Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age

Alexander Armstrong; Huong Ho; Mark Tacey; Damien Bolton; Yee Chan; Alwin Tan; Chee Wee Cham; Trung Pham; Kevin McMillan; George Koufogiannis; Paul Manohar; Mario Guerrieri; Michael Ng; Daryl Lim Joon; Farshad Foroudi; Mun Yee Tan; Michael Chao

doi:10.5114/jcb.2024.135630

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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1/2024
vol. 16

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abstract:

Original paper

Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age

Alexander Armstrong

¹

,

Huong Ho

²

,

Mark Tacey

^{3, 4}

,

Damien Bolton

⁵

,

Yee Chan

⁶

,

Alwin Tan

⁷

,

Chee Wee Cham

⁷

,

Trung Pham

⁸

,

Kevin McMillan

⁹

,

George Koufogiannis

¹⁰

,

Paul Manohar

¹¹

,

Mario Guerrieri

¹²

,

Michael Ng

¹²

,

Daryl Lim Joon

¹³

,

Farshad Foroudi

¹³

,

Mun Yee Tan

¹⁴

,

Michael Chao

^{12, 13}

Department of Radiation Oncology, North Coast Cancer Institute, Lismore Cancer Care and Hematology Unit, Lismore, NSW, Australia
GenesisCare Ringwood Vic., Australia
Department of Radiation Oncology, Austin Health, Heidelberg, Australia
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Department of Surgery, Austin Health, Heidelberg, Vic., Australia
Department of Surgery, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Vic., Australia
The Bays Hospital, Mornington, Vic., Australia
Mulgrave Private Hospital, Mulgrave, Vic., Australia
Box Hill Hospital, Box Hill, Vic., Australia
Ringwood Private Hospital, Ringwood East, Vic., Australia
St John of God Specialist Centre, Berwick, Vic., Australia
Genesis Cancer Care Victoria, Melbourne, Australia
Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Vic., Australia
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia

J Contemp Brachytherapy 2024; 16, 1: 6–11

DOI: https://doi.org/10.5114/jcb.2024.135630

Online publish date: 2024/02/23

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Purpose:
Low-dose-rate (LDR) brachytherapy in young men remains controversial amongst urologists due to their concerns regarding long-term biochemical control and treatment-related toxicities. The purpose of this study was to evaluate the treatment outcomes of men under 60 years of age who underwent LDR brachytherapy with iodine-125 (¹²⁵I) for clinically localized low- to intermediate-risk prostate cancer.

Material and methods:
All consecutive patients with clinically localized prostate cancer treated at our institution from 2003 to 2016 with ¹²⁵I monotherapy were included in the study. Prescription dose was 145.0 Gy modified peripheral loading (MPD). All patients were assessed for biochemical progression-free survival using Phoenix definition (nadir +2 ng/ml), clinical progression-free survival, overall survival (OS), and any associated treatment toxicity.

Results:
A total of 161 patients were included, with a median follow-up of 6.8 years (range, 3-14.54 years). Median age at implant was 57 years (range, 53-59 years). Mean prostate specific antigen (PSA) level at diagnosis was 4.43 ng/ml (SD = 2.29). Majority of men had low-risk prostate cancer (70.2%). Biochemical progression-free survival at 8 years was 94% for the entire cohort. Median PSA at 4 years was 0.169 (IQR, 0.096-0.360), with 45% of patients having a PSA greater than 0.2. OS was 96.9%, with 5 deaths reported but only one was secondary to prostate cancer. Late grade > 2 genitourinary toxicities were reported in 18 patients (11.2%). Three patients (1.9%) developed secondary cancers, all considered unrelated to their LDR brachytherapy.

Conclusions:
With excellent long-term treatment outcomes and minimal associated toxicities, our results showed that LDR brachytherapy can be an effective treatment of choice in younger men.

keywords:

Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age

prostate cancer, brachytherapy, toxicity, low-dose-rate, long-term treatment outcomes