Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2012

Abstract number 2

Multi-institutional outcomes following LDR brachytherapy in patients with higher risk cancer.

R. Conroy
The Christie NHS Foundation Trust, Manchester
P. Hoskin
Mount Vernon Hospital, Middlesex
D. Bottomley
St James’s Institute of Oncology, Leeds
P.Mandell
The Christie NHS Foundation Trust, Manchester
R. Swindell
The Christie NHS Foundation Trust, Manchester
J. Wylie
The Christie NHS Foundation Trust, Manchester

Aims/Introduction: We report the outcomes for a cohort of men with higher risk prostate adenocarcinoma treated with LDR brachytherapy in a multi-institutional UK practice.

Methods: 217 men treated between 2003-2007 with Iodine-125 brachytherapy at Christie, Leeds and Mount Vernon were identified from a multi-institutional database. Higher risk was defined as patients with ≥ 2 D’Amico intermediate risk factors (PSA 10-20, GS 7 or clinical T2c) or ≥1 high risk factor (PSA > 20, GS ≥ 8). Kaplan-Meier methods were used to estimate biochemical relapse free survival (BRFS) defined using both Phoenix and ASTRO definitions. A univariate analysis was performed to assess the significance of Gleason score, PSA, T-stage, pre- or post-implant dosimetry, and additional hormones on BRFS.

Results: The median age was 65yrs (43-79yrs) with a median PSA follow up of 62months (14-102months).
Median pre-implant doses (ranges) were: V150 59.6(43.7-89.8), V200 20.1(11.6-36).
75 patients had post-implant dosimetry, median dose (range) was: D90 132.8Gy (75-192Gy).
No patients had external beam radiotherapy.
67 patients had additional hormone treatment, median duration 7 months (3 – 22 months).
The 3 and 5 year BRFS as defined by Phoenix were 85.4% and 74.4% and as defined by ASTRO were 76.6% and 69.8%.
On univariate analysis there were no statistically significant predictors of inferior outcome.

Conclusion: Single modality LDR brachytherapy is a well established treatment for low risk prostate adenocarcinoma reporting excellent long term BRFS. Some authors have advocated the addition of external beam radiotherapy when treating higher risk disease. These results show that good BRFS can be obtained with LDR brachytherapy alone and no additional benefit has been shown by the addition of adjuvant hormone therapy. These results appear comparable with other treatment modalities available to these patients.