title: Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy.
abstract: OBJECTIVE
  To analyze the correlations among comorbidity and overall survival (OS), biochemical progression-free survival (b-PFS) and toxicity in elderly patients with localized prostate cancer treated with (125)I brachytherapy.
  
  
  METHODS
  Elderly men, aged ≥65 years, with low-intermediate risk prostate cancer, were treated with permanent (125)I brachytherapy as monotherapy. Comorbidity data were obtained from medical reports using age-adjusted Charlson comorbidity index (a-CCI). The patients were categorized into two age groups (<75 and ≥75 years old), and two comorbidity score groups (a-CCI ≤3 and >3). Toxicity was scored with Radiation Therapy Oncology Group (RTOG) scale.
  
  
  RESULTS
  From June 2003 to October 2009, a total of 92 elderly patients underwent prostate brachytherapy, including 57 men (62%) with low-risk prostate cancer, and 35 men (38%) with intermediate-risk prostate cancer. The median age of patients was 75 years (range, 65-87 years). Forty-seven patients (51%) had a-CCI ≤3 and 45 patients (49%) a-CCI >3. With a median follow-up period of 56 months (range, 24-103 months), the 5-year actuarial OS and b-PFS were 91.3% and 92.4% respectively, without statistical significance between two Charlson score groups. Toxicity was mild. None of the patients experienced gastrointestinal (GI) toxicity, and only 4 patiens (4%) experienced late genitourinary (GU) grade-3 (G3) toxicity. No correlation between acute GU and GI toxicity and comorbidity was showed (P=0.50 and P=0.70, respectively).
  
  
  CONCLUSIONS
  Our data suggest that elderly men with low-intermediate risk prostate cancer and comorbidity can be considered for a radical treatment as (125)I low-dose rate brachytherapy.
authors.affiliation: Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture 85028, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Chiumento
authors.forename: Alba
authors.initials: A
authors.lastname: Fiorentino
authors.forename: Mariella
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Rocchina
authors.initials: R
authors.lastname: Caivano
authors.forename: Stefania
authors.initials: S
authors.lastname: Clemente
authors.forename: Piernicola
authors.initials: P
authors.lastname: Pedicini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fusco
keywords: Prostate cancer; biochemical control; brachytherapy; comorbidity; elderly; overall survival; toxicity