Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2011

Abstract number 5

UK Experience of Real Time Prostate Brachytherapy: A Report from Two Centres

Eleanor James, Berkshire Cancer Centre, Reading
Chris Elwell, Northampton Cancer Centre
Stuart Duggleby, Northampton Cancer Centre
Philip Camilleri, Northampton Cancer Centre
Andrew Doggart, Berkshire Cancer Centre
Paul Rogers, Berkshire Cancer Centre

Aims: Real-time prostate brachytherapy  has been used in a minority of UK centres since 2002. We report results from two UK centres prescribing to 160Gy for comparison with the pre-plan experience

Methods: Patients treated at Reading and Northampton Cancer Centres were prospectively registered on databases. Patient characteristics, PSA, staging, intra-operative and post-implant dosimetry, and follow-up data were recorded. Patients with a minimum of 12 months of follow were included. Toxicity, median 4-year PSA and 5-year bNED were calculated.

518 patients were registered between 2002 and 2010 (275 from Reading and 243 from Northampton). 79 (17.6%) patients with large prostates of 50-100mls were treated. Median follow up is 36 months (range 12 – 84). Patient and tumour characteristics were similar at both centres.

Results: 5-year ASTRO bNED was 95.3% for low risk (NCCN definition), and 84.4% for intermediate risk. The median 4-year PSA was 0.1.  None of the large prostates have relapsed to date.

Intraoperative urethral D10 median was 202.9Gy (range 126.7-320.9), with a postoperative rise to 230Gy (118.5-395.9). Strictures occurred in 7 patients (1.4%). Re-catheterisation occurred in 1.4%, resulting in 3 TURPS (0.6%). Median IPSS pre-procedure was 4, peaked at 3 months to 11, and was settled at 5 by 12 months.

Median intraoperative D90 was 189.0Gy (162.6-214.7) at Reading and 188.0Gy (161.0-212.0) at Northampton; post-operative D90s were 173.3Gy (range 137.0-222.3), 170.0Gy (116.0-226.0) respectively, a median reduction in dose of 8.3% and 9.6%. 

Conclusion: The quality of the brachytherapy implant is an important predictor of long term outcome for both real-time and pre-plan techniques.

Real-time gives favourable post-implant D90s, with an 8.3% reduction in post-implant values, compared with 25-33% for pre-plan techniques. It is well tolerated, and allows successful treatment of larger prostates.