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Fellin G, Mirri MA, Santoro L, Jereczek-Fossa BA, Divan C, Mussari S, Ziglio F, La Face B, Barbera F, Buglione M, Bandera L, Ghedi B, Di Muzio NG, Losa A, Mangili P, Nava L, Chiarlone R, Ciscognetti N, Gastaldi E, Cattani F, Spoto R, Vavassori A, Giglioli FR, Guarneri A, Cerboneschi V, Mignogna M, Paoluzzi M, Ravaglia V, Chiumento C, Clemente S, Fusco V, Santini R, Stefanacci M, Mangiacotti FP, Martini M, Palloni T, Schinaia G, Lazzari G, Silvano G, Magrini S, Ricardi U, Santoni R, Orecchia R. Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions. Br J Radiol 2016; 89:20150981. [PMID: 27384381 DOI: 10.1259/bjr.20150981] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
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Affiliation(s)
- Giovanni Fellin
- 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Maria A Mirri
- 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy
| | - Luigi Santoro
- 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Barbara A Jereczek-Fossa
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Claudio Divan
- 6 Division of Urology, Santa Chiara Hospital, Trento, Italy
| | - Salvatore Mussari
- 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Francesco Ziglio
- 7 Service of Health Physics, Santa Chiara Hospital, Trento, Italy
| | - Beniamino La Face
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy
| | - Fernando Barbera
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Laura Bandera
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Barbara Ghedi
- 10 Department of Health Physics, Spedali Civili Hospital, Brescia, Italy
| | - Nadia G Di Muzio
- 11 Department of Radiotherapy, San Raffaele Turro Hospital, Milan, Italy
| | - Andrea Losa
- 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy
| | - Paola Mangili
- 13 Service of Health Physics, San Raffaele Turro Hospital, Milan, Italy
| | - Luciano Nava
- 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy
| | - Renato Chiarlone
- 14 Department of Radiotherapy, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Nunzia Ciscognetti
- 15 Service of Health Physics, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Emilio Gastaldi
- 16 Department of Urology, ASL2 Savonese, San Paolo Hospital, Savona, Italy
| | - Federica Cattani
- 17 Service of Health Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Francesca R Giglioli
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessia Guarneri
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Valentina Cerboneschi
- 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy
| | - Marcello Mignogna
- 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy
| | - Mauro Paoluzzi
- 20 Operative Unit of Urology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy
| | - Valentina Ravaglia
- 21 Department of Medical Physics, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy
| | | | | | | | - Roberto Santini
- 23 Unit of Radiotherapy, Pistoia Hospital, USL3, Pistoia, Italy
| | | | | | - Marco Martini
- 25 Department of Urology, San Filippo Neri Hospital, ASL RME, Rome, Italy
| | - Tiziana Palloni
- 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy
| | | | - Grazia Lazzari
- 27 Division of Radiation Oncology, Azienda USL, Taranto, Italy
| | | | - Stefano Magrini
- 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.,9 Brescia University, Brescia, Italy
| | - Umberto Ricardi
- 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Roberto Orecchia
- 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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