title: Conventional versus automated implantation of loose seeds in prostate brachytherapy: analysis of dosimetric and clinical results.
abstract: OBJECTIVE
  To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation.
  
  
  METHODS
  574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival.
  
  
  RESULTS
  419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed.
  
  
  CONCLUSIONS
  Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis<3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.
authors.affiliation: Radiation Oncology Department, Institut Claudius Regaud, Toulouse, France. Electronic address: genebes.caroline@claudiusregaud.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Genebes
authors.forename: Thomas
authors.initials: T
authors.lastname: Filleron
authors.forename: Pierre
authors.initials: P
authors.lastname: Graff
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jonca
authors.forename: Eric
authors.initials: E
authors.lastname: Huyghe
authors.forename: Matthieu
authors.initials: M
authors.lastname: Thoulouzan
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.forename: Bernard
authors.initials: B
authors.lastname: Malavaud
authors.forename: Richard
authors.initials: R
authors.lastname: Aziza
authors.forename: Thomas
authors.initials: T
authors.lastname: Brun
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Bachaud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D015996:Survival Rate; D014526:Urethritis / Q000209:etiology / Q000473:pathology; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen