Improved biochemical control and clinical disease-free survival with intraoperative versus preoperative preplanning for transperineal interstitial permanent prostate brachytherapy.
Purpose: We hypothesized that intraoperative preplanning for transperineal interstitial permanent prostate brachytherapy may yield better prostate cancer control than preoperative preplanning. We tested this hypothesis by comparing treatment outcomes of patients who underwent implantation using thes...
| Publicado en: | Cancer Journal Vol. 12; no. 4; pp. 289 - 298 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Jul/Aug2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106019085&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106019085 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15289117 4U5 jtl: Cancer Journal issn: 15289117 maglogo: N pubinfo: dt: Jul/Aug2006 vid: 12 iid: 4 pid: 5086 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 106019085 106019085 NLM16925973 2009277144 10.1097/00130404-200607000-00007 NLM16925973 106019085 ppf: 289 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Improved biochemical control and clinical disease-free survival with intraoperative versus preoperative preplanning for transperineal interstitial permanent prostate brachytherapy. aug: au: Shah JN Wuu CS Katz AE Laguna JL Benson MC Ennis RD Shah, Jinesh N Wuu, Cheng-Shie Katz, Aaron E Laguna, Joseph L Benson, Mitchell C Ennis, Ronald D affil: Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, New York 10019, USA sug: subj: Adenocarcinoma Radiotherapy Prostatic Neoplasms Radiotherapy Adenocarcinoma Surgery Brachytherapy Intraoperative Period Male Prognosis Prospective Studies Prostatic Neoplasms Surgery Radiation Dosage Radiotherapy, Computer-Assisted Human Male ab: Purpose: We hypothesized that intraoperative preplanning for transperineal interstitial permanent prostate brachytherapy may yield better prostate cancer control than preoperative preplanning. We tested this hypothesis by comparing treatment outcomes of patients who underwent implantation using these two preplanning methods.Patients and Methods: We analyzed the data of 135 consecutive patients with localized prostate cancer treated from 1996 to 2001 with transperineal interstitial permanent prostate brachytherapy+/-preimplantation hormonal therapy: 42 received preoperative preplanning (group 1), and 93 underwent intraoperative preplanning (group 2). Biochemical status was assessed using two failure definitions: American Society for Therapeutic Radiology and Oncology (ASTRO) (three consecutive rises in prostate-specific antigen level) and Houston (prostate-specific antigen level>or=current nadir+2 ng/mL). Clinical disease-free survival and postimplantation dosimetry were also examined.Results: All disease control outcomes were superior for group 2. The 4-year ASTRO biochemical no evidence of disease rate was 80% for group 1 versus 94% for group 2. The 4-year Houston biochemical no evidence of disease rate was 82% for group 1 versus 96% for group 2. The 4-year clinical disease-free survival rate was 87% for group 1 versus 99% for group 2. Preplanning method (preoperative versus intraoperative) remained predictive of disease control outcomes in multivariate analyses with the covariates of pretreatment prostate-specific antigen level, Gleason score, clinical stage, and case sequence number (proxy for brachytherapist experience and "stage migration"). Dosimetric prostate coverage was superior for group 2. The mean percentage of the prescription dose delivered to 90% of the prostate volume (%D90) was 75% for group 1 versus 90% for group 2. A %D90>or=70% predicted for improved disease control; fewer group 1 than 2 patients met this dosimetric criterion (55% versus 87%).Discussion: Intraoperative preplanning yielded superior disease control outcomes in this analysis, likely due at least in part to improved dosimetric prostate coverage with this method. Although not mandatory for obtaining high prostate brachytherapy efficacy, intraoperative preplanning nevertheless may offer an excellent means of improving dosimetric prostate coverage and therefore disease control outcomes. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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