title: Long-Term Efficacy and Toxicity of Low-Dose-Rate ¹²⁵I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer.
abstract: OBJECTIVE
  To report long-term efficacy and toxicity for a single-institution cohort of patients treated with low-dose-rate prostate brachytherapy permanent implant (PI) monotherapy.
  
  
  METHODS
  From 1996 to 2007, 1989 patients with low-risk (61.3%), intermediate-risk (29.8%), high-intermediate-risk (4.5%), and high-risk prostate cancer (4.4%) were treated with PI and followed up prospectively in a registry. All patients were treated with (125)I monotherapy to 144 Gy. Late toxicity was coded retrospectively according to a modified Common Terminology Criteria for Adverse Events 4.0 scale. The rates of biochemical relapse-free survival (bRFS), distant metastasis-free survival (DMFS), overall survival (OS), and prostate cancer-specific mortality (PCSM) were calculated. We identified factors associated with late grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity, bRFS, DMFS, OS, PCSM, and incontinence.
  
  
  RESULTS
  The median age of the patients was 67 years, and the median overall and prostate-specific antigen follow-up times were 6.8 years and 5.8 years, respectively. The overall 5-year rates for bRFS, DMFS, OS, and PCSM were 91.9%, 97.8%, 93.7%, and 0.71%, respectively. The 10-year rates were 81.5%, 91.5%, 76.1%, and 2.5%, respectively. The overall rates of late grade ≥3 GU and GI toxicity were 7.6% and 0.8%, respectively. On multivariable analysis, age and prostate length were significantly associated with increased risk of late grade ≥3 GU toxicity. The risk of incontinence was highly correlated with both pre-PI and post-PI transurethral resection of the prostate.
  
  
  CONCLUSIONS
  Prostate brachytherapy as monotherapy is an effective treatment for low-risk and low-intermediate-risk prostate cancer and appears promising as a treatment for high-intermediate-risk and high-risk prostate cancer. Significant long-term toxicities are rare when brachytherapy is performed as monotherapy.
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kittel
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Stephans
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Rahul D
authors.initials: RD
authors.lastname: Tendulkar
authors.affiliation: Department of Urology, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Ulchaker
authors.affiliation: Department of Urology, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Angermeier
authors.affiliation: Department of Urology, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Department of Urology, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stephenson
authors.affiliation: Department of Urology, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: D Allan
authors.initials: DA
authors.lastname: Wilkinson
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio. Electronic address: ciezkij@ccf.org.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D012306:Risk; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen