title: Simultaneous radiotherapy for prostate cancer: 125I prostate implant followed by external-beam radiation.
abstract: OBJECTIVE
  Using a rigorous prostate-specific antigen definition of disease-freedom, the 10-year disease-free survival rates after simultaneous radiation of prostate cancer are presented.
  
  
  METHODS
  From January 1984 through December 1996, 1020 men with clinical stage T1T2N0 prostate cancer were treated by simultaneous radiation: radioactive 125I prostate implantation followed by external-beam radiation. The median pretreatment prostate-specific antigen was 7.5 ng/mL (range, 0.2-188 ng/mL). Implantation was performed by both the retropubic and the transperineal technique, always followed by external-beam radiation. None received hormone treatment. Disease freedom is defined as achieving and maintaining a posttreatment prostate-specific antigen of < or = 0.5 ng/mL. The median follow-up is 3 years (range, 1-14 years).
  
  
  RESULTS
  The overall 5- and 10-year disease-free survival rates are 79% and 72%, respectively, after which a plateau is reached. At 5 years posttreatment, significantly better disease-free survival results are documented with simultaneous radiation by the ultrasound technique (92%) compared with the retropubic implant technique (73%). On multivariate analysis, pretreatment prostate-specific antigen is the most significant factor associated with disease-free survival, followed by implant technique.
  
  
  CONCLUSIONS
  The 10-year disease-free survival rate after simultaneous radiation is comparable to the 10-year results after radical prostatectomy. Disease freedom is defined by the same prostate-specific antigen criteria used for surgery. A plateau in the disease-free curve suggests cure. Of equal importance, the information described in this report should form only a baseline relative to future results as men treated with simultaneous radiation using the transperineal implant technique reach longer follow-up.
authors.affiliation: Radiotherapy Clinics of Georgia, Decatur, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Critz
authors.forename: A K
authors.initials: AK
authors.lastname: Levinson
authors.forename: W H
authors.initials: WH
authors.lastname: Williams
authors.forename: C T
authors.initials: CT
authors.lastname: Holladay
authors.forename: V D
authors.initials: VD
authors.lastname: Griffin
authors.forename: D A
authors.initials: DA
authors.lastname: Holladay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018572:Disease-Free Survival; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen