[Permanent iodine 125 implant brachytherapy in localized prostate cancer: results of the first 4 years of experience].
OBJECTIVE
This study reports the preliminary national results of permanent Iodine 125 implant brachytherapy for the treatment of localized prostate cancer with a follow-up of 4 years.


METHODS
The authors analyse a series of 260 patients treated consecutively according to the same technique (single-centre, with estimated dosimetry and the use of fixed implants) in terms of morbidity, recorded prospectively, and in terms of cancer control. In the group of 260 patients with stage T1-T2 prostate cancer 68.4% belonged to the low-risk group (PSA < 10 and Gleason score < 7), 28.4% belonged to the intermediate-risk group (PSA > 10 or Gleason score > 6) and 3% belonged to the high-risk group (PSA > 10 and Gleason score > 6). The mean follow-up was 29.5 months (range: 8-56 months). Adverse effects were dominated by obstructive and/or irritating voiding disorders in the majority of cases, with progressive improvement in 98% of cases. Acute urinary retention required drainage in 10.7% of cases. An endoscopic disobstruction operation was performed after at least 6 months in 2.3% of cases. Anorectitis was reported in 21.91% of cases: stage I in 20.3% and stage II in 1.5%, treated medically in every case. In the year following implantation, 34.2% of patients complained of erectile dysfunction that was successfully treated medically. Analysis of the dosimetric data after implantation demonstrated a learning curve in which optimal coverage of the therapeutic target by the dose of irradiation prescribed was obtained between the first 20 and 30 patients. This systematic, patient-by-patient analysis allowed optimization of the implantation technique, especially by ensuring better coverage of the base and anterior part of the prostate.


RESULTS
The 3-year laboratory recurrence-free survival was 93.8% for all patients and 97. 7% for the good prognosis group. Fifteen of the 16 recurrences occurred during the first 18 months of the experience. The results of this study are concordant with those of North American teams at the same stage of experience. In this programme, optimization of the technique and patient selection criteria achieved excellent results in terms of morbidity and cancer control. The authors propose elective brachytherapy to the group of patients with a poor prognosis, a prostate volume less than 50 ml and with no obvious urinary functional disorders. An analysis is underway to confirm these results with a longer follow-up.
Bladou
Franck
F
Service d'Urologie, Hôpital Salvator, Marseille, France. franck.bladou@ap-hm.fr
Salem
Naji
N
Simonian-Sauve
Michelle
M
Rosello
Roland
R
Ternier
Frédéric
F
Resbeut
Michel
M
Alzieu
Claude
C
Karsenty
Gilles
G
Serment
Gérard
G
Gravis
Gwenaëlle
G
Maraninchi
Dominique
D
D000230:Adenocarcinoma / Q000097:blood / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013997:Time Factors
D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
La curiethérapie par implants permanents d'iode 125 dans le cancer localise de prostate: résultats des 4 premières années d'experience.