A comparison of the impact of isotope (¹²⁵I vs. ¹⁰³Pd) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer

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• 作者：Marisa A. Kollmeier¹ ; ^{kollmeim@mskcc.org} ; Xin Pei¹ ; Ece Algur¹ ; Yoshiya Yamada¹ ; Brett W. Cox¹ ; Gil’ ; ad N. Cohen² ; Marco Zaider² ; Michael J. Zelefsky¹
• 关键词：Iodine-125 ; Palladium-103 ; External beam radiation therapy ; Prostate cancer ; Brachytherapy
• 刊名：Brachytherapy
• 出版年：2012
• 期刊代码：278_15384721
• 类别：med
• 出版时间：July-August, 2012
• 卷：11
• 期：4
• 页码：271-276
• 文件大小：201 K

摘要

Purpose

To compare biochemical outcomes and morbidity associated with iodine-125 (¹²⁵I) and palladium-103 (¹⁰³Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer.

Methods and Materials

Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy (¹²⁵I prescription dose, 110 Gy: n = 199; ¹⁰³Pd prescription dose, 100 Gy: n = 60) followed by external beam radiotherapy (median dose, 50.4 Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires.

Results

Overall, acute Grade 鈮? genitourinary toxicity occurred in 21%and 30%of patients treated with ¹²⁵I and ¹⁰³Pd, respectively (p = 0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p = 0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for ¹²⁵I and ¹⁰³Pd patients, respectively (p = 0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p = 0.046). Late Grade 鈮? gastrointestinal toxicity occurred in 7%of ¹²⁵I patients and 6%of patients treated with ¹⁰³Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received ¹⁰³Pd (p = 0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for ¹²⁵I and ¹⁰³Pd patients was 95.2%and 98.2%(p = 0.73), respectively.

Conclusion

There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between ¹²⁵I and ¹⁰³Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of ¹⁰³Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between ¹⁰³Pd and ¹²⁵I.