Long-term results of permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003.
OBJECTIVE
To analyse long-term overall survival, relapse-free survival and late toxicities in a series of 675 patients treated between 1999 and 2003, with a median follow-up of 132 months.


METHODS
The cohort included low-risk patients and a selection of "favourable-intermediate" risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125 iodine seeds. Hormone therapy, consisting most often of an anti-androgen alone, was given in 393 patients (58%).


RESULTS
The 10-year overall survival was 92% (95% confidence interval [CI]: 90-94) without a significant difference between the low and the select intermediate-risk groups (P=0.17). The 10-year relapse-free survival rate for the entire cohort was 82% (95% CI: 79-85), and was significantly higher in the low-risk group than in the intermediate one (87 vs 71%; P<0.0001). Twenty-six percent of the relapses observed in this series occurred after more than 10 years of follow-up. The 10-year cumulative incidence of grade 3-4 urinary toxicity (whatever the delay and the recovery) was 5.78%. The cumulative incidence of grades 3-4 rectal toxicity in the present series was 1.65% at 10 years. As for sexual toxicity, 61% of our patients retained an erectile capacity at 10 years (with or without oral medication), with age being a major factor.


CONCLUSIONS
With a median follow-up of more than 11 years, this series appears to confirm the excellent long-term results of low-dose rate prostate brachytherapy, both in terms of survival and in terms of toxicity.
Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Centre de radiothérapie Charlebourg-La-Défense, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France. Electronic address: jean-marc.cosset@amethyst-radiotherapy.com.
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JM
Cosset
Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Fondation Saint-Jean-de-Dieu-Oudinot, 19, rue Oudinot, 75007 Paris, France.
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T
Flam
Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
L
L
Belin
Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
N
N
Thiounn
Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
N
N
Pierrat
Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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D
Pontvert
Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Charles Lemoyne Hospital, 3120, boulevard Taschereau, Greenfield Park, J4V 2H1 Montréal, QC, Canada.
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G
Wakil
Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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A
Savignoni
Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Centre de radiothérapie Hartmann, 4, rue Kléber, 93200 Levallois-Perret, France.
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L
Chauveinc
D000367:Age Factors; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects; D015331:Cohort Studies; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012003:Rectal Fistula / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
D000726:Androgen Antagonists
Brachytherapy; Cancer prostatique; Curiethérapie; Implants permanents; Permanent implant; Prostate cancer; Toxicity; Toxicité