Andrius Ivanauskas, Eduardas Aleknavičius, Ernestas Janulionis, Arvydas Burneckis, Simona Letautienė, Albertas Ulys, Mantas Trakymas


Introduction. It’s about three decades when prostatebrachytherapy with radioactive implants has beenperformed in cancer treatment practice. The transrectalultrasound guidance let this method to developand to become more and more usable. AccordingESTRO/EAU/EORTC recommendations – dose tothe target (prostate) must be 145 Gy or higher . Itis essencial condition to reach good treatment results.Consolidation of various MRI regimes (T2,MRI diffusion, perfusion, spectroscopy) can giveus this information ,which nor other method can.Because of this we can use multiparametrical MRInot for only diagnostic but also brachytherapy planningpurposes. We define adaptive radiotherapy orbrachytherapy as radiation tumour treatment, whenradiation dose is delivered to the exact tumour (focaltherapy) or when there are several volumes withdifferent radiation doses. According to the literature– prostate brachytherapy with I-125 implant is notpart of adaptive prostate treatment protocols, buttechnically is possible and could be an ideal methodof adaptive prostate cancer treatment.Objectives. In 2010 in Vilnius University Instituteof Oncology (VUOI) we initialized clinical studycalled “Adaptive prostate cancer treatment withI-125 implants, safety and efficacy study”. It is openprospective non-randomized study. In this reviewwe will concentrate on giving the early and late radiationtoxicity results of our study and shortly deliversome our experience about impact of US andMRI in prostate tumour diagnosis and treatmentwith adaptive I-125 brachytherapy.Methods and materials. From July 2011 until December2013 52 (50 planned) patients who had favorablerisk cancer took part in this study. The ageof the patients was 49 – 75 years. Patients’ T werefrom cT1c to cT2c. PSA level 3,13 – 14,6 ng/ml.Gleason score of all patients – 6. All these low andintermediate risk prostate cancer patients undergonethe procedure of real time planned low dose rate(LDR) brachytherapy with I-125 prostate implants.During the adaptive prostate low dose rate (LDR)brachytherapy (BT) with I-125 implants we havedone dose escalation 200 Gy or more to the prostatemalignant lessions defined with biopsy, MRI and/orUS and the dose to the other prostate area were homogeneousand reached not less than 160 Gy(from 167 Gy – to 194 Gy).Results. This is a table with incidence and degree ofearly (until 6 mths. after treatment) and late (after 6mths. after treatment) genitourinary (GU) and gastrointestinal(GI) toxicity of adaptive prostate LDRBT study (Table).Conclusions. Acute GU toxicity is presenting in allpatients, but there are very low count of IIItoxicity. Late grade II GI toxicity manifested withblood traces in faeces, which were managed withmedicines. Late toxicity rates of our study is similarto those demonstrated by other authors. Still our adaptive brachytherapy methodic is very newground in brachytherapy and the count of patientseither follow up period is very short, so we shouldkeep on doing this technique and keep on goingwith follow up of these patients to get more confidentresults on toxicity.PSA dynamics, quality of life and benefits of MRIand US for our method remains the main questionsto answer in our early future articles.

Keyword(s): LDR prostate brachytherapy, I-125 seeds, adaptive prostate brachytherapy, early radiation toxicity, late radiation toxicity
DOI: 10.5200/sm-hs.2014.123
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