title: Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05).
abstract: OBJECTIVE
  To evaluate the effectiveness of transrectal ultrasound-guided permanent radioactive (125)I implantation of the prostate for organ-confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting.
  
  
  METHODS
  Patients accrued to this study had histologically confirmed, locally confined, adenocarcinoma of the prostate with clinical Stage T1b, T1c, or T2a, no nodal or metastatic disease, prostate-specific antigen level of < or =10 ng/mL, and Gleason score of < or =6. All patients underwent transrectal ultrasound-guided radioactive (125)I permanent seed implantation into the prostate. The prescribed dose was 145 Gy to the prostate planning target volume.
  
  
  RESULTS
  A total of 27 institutions accrued a total of 101 patients to this protocol, with no institution accruing >8 patients. Six patients were ineligible, leaving 95 properly entered as eligible in the study. The median follow-up was 5.3 years (range, 0.4-6.5 years). At 5 years, 5 patients had local failure, 1 had evidence of distant failure, and 6 (6%) had biochemical failure. The overall survival rate at 5 years was 96.7%. At last follow-up, no patient had died of prostate cancer or related toxicities. Eight patients had a maximal acute toxicity level of 3, and no patient had Grade 4 or 5 acute toxicity. During follow-up, 2 patients had maximal Grade 3 toxicity, both related to bladder issues, and no patient experienced Grade 4 or 5 toxicity.
  
  
  CONCLUSIONS
  The results of this clinical protocol (a multi-institutional trial of brachytherapy for localized adenocarcinoma of the prostate) have demonstrated that this type of trial can be successfully completed through the Radiation Therapy Oncology Group. Biochemical disease-free survival was comparable with other brachytherapy published series and with the results after surgery and external beam radiotherapy.
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. clawton@radonc.mcw.edu
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Lawton
authors.forename: Michelle
authors.initials: M
authors.lastname: DeSilvio
authors.forename: W Robert
authors.initials: WR
authors.lastname: Lee
authors.forename: Leonard
authors.initials: L
authors.lastname: Gomella
authors.forename: David
authors.initials: D
authors.lastname: Grignon
authors.forename: Michael
authors.initials: M
authors.lastname: Gillin
authors.forename: Gerard
authors.initials: G
authors.lastname: Morton
authors.forename: Thomas
authors.initials: T
authors.lastname: Pisansky
authors.forename: Howard
authors.initials: H
authors.lastname: Sandler
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen