Purpose: To determine the displacement of needles (ND) and its impact in the outcome of initial and locally advanced prostate cancer treated with conventional external beam radiation therapy (EBRT) and fractionated transrectal ultrasound-guided high-dose-rate afterloading brachytherapy (HDR-BT) as a boost. Methods and Materials: From 03/97 to 08/98 a total of 47 patients were eligible for study entry. Patients with 1992 AJCC clinical stage T3a or less and prostatic volume ≤60 cm3 were eligible. Prior to HDR-BT, all patients had a course of pelvic localized EBRT up to a median dose of 46 Gy (range 45–50.4). Results: Median age was 68 years (range 47–83) and median follow-up 48 months (range 36–53). Minimal or no needle displacement occurred in 17% (8/47) of patients. There were 61.7% (29/47) of patients who needed one correction and 21.3% (10/47) who needed two corrections. There were no correlations with ND (p = 0.130) and times of ND (p = 0.295) occurrence with bNED. The crude and actuarial biochemical controls (bNED) in 53 months for all patients were 87.2 and 82.3% respectively. Actuarial bNED after 4 years in patients without and with ND were 75 and 89.7% (p = 0.254). Discussion: There are many advantages when HDR-BT is used, but the most important ones are the capability of on-line dosimetry and quality control. The procedure is very conformal, with dose-volume histograms representing the administered dose, but we still need to wait for results of phase III open trials that analyze HDR-BT and conformal therapy.

Keywords:
Prostate cancer, High-dose-rate afterloading brachytherapy, Quality control, Biochemical control
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© 2003 S. Karger AG, Basel
2003
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