title: Comparison of permanent (125)I seeds implants with two different techniques in 500 cases of prostate cancer.
abstract: OBJECTIVE
  To perform a comparative study of 500 consecutive (125)I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning.
  
  
  METHODS
  From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%.
  
  
  RESULTS
  Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy.
  
  
  CONCLUSIONS
  The outcome of patients with low risk prostate carcinoma treated with (125)I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.
authors.affiliation: Department of Radiation Oncology.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Guinot
authors.affiliation: Department of Urology, Fundacion Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain.
authors.forename: Jose Vicente
authors.initials: JV
authors.lastname: Ricós
authors.affiliation: Department of Radiation Oncology.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Tortajada
authors.affiliation: Department of Radiation Oncology.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Santos
authors.affiliation: Department of Urology, Fundacion Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Casanova
authors.affiliation: Department of Radiation Oncology.
authors.forename: Jose
authors.initials: J
authors.lastname: Clemente
authors.affiliation: Department of Radiation Oncology.
authors.forename: Josefa
authors.initials: J
authors.lastname: Samper
authors.affiliation: Department of Radiation Oncology.
authors.forename: Paula
authors.initials: P
authors.lastname: Santamaría
authors.affiliation: Department of Radiation Oncology.
authors.forename: Leoncio
authors.initials: L
authors.lastname: Arribas
keywords: LDR brachytherapy; permanent; prostate cancer; real-time; seeds; technique