title: High-dose regions versus likelihood of cure after prostate brachytherapy.
abstract: OBJECTIVE
  To analyze the effect of high-dose regions on biochemical cancer control rates after prostate brachytherapy.
  
  
  METHODS
  Patients with 1997 American Joint Committee on Cancer clinical Stage T1c-T2a prostate carcinoma (Gleason grade 5-6, prostate-specific antigen level 4-10 ng/mL) were randomized to implantation with 125I (144 Gy) vs. 103Pd (125 Gy, National Institute of Standards and Technology 1999). Isotope implantation was performed by standard techniques, using a modified peripheral loading pattern. Of the 313 patients entered in the protocol, 270 were included in this analysis. The 125I source strength ranged from 0.4 to 0.89 mCi (median, 0.55 mCi), and the 103Pd source strength ranged from 1.3 to 1.6 mCi (median, 1.5 mCi). CT was performed within 4 h after implantation. The dosimetric parameters analyzed included the percentage of the postimplant prostate volume covered by the 100%, 150%, 200%, and 300% prescription dose (V100, V150, V200, and V300, respectively). The median time to the last follow-up for patients without failure was 2.7 years. Freedom from biochemical failure was defined as a serum prostate-specific antigen level of < or =0.5 ng/mL at last follow-up. Patients were censored at last follow-up if their serum prostate-specific antigen level was still decreasing.
  
  
  RESULTS
  The mean V100, V150, V200, and V300 value was 90% (+/-8%), 63% (+/-14), 35% (+/-13%), and 14% (+/-7%), respectively. Patients with a V100 of > or =90% had a 3-year freedom from biochemical failure rate of 96% vs. 87% for those with a V100 of <90% (p=0.0029). Overall, patients with more high-dose regions had a greater chance of biochemical control. However, when only patients with a V100 of > or =90% were analyzed, no relationship was found between higher dose regions and the likelihood of cancer control. This lack of effect on biochemical control was apparent for both isotopes.
  
  
  CONCLUSIONS
  High-dose regions do not appear to affect cancer control rates, as long as >90% of the prostate volume is covered by the prescription dose.
authors.affiliation: Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA 98108-1597, USA. kent.wallner@med.va.gov
authors.forename: Kent
authors.initials: K
authors.lastname: Wallner
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
authors.forename: Steven
authors.initials: S
authors.lastname: Sutlief
authors.forename: Laurence
authors.initials: L
authors.lastname: True
authors.forename: Wayne
authors.initials: W
authors.lastname: Butler
mesh_terms: D001918:Brachytherapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D010165:Palladium / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D017211:Treatment Failure
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen