title: (125)I monotherapy using D90 implant doses of 180 Gy or greater.
abstract: OBJECTIVE
  The purpose of this study was to characterize the oncologic results and toxicity profile of patients treated with (125)I implants using the dose delivered to 90% of the gland from the dose-volume histogram (D90) of greater than 144 Gy.
  
  
  METHODS
  From June 1995 to Feb 2005, a total of 643 patients were treated with (125)I monotherapy for T1-T2 prostate cancer with a D90 of 180 Gy or greater (median, 197 Gy; range, 180-267 Gy). Implantations were performed using a real-time ultrasound-guided seed-placement method and intraoperative dosimetry to optimize target coverage and homogeneity by using modified peripheral loading. We analyzed biochemical disease-free survival (bDFS) of 435 patients who had a minimum 2-year prostate-specific antigen follow-up (median follow-up, 6.7 years; range, 2.0-11.1 years).
  
  
  RESULTS
  Five-year bDFS rates for the entire cohort using the American Society for Therapeutic Radiology and Oncology and Phoenix definitions were 96.9% and 96.5%, respectively. Using the Phoenix definition, 5-year bDFS rates were 97.3% for low-risk patients and 92.8% for intermediate/high-risk patients. The positive biopsy rate was 4.1%. The freedom rate from Grade 2 or higher rectal bleeding at 5 years was 88.5%. Acute urinary retention occurred in 10.7%, more commonly in patients with high pretreatment International Prostate Symptom Scores (p < 0.01). In patients who were potent before treatment, 73.4% remained potent at 5 years after implantation.
  
  
  CONCLUSIONS
  Patients with a minimum D90 of 180 Gy had outstanding local control based on prostate-specific antigen control and biopsy data. Toxicity profiles, particularly for long-term urinary and sexual function, were excellent and showed that D90 doses of 180 Gy or greater performed using the technique described were feasible and tolerable.
authors.affiliation: Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Kao
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
authors.forename: Amir
authors.initials: A
authors.lastname: Lavaf
authors.forename: Vishruta
authors.initials: V
authors.lastname: Dumane
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Cesaretti
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
mesh_terms: D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D018084:Ultrasonography, Interventional
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen