1. [Permanent implant prostate cancer brachytherapy: 2013 state-of-the art].
- Author
-
Cosset JM, Hannoun-Lévi JM, Peiffert D, Delannes M, Pommier P, Pierrat N, Nickers P, Thomas L, and Chauveinc L
- Subjects
- Automation, Brachytherapy adverse effects, Brachytherapy instrumentation, Drug Implants, Erectile Dysfunction etiology, Erectile Dysfunction prevention & control, Humans, Iodine Radioisotopes administration & dosage, Male, Organs at Risk, Patient Selection, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology, Radiation Injuries etiology, Radiation Injuries prevention & control, Radiography, Radiometry, Radiopharmaceuticals administration & dosage, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Image-Guided, Rectum radiation effects, Risk Assessment, Salvage Therapy, Urethra radiation effects, Urinary Retention etiology, Urinary Retention prevention & control, Brachytherapy methods, Iodine Radioisotopes therapeutic use, Prostatic Neoplasms radiotherapy, Radiopharmaceuticals therapeutic use
- Abstract
With an experience of more than 25 years for the pioneers (and more than 14 years in France), permanent implant brachytherapy using iodine 125 seeds (essentially) is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. The possible extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group has now been confirmed by several studies. Moreover, for the other patients in the intermediate-risk group and for the patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best ways to escalate the dose. Different permanent implant brachytherapy techniques have been proposed; preplanning or real-time procedure, loose or stranded seeds (or both), manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints, which have been recently redefined by the international societies, such as the GEC-ESTRO group. Mid- and long-term results, which are now available in the literature, indicate relapse-free survival rates of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3 to 5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome, which may significantly alter the quality of life of the patients, and last several months. In spite of those drawbacks, with excellent long-term results, low rates of incontinence and impotence, and emerging new indications (focal brachytherapy, salvage brachytherapy after localized failure of an external irradiation), permanent implant prostate brachytherapy can be expected to be proposed to an increasing number of patients in the next future., (Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF