A Dose-response analysis of biochemical control outcomes after 125I monotherapy for patients with favorable-risk prostate cancer

Yutaka Shiraishi, Atsunori Yorozu, Toshio Ohashi, Kazuhito Toya, Shiro Saito, Toru Nishiyama, Yasuto Yagi, Naoyuki Shigematsu

Research output: Contribution to journalArticle

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Abstract

Purpose To define the optimal dose for 125I prostate implants by correlating postimplantation dosimetry findings with biochemical failure and toxicity.

Methods and Materials Between 2003 and 2009, 683 patients with prostate cancer were treated with 125I prostate brachytherapy without supplemental external beam radiation therapy and were followed up for a median time of 80 months. Implant dose was defined as the D90 (the minimal dose received by 90% of the prostate) on postoperative day 1 and 1 month after implantation. Therefore, 2 dosimetric variables (day 1 D90 and day 30 D90) were analyzed for each patient. We investigated the dose effects on biochemical control and toxicity.

Results The 7-year biochemical failure-free survival (BFFS) rate for the group overall was 96.4% according to the Phoenix definition. A multivariate analysis found day 1 D90 and day 30 D90 to be the most significant factors affecting BFFS. The cutoff points for day 1 D90 and day 30 D90, calculated from ROC curves, were 163 Gy and 175 Gy, respectively. By use of univariate analysis, various dosimetric cutoff points for day 30 D90 were tested. We found that day 30 D90 cutoff points from 130 to 180 Gy appeared to be good for the entire cohort. Greater D90s were associated with an increase in late genitourinary or gastrointestinal toxicity ≥ grade 2, but the increase was not statistically significant.

Conclusions Improvements in BFFS rates were seen with increasing D90 levels. Day 30 D90 doses of 130 to 180 Gy were found to serve as cutoff levels. For low-risk and low-tier intermediate-risk prostate cancer patients, high prostate D90s, even with doses exceeding 180 Gy, achieve better treatment results and are feasible.

Original languageEnglish
Pages (from-to)1069-1075
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number5
DOIs
Publication statusPublished - 2014 Dec 1

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Prostate
Prostatic Neoplasms
cancer
dosage
cut-off
toxicity
Survival Rate
Brachytherapy
ROC Curve
Phoenix (AZ)
Radiotherapy
Multivariate Analysis
dosimeters
Survival
radiation therapy
grade
implantation
curves
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

A Dose-response analysis of biochemical control outcomes after 125I monotherapy for patients with favorable-risk prostate cancer. / Shiraishi, Yutaka; Yorozu, Atsunori; Ohashi, Toshio; Toya, Kazuhito; Saito, Shiro; Nishiyama, Toru; Yagi, Yasuto; Shigematsu, Naoyuki.

In: International Journal of Radiation Oncology Biology Physics, Vol. 90, No. 5, 01.12.2014, p. 1069-1075.

Research output: Contribution to journalArticle

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abstract = "Purpose To define the optimal dose for 125I prostate implants by correlating postimplantation dosimetry findings with biochemical failure and toxicity.Methods and Materials Between 2003 and 2009, 683 patients with prostate cancer were treated with 125I prostate brachytherapy without supplemental external beam radiation therapy and were followed up for a median time of 80 months. Implant dose was defined as the D90 (the minimal dose received by 90{\%} of the prostate) on postoperative day 1 and 1 month after implantation. Therefore, 2 dosimetric variables (day 1 D90 and day 30 D90) were analyzed for each patient. We investigated the dose effects on biochemical control and toxicity.Results The 7-year biochemical failure-free survival (BFFS) rate for the group overall was 96.4{\%} according to the Phoenix definition. A multivariate analysis found day 1 D90 and day 30 D90 to be the most significant factors affecting BFFS. The cutoff points for day 1 D90 and day 30 D90, calculated from ROC curves, were 163 Gy and 175 Gy, respectively. By use of univariate analysis, various dosimetric cutoff points for day 30 D90 were tested. We found that day 30 D90 cutoff points from 130 to 180 Gy appeared to be good for the entire cohort. Greater D90s were associated with an increase in late genitourinary or gastrointestinal toxicity ≥ grade 2, but the increase was not statistically significant.Conclusions Improvements in BFFS rates were seen with increasing D90 levels. Day 30 D90 doses of 130 to 180 Gy were found to serve as cutoff levels. For low-risk and low-tier intermediate-risk prostate cancer patients, high prostate D90s, even with doses exceeding 180 Gy, achieve better treatment results and are feasible.",
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