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Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation.

Abstract：

PURPOSE:To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS:From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS:The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION:The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.

journal_name

Brachytherapy

journal_title

Brachytherapy

authors

Le Fur E,Malhaire JP,Nowak E,Rousseau B,Erauso A,Pene-Baverez D,Papin G,Delage F,Perrouin-Verbe MA,Fournier G,Pradier O,Valeri A

doi

10.1016/j.brachy.2013.04.002

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

589-95

issue

eissn

1538-4721

issn

1873-1449

pii

S1538-4721(13)00245-6

journal_volume

pub_type

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Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation.