title: Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions.
abstract: OBJECTIVE
  Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.
  
  
  METHODS
  Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.
  
  
  RESULTS
  Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.
  
  
  CONCLUSIONS
  This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.
  
  
  CONCLUSIONS
  Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.
authors.affiliation: 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fellin
authors.affiliation: 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Mirri
authors.affiliation: 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.affiliation: 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.|5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: 6 Division of Urology, Santa Chiara Hospital, Trento, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Divan
authors.affiliation: 1 Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mussari
authors.affiliation: 7 Service of Health Physics, Santa Chiara Hospital, Trento, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ziglio
authors.affiliation: 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: La Face
authors.affiliation: 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Barbera
authors.affiliation: 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.|9 Brescia University, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.|9 Brescia University, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bandera
authors.affiliation: 10 Department of Health Physics, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ghedi
authors.affiliation: 11 Department of Radiotherapy, San Raffaele Turro Hospital, Milan, Italy.
authors.forename: Nadia G
authors.initials: NG
authors.lastname: Di Muzio
authors.affiliation: 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Losa
authors.affiliation: 13 Service of Health Physics, San Raffaele Turro Hospital, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mangili
authors.affiliation: 12 Department of Urology, San Raffaele Turro Hospital, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Nava
authors.affiliation: 14 Department of Radiotherapy, ASL2 Savonese, San Paolo Hospital, Savona, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Chiarlone
authors.affiliation: 15 Service of Health Physics, ASL2 Savonese, San Paolo Hospital, Savona, Italy.
authors.forename: Nunzia
authors.initials: N
authors.lastname: Ciscognetti
authors.affiliation: 16 Department of Urology, ASL2 Savonese, San Paolo Hospital, Savona, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Gastaldi
authors.affiliation: 17 Service of Health Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cattani
authors.affiliation: 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Spoto
authors.affiliation: 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavassori
authors.affiliation: 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Francesca R
authors.initials: FR
authors.lastname: Giglioli
authors.affiliation: 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Guarneri
authors.affiliation: 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cerboneschi
authors.affiliation: 19 Department of Radiation Oncology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Mignogna
authors.affiliation: 20 Operative Unit of Urology, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Paoluzzi
authors.affiliation: 21 Department of Medical Physics, S. Luca Hospital, Lucca, Healthcare Company Tuscany Usl Nord Ovest Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ravaglia
authors.affiliation: 22 Department of Radiation Oncology, IRCCS CROB, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Chiumento
authors.affiliation: 22 Department of Radiation Oncology, IRCCS CROB, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Clemente
authors.affiliation: 22 Department of Radiation Oncology, IRCCS CROB, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fusco
authors.affiliation: 23 Unit of Radiotherapy, Pistoia Hospital, USL3, Pistoia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santini
authors.affiliation: 23 Unit of Radiotherapy, Pistoia Hospital, USL3, Pistoia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Stefanacci
authors.affiliation: 24 Service of Health Physics, San Filippo Neri Hospital, ASL RME, Rome, Italy.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Mangiacotti
authors.affiliation: 25 Department of Urology, San Filippo Neri Hospital, ASL RME, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Martini
authors.affiliation: 2 Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Palloni
authors.affiliation: 26 MEMOTEF Department, "La Sapienza" University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schinaia
authors.affiliation: 27 Division of Radiation Oncology, Azienda USL, Taranto, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Lazzari
authors.affiliation: 26 MEMOTEF Department, "La Sapienza" University, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Silvano
authors.affiliation: 8 Department of Radiotherapy, Spedali Civili Hospital, Brescia, Italy.|9 Brescia University, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Magrini
authors.affiliation: 18 Department of Radiotherapy, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.affiliation: 28 University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Santoni
authors.affiliation: 4 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.|5 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods* / Q000401:mortality; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010818:Practice Patterns, Physicians'; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen