A comparison of the impact of isotope (I-125 vs. Pd-103) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Brachytherapy (Impact Factor: 2.76). 12/2011; 11(4):271-6. DOI: 10.1016/j.brachy.2011.11.002
Source: PubMed


To compare biochemical outcomes and morbidity associated with iodine-125 ((125)I) and palladium-103 ((103)Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer.
Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy ((125)I prescription dose, 110Gy: n=199; (103)Pd prescription dose, 100Gy: n=60) followed by external beam radiotherapy (median dose, 50.4Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires.
Overall, acute Grade ≥2 genitourinary toxicity occurred in 21% and 30% of patients treated with (125)I and (103)Pd, respectively (p=0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p=0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for (125)I and (103)Pd patients, respectively (p=0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p=0.046). Late Grade ≥2 gastrointestinal toxicity occurred in 7% of (125)I patients and 6% of patients treated with (103)Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received (103)Pd (p=0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for (125)I and (103)Pd patients was 95.2% and 98.2% (p=0.73), respectively.
There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between (125)I and (103)Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of (103)Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between (103)Pd and (125)I.

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    • "Obstructive voiding symptoms are the primary urinary morbidity following brachytherapy. Treatment-related factors such as physician experience [31,32], isotope selection [33,34] and/or the number of needle applicators utilized [35,36] may affect the incidence and severity of obstructive voiding symptoms. Acute urinary retention (AUR) is common and may occur in 5-20% of patients [31]. "
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    Radiation Oncology 07/2014; 9(1):163. DOI:10.1186/1748-717X-9-163 · 2.55 Impact Factor
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    • "Use of short half-life radionuclides (103Pd and 131Cs at 17 and 9.7 days, respectively) reduces concern regarding concurrent EBRT dosing since > 90% of the brachytherapy dose is delivered after 8 weeks. However, the optimal role of each radionuclide has not been determined, nor has this question been asked in a randomized, multi-institutional, prospective study [42, 43]. "
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    Journal of Contemporary Brachytherapy 06/2013; 5(2):89-92. DOI:10.5114/jcb.2013.35562 · 1.28 Impact Factor
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    International journal of radiation oncology, biology, physics 03/2012; 84(3):707-11. DOI:10.1016/j.ijrobp.2012.01.009 · 4.26 Impact Factor
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