Flam

Long-term results of permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003

PURPOSEnTo analyse long-term overall survival, relapse-free survival and late toxicities in a series of 675 patients treated between 1999 and 2003, with a median follow-up of 132 months.nnnPATIENTS AND METHODSnThe cohort included low-risk patients and a selection of favourable-intermediate risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125 iodine seeds. Hormone therapy, consisting most often of an anti-androgen alone, was given in 393 patients (58%).nnnRESULTSnThe 10-year overall survival was 92% (95% confidence interval [CI]: 90-94) without a significant difference between the low and the select intermediate-risk groups (P=0.17). The 10-year relapse-free survival rate for the entire cohort was 82% (95% CI: 79-85), and was significantly higher in the low-risk group than in the intermediate one (87 vs 71%; P<0.0001). Twenty-six percent of the relapses observed in this series occurred after more than 10 years of follow-up. The 10-year cumulative incidence of grade 3-4 urinary toxicity (whatever the delay and the recovery) was 5.78%. The cumulative incidence of grades 3-4 rectal toxicity in the present series was 1.65% at 10 years. As for sexual toxicity, 61% of our patients retained an erectile capacity at 10 years (with or without oral medication), with age being a major factor.nnnCONCLUSIONnWith a median follow-up of more than 11 years, this series appears to confirm the excellent long-term results of low-dose rate prostate brachytherapy, both in terms of survival and in terms of toxicity.

La curiethérapie du cancer prostatique par implants permanents

With an experience of more than 20 years for the pionneers (and more than 10 years in France), permanent implant brachytherapy using Iodin 125 seeds is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. An extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group is presently under study. Moreover, for patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best way to escalate the dose for some patients. Various permanent implant brachytherapy techniques have been proposed; preplanning or real-time techniques, loose seeds or stranded seeds, manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints which have been recently redefined by the Groupe européen de curiethérapie--European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) group. Mid- and long-term results which are now available in the literature indicate relapse-free survival of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Some comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3-5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome which may be significant and last several months. In spite of those drawbacks, with excellent long-term results and low rates of incontinence and impotence, brachytherapy can be expected to be proposed to an increasing number of patients in France in the next future.

Les indications de la curiethérapie de prostate par implantation permanente

Resume Dans les dix dernieres annees, la curietherapie prostatique par implantation permanente s’est imposee comme une reelle alternative therapeutique dans le traitement des cancers localises de la prostate. La publication recente de resultats a 10-12 ans montre des resultats equivalents, pour une population selectionnee, a ceux de la chirurgie et de la radiotherapie conformationnelle, avec un faible taux de complications. Les criteres de selection ont bien ete definis par les societes savantesxa0: tumeur classee T1 ou T2, concentration serique de PSA

La curiethérapie prostatique: une alternative thérapeutique. Revue de la littérature

Resume Pour les patients ayant une esperance de vie superieure a dix ans, le traitement de reference des cancers de la prostate localises est actuellement la prostatectomie totale. Devant les importantes complications de ce traitement, la radiotherapie externe, maintenant conformationnelle et avec modulation dintensite, ou une simple surveillance sont souvent proposees aux patients. De nouvelles approches therapeutiques sont possibles. La curietherapie est lune des plus etudiees. Deux techniques sont actuellement pratiquees, les implantations permanentes, avec le plus souvent liode 125 ou le palladium 103, et les implants temporaires. Aux Etats-Unis, ou la curietherapie prostatique connait un essor, la premiere technique est la plus utilisee. Le recul des premieres equipes est maintenant de dix ans, avec des resultats encourageants, des survies comparables a celles obtenues avec la prostatectomie radicale et un taux de complication plus faible. Nous presentons ici une revue de la litterature montrant linteret de cette technique comme alternative therapeutique dans le cancer localise de la prostate.

Second malignancies after permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003

PURPOSEnTo analyse the rate of secondary malignancies observed in a series of 675xa0prostate cancer patients who underwent a permanent implant brachytherapy between 1999 and 2003, and to compare the incidence with the expected rate in a matched general French population.nnnMATERIAL AND METHODSnThe cohort included low-risk patients and a selection of favourable-intermediate risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125-iodine seeds and a prescription dose of 145Gy. The mean follow-up was 132xa0months.nnnRESULTSnThe 10-year overall survival for the entire cohort was 92% (95% confidence interval [CI]: 90-94). The 10-year relapse-free survival rate was 82% (95% CI: 79-85). Overall, 61xa0second cancers were registered. When comparing with a matched general French population, the standard incidence ratio (SIR) for bladder cancer was 1.02 (95% CI: 0.46-1.93). For colorectal cancer, the SIR was 0.45 (95% CI: 0.19-0.89). For lung cancer, the SIR was 0.38 (95% CI: 0.17-0.76). The SIR for all cancers was 0.61 (95% CI: 0.47-0.79). When excluding secondary colorectal and lung cancers (both with low SIRs in this series), the SIR for all cancers was 1.06 (95% CI: 0.77-1.29).nnnCONCLUSIONnWith a mean follow-up of more than 11xa0years, this series does not detect any excess risk of second cancers associated with permanent implant prostate brachytherapy. However, due to power limitation, a small increase in the risk of secondary malignancies cannot be totally ruled out.