title: Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer.
abstract: OBJECTIVE
  To report the 5-year tumor control and toxicity outcomes for patients with localized prostate treated with I-125 permanent implantation using an intraoperative real-time conformal planning technique.
  
  
  METHODS
  Between January 1998 and June 2002, 367 patients with prostate cancer were treated with I-125 permanent interstitial implantation using a transrectal ultrasound-guided approach. Real-time intraoperative treatment planning which incorporated inverse planning optimization was used. The median follow-up time was 63 months.
  
  
  RESULTS
  The median V100 and D90 were 96% and 173 Gy, respectively. In 96% of cases a D90 of >140 Gy was achieved. The median urethral and rectal doses were 100% and 33% of the prescription doses, respectively. The 5-year PSA relapse-free survival outcomes for favorable and intermediate risk patients according to the ASTRO definition were 96% and 89%, respectively. In these patients no dosimetric parameter was identified which influenced the biochemical outcome. Of 38% who developed acute Grade 2 urinary symptoms, 63% had resolution of their symptoms within a median time of 6 months. The incidence of late rectal and urinary Grade 3 or higher toxicities were 1% and 4%, respectively. Seven percent (n = 27) developed late rectal bleeding (Grade 2) and 19% experienced late Grade 2 urinary symptoms.
  
  
  CONCLUSIONS
  Real-time intraoperative planning consistently achieved optimal coverage of the prostate with the prescription dose with concomitant low doses delivered to the urethra and rectum. Biochemical control outcomes were excellent at 5 years and late toxicity was unusual. These data demonstrate that real-time planning methods can consistently and reliably deliver the intended dose distribution to achieve an optimal therapeutic ratio between the target and normal tissue structures.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. zelefskm@mskcc.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.forename: Gil'ad N
authors.initials: GN
authors.lastname: Cohen
authors.forename: Alison
authors.initials: A
authors.lastname: Shippy
authors.forename: Heather
authors.initials: H
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Fridman
authors.forename: Marco
authors.initials: M
authors.lastname: Zaider
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D018084:Ultrasonography, Interventional
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen