title: 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study.
abstract: OBJECTIVE
  Pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose- rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning.
  
  
  METHODS
  Between 05/2002 and 05/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) < or = 10 ng/ml, Gleason score < or = 7 and clinical stage < or = T2a were treated. Median PSA was 6.4 ng/ml and median Gleason score 5. 24/52 patients had stage T1c and 28/52 stage T2a. For transrectal ultrasound-(TRUS-)guided transperineal implantation of flexible plastic needles into the prostate, the real-time HDR planning system SWIFT((R)) was used. After implantation, CT-based 3-D postplanning was performed. All patients received one implant for four fractions of HDR brachytherapy in 48 h using a reference dose (D(ref)) of 9.5 Gy to a total dose of 38.0 Gy. Dose-volume histograms (DVHs) were analyzed to evaluate the conformal quality of each implant using D(90), D(10) urethra, and D(10) rectum. Acute toxicity was evaluated using the CTC (Common Toxicity Criteria) scales.
  
  
  RESULTS
  Median D(90) was 106% of D(ref) (range: 93-115%), median D(10) urethra 159% of D(ref) (range: 127-192%), and median D(10) rectum 55% of D(ref) (range: 35-68%). Median follow-up is currently 8 months. In 2/52 patients acute grade 3 genitourinary toxicity was observed. No gastrointestinal toxicity > grade 1 occurred.
  
  
  CONCLUSIONS
  3-D conformal HDR brachytherapy as monotherapy using intraoperative real-time planning is a feasible and highly conformal treatment for localized prostate cancer associated with minimal acute toxicity. Longer follow-up is needed to evaluate late toxicity and biochemical control.
authors.affiliation: Department of Radiation Oncology, Klinikum Offenbach, Offenbach/Main, Germany. Doc-Martin@t-online.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Martin
authors.forename: Dimos
authors.initials: D
authors.lastname: Baltas
authors.forename: Ralf
authors.initials: R
authors.lastname: Kurek
authors.forename: Sandra
authors.initials: S
authors.lastname: Röddiger
authors.forename: Marina
authors.initials: M
authors.lastname: Kontova
authors.forename: Georgios
authors.initials: G
authors.lastname: Anagnostopoulos
authors.forename: Thomas
authors.initials: T
authors.lastname: Dannenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Buhleier
authors.forename: Georgies
authors.initials: G
authors.lastname: Skazikis
authors.forename: Ulf
authors.initials: U
authors.lastname: Tunn
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D012007:Rectum / Q000528:radiation effects; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014521:Urethra / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen