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ABSTRACT: OBJECTIVE: To compare two widely used permanent prostate brachytherapy techniques, preplanning and intraoperative planning, based on postimplant dosimetry, toxicity and biochemical outcomes. METHODS: Between 2003 and 2006, 665 men with localized prostate cancer were treated with permanent interstitial implantation. The first 227 consecutive men were treated with the preplanning technique, followed by 438 men treated with the intraoperative technique. Late toxicity was scored by the Common Terminology Criteria for Adverse Events v.4.0. Biochemical failure was defined as a prostate-specific antigen increase of more than 2 ng/ml above the nadir value excluding a benign bounce. Univariate and multivariate analyses were performed to identify the variables associated with biochemical failure-free survival. RESULTS: Postimplant target coverage was similar in the two groups, with a small difference in risk organ doses. Mean V100 was 96.3 vs. 96.7% (P = 0.205), D90 was 119.6 vs. 119.4% (P = 0.884), urethral D10 was 157.5 vs. 146.1% (P = 0.010), rectal V100 was 0.57 vs. 0.43 cc (P = 0.002) in the preplanning and intraoperative planning groups, respectively. Acute and late Grade 3 genitourinary and gastrointestinal toxicities were <1% for both methods. The 5-year biochemical failure-free survival rate was 95.4% for the preplanning and 94.0% for the intraoperative planning group (P = 0.776). Multivariate analysis revealed Gleason score, biopsy positive rate and V100 to be predictors of biochemical failure-free survival, while the planning technique was not significant. CONCLUSION: This large-scale analysis of high-quality implants revealed similar postimplant dosimetry, toxicity profiles and biochemical failure-free survival for the preplanning and intraoperative planning methods.
Japanese Journal of Clinical Oncology 01/2013; · 1.78 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the long-term effects of permanent seed implant prostate brachytherapy (BT) on sexual function (SF).
From September 2003 to July 2005, 56 patients underwent radical retropubic prostatectomy (RRP) without any hormone therapy, while 353 patients had undergone BT without any adjuvant hormone therapy in a single institute. Out of these 353 patients in the BT group, 305 patients received neoadjuvant hormone therapy (BT NHT + group), while 48 did not (BT NHT - group). SF was prospectively evaluated using the UCLA Prostate Cancer Index (UCLA-PCI). Potency was defined as the UCLA-PCI Q26 point of > or = 3.
The preimplant UCLA-PCI scores of SF for BT NHT - and BT NHT + groups were 50.9 and 13.4, respectively. The SF score of the NHT - group post operatively decreased to 38.9 within 6 months, but was maintained at the same level after that. With the recovery of the androgen, SF score of the NHT + group improved after BT: however, it did not reach up to that of the NHT - group. In the univariate analysis, patient's age was the only predictive factor for SF after BT. Thirty-four out of 48 patients in the BT NHT - group and 23 out of 56 patients in the RRP group showed adequate potency before surgery. Their 5-year potency preservation rate was 73.6% in the BT NHT - group and 4.3% in the RRP group.
SF slightly decreased immediately after BT but was usually maintained during the course observation for 5 years. The 5-year SF preservation rate after BT was 73.6%.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 07/2012; 103(4):599-603.
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ABSTRACT: To evaluate prostate specific antigen (PSA) bounce that may occur as a time PSA rise phenomenon during follow up period after brachytherapy (BT) with permanent seed implantation for prostate cancer. (Materials and methods) Seven hundred and forty-six patients had undergone BT from November 2003 to April 2007 in a single institute, and of 130 patients who did not receive hormone therapy and had minimal 3-year follow up are analyzed. PSA bounce was defined as a rise of at least 0.4 ng/ml with spontaneous return to pre-bounce level or lower.
Among the 130 patients, 40 patients (30.8%) developed PSA bounce, and median time to PSA bounce was 18 months after the BT. With univariate analysis, younger patients (P = 0.027) and larger prostate (P = 0.030) had statistically significant correlation with PSA bounce. With multivariate analysis, younger patients were identified as only independent factor for predicting PSA bounce. Eight patients out of 130 patients (6.2%) triggered the Phoenix definition (nadir + 2 ng/ml) of PSA failure, however, clinical failure was seen only in 3 patients, and other 5 patients were considered as PSA bounce.
PSA bounce is likely to occur in younger patients within 3 years after BT. It is clinically important to distinguish PSA bounce from PSA failure during following period after BT.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 09/2011; 102(5):669-74.
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Nippon rinsho. Japanese journal of clinical medicine 06/2011; 69 Suppl 5:440-6.
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Yutaka Shiraishi,
Atsunori Yorozu,
Toshio Ohashi, Kazuhito Toya,
Satoshi Seki,
Kayo Yoshida,
Tomoya Kaneda,
Shiro Saito,
Toru Nishiyama,
Takashi Hanada,
Naoyuki Shigematsu
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ABSTRACT: To determine the rectal tolerance to Grade 2 rectal bleeding after I-125 seed brachytherapy combined with external beam radiotherapy (EBRT), based on the rectal dose-volume histogram.
A total of 458 consecutive patients with stages T1 to T3 prostate cancer received combined modality treatment consisting of I-125 seed implantation followed by EBRT to the prostate and seminal vesicles. The prescribed doses of brachytherapy and EBRT were 100 Gy and 45 Gy in 25 fractions, respectively. The rectal dosimetric factors were analyzed for rectal volumes receiving >100 Gy and >150 Gy (R100 and R150) during brachytherapy and for rectal volumes receiving >30 Gy to 40 Gy (V30-V40) during EBRT therapy in 373 patients for whom datasets were available. The patients were followed from 21 to 72 months (median, 45 months) after the I-125 seed implantation.
Forty-four patients (9.7%) developed Grade 2 rectal bleeding. On multivariate analysis, age (p = 0.014), R100 (p = 0.002), and V30 (p = 0.001) were identified as risk factors for Grade 2 rectal bleeding. The rectal bleeding rate increased as the R100 increased: 5.0% (2/40 patients) for 0 ml; 7.5% (20/267 patients) for >0 to 0.5 ml; 11.0% (11/100 patients) for >0.5 to 1 ml; 17.9% (5/28 patients) for >1 to 1.5 ml; and 27.3% (6/22 patients) for >1.5 ml (p = 0.014). Grade 2 rectal bleeding developed in 6.4% (12/188) of patients with a V30 ≤35% and in 14.1% (26/185) of patients with a V30 >35% (p = 0.02). When these dose-volume parameters were considered in combination, the Grade 2 rectal bleeding rate was 4.2% (5/120 patients) for a R100 ≤0.5 ml and a V30 ≤35%, whereas it was 22.4% (13/58 patients) for R100 of >0.5 ml and V30 of >35%.
The risk of rectal bleeding was found to be significantly volume-dependent in patients with prostate cancer who received combined modality treatment. Rectal dose-volume analysis is a practical method for predicting the risk of development of Grade 2 rectal bleeding.
International journal of radiation oncology, biology, physics 03/2011; 81(3):e127-33. · 4.59 Impact Factor
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Takefumi Satoh,
Hiromichi Ishiyama,
Kazumasa Matsumoto,
Hideyasu Tsumura,
Masashi Kitano,
Kazushige Hayakawa,
Shin Ebara,
Yasutomo Nasu,
Hiromi Kumon,
Susumu Kanazawa,
Kenta Miki,
Shin Egawa,
Manabu Aoki, Kazuhito Toya,
Atsushi Yorozu,
Hirohiko Nagata,
Shiro Saito,
Shiro Baba
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ABSTRACT: OBJECTIVE
To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level ‘bounce’ after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer.PATIENTS AND METHODSA multi-institutional pooled analysis was carried out in 388 consecutive patients with T1–T2N0M0 prostate cancer treated with 125I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had ≥1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall.RESULTSThe actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after 125I-BT. Among the before and after 125I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001).CONCLUSIONSPSA bounce is a common phenomenon after 125I-BT and occurred at a rate of 19–51% in the Japanese men who underwent 125I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after 125I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.
BJU International 03/2009; 103(8):1064 - 1068. · 2.84 Impact Factor
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Takefumi Satoh,
Hiromichi Ishiyama,
Kazumasa Matsumoto,
Hideyasu Tsumura,
Masashi Kitano,
Kazushige Hayakawa,
Shin Ebara,
Yasutomo Nasu,
Hiromi Kumon,
Susumu Kanazawa,
Kenta Miki,
Shin Egawa,
Manabu Aoki, Kazuhito Toya,
Atsushi Yorozu,
Hirohiko Nagata,
Shiro Saito,
Shiro Baba
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ABSTRACT: To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level 'bounce' after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer.
A multi-institutional pooled analysis was carried out in 388 consecutive patients with T1-T2N0M0 prostate cancer treated with (125)I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had >or=1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall.
The actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after (125)I-BT. Among the before and after (125)I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001).
PSA bounce is a common phenomenon after (125)I-BT and occurred at a rate of 19-51% in the Japanese men who underwent (125)I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after (125)I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.
BJU International 12/2008; 103(8):1064-8. · 2.84 Impact Factor
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ABSTRACT: Permanent interstitial brachytherapy with iodine-125 (I-125) or palladium 103 (Pd-103) seeds is a common treatment option in the United States, and numerous articles on outcomes after long-term follow up have been published. With the treatment's apparent high efficacy and low morbidity, permanent seed implantation has become the most frequently employed procedure for localized prostate cancer and has replaced radical prostatectomy. Even taking into account the good features of the treatment, the performance of permanent seed implantation in Japan had not been allowed because of the country's strict laws on radiation safety. However, after a long period of discussion between Japanese medical associations and the government, permanent interstitial brachytherapy with I-125 was finally approved in Japan in July 2003. The guidelines for this treatment include several restrictions that should be followed by each institution that is to perform the treatment. Over 70 institutes around the country had started the treatment before the end of June 2007. With high expectations for this new radiation therapy, which may be effective, and less invasive than previous treatments and with a low incidence of treatment morbidity, brachytherapy for prostate cancer will become more common in Japan. For the purpose of improving the quality of seed implantation, which may lead to better clinical outcomes and radiation safety, medical conferences and technical training courses have been carried out regularly, and multi-institutional clinical studies have also been carried out countrywide.
International Journal of Clinical Oncology 01/2008; 12(6):395-407. · 1.41 Impact Factor
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ABSTRACT: To investigate rectal morbidity after I-125 prostate brachytherapy and to analyze predictive factors of rectal morbidity.
A group of 227 consecutive patients with localized prostate cancer were treated with I-125 prostate brachytherapy with or without external beam radiotherapy (EBRT) between September 2003 and January 2005. Rectal morbidity (diarrhea, bleeding and pain) was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Dosimetry was based on computerized tomography (CT) scan 1 month post-implant. The clinical, treatment-related and dosimetric factors were evaluated for the risk of grade 2 rectal morbidity. Rectal dosimetric factors included the rectal volume that received >100% and 150% of the prescribed dose, and the maximal rectal dose which was defined as the sum of the minimal dose received by 1% of the rectum volume and the prescribed dose of EBRT.
Grade 2 rectal bleeding occurred in 10 (4.4%): for nine patients within the first year and for one patient between the first and second year. Grade 2 diarrhea occurred in one patient (0.4%) within the first year. No patient reported grade 2 pain. In the univariate analysis with grade 2 rectal bleeding, there were significant correlations with number of seeds, supplemental EBRT, and all of the rectal dosimetric parameters. On subsequent multivariate analysis, the only significant factor was the maximal rectal dose (P < 0.001). Rectal dose > 160 Gy was correlated to grade 2 rectal morbidity. All the patients with rectal dose > 160 Gy received EBRT.
Manifestations of rectal morbidity are acceptable events after I-125 prostate brachytherapy. Rectal dose-volume histogram for the brachytherapy is a predictive method for assessing the risk of developing grade 2 rectal bleeding. Delivery of the rectal dose should not exceed 160 Gy in order to avoid rectal complications.
Japanese Journal of Clinical Oncology 03/2007; 37(2):121-6. · 1.78 Impact Factor
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ABSTRACT: Enlarged prostate often causes pubic arch interference during needle insertion on transperineal interstitial permanent prostate brachytherapy. Pre-treatment hormonal therapy is necessary for downsizing the prostate gland in such cases. The degree of prostate downsizing with anti-androgen treatment before iodine 125 permanent seed implant brachytherapy and its relation to clinical as well as pathological parameters were assessed.
From September 2003 to March 2005, 110 patients underwent permanent seed implantation and 86 patients of all received antiandrogen depriviation prior to the treatment at our institute. Prostate volume was measured using transrectal ultrasound at the time of cancer diagnosis and before the seed implant. Correlations between prostate downsizing and clinical as well as pathological parameters were evaluated.
Mean percent volume of the prostate after the size reduction with average of 6.0 months antiandrogen monotherapy, 7.7 months LHRH agoniost and 8.2 months maximum androgen blockage (MAB) was 83%, 63%, and 60%, respectively. Mann-Whitney U test revealed that the degree of prostate downsizing is significantly correlated with the prostate volume in patients with prostate cancer utilizing LHRH agonists.
Antiandrogen monotherapy can be an alternative for prostate downsizing before interstitial brachytherapy. Utilizing LHRH agonists or MAB is recommended for cases with larger gland volume.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 12/2006; 97(7):835-8.
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ABSTRACT: This study was conducted to assess serial changes in the International Prostate Symptom Score (IPSS) within the first 12 months after iodine-125 (I-125) prostate brachytherapy.
Between September 2003 and June 2004, a group of 103 patients with localized prostate cancer was treated with I-125 prostate brachytherapy, either alone (monotherapy; 60 patients) or in combination with external-beam radiotherapy (combined therapy; 43 patients). The IPSS was obtained at preimplant, and at 1, 6, and 12 months after treatment. The minimum IPSS follow-up for this study was 12 months. Dosimetry was based on computed tomography (CT) scan 1 month postimplant. Clinical, treatment-related, and dosimetric factors were assessed for correlations with the maximum IPSS increase (the peak IPSS minus the preimplant IPSS).
The median preimplant IPSS was 7.0, with a median peak of 16 at 1 month. The IPSS returned to baseline in 42 patients (40.8%) and it returned to within 3 points of the baseline in 64 (62.1%) at 1-year follow-up. On univariate and multivariate analyses, the maximum IPSS increase was best predicted by lower preimplant IPSS, in both the monotherapy and combined therapy groups.
In our series, IPSS after prostate brachytherapy peaked at 1 month and gradually returned to approximately baseline at 12 months.
International Journal of Clinical Oncology 09/2006; 11(4):320-5. · 1.41 Impact Factor
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ABSTRACT: To analyze predictive factors of acute urinary retention requiring catheterization after (125)I prostate brachytherapy.
A group of 227 consecutive patients with localized prostate cancer were treated with (125)I prostate brachytherapy between September 2003 and December 2004. The clinical, treatment-related and dosimetric factors were evaluated for the need for catheterization owing to urinary retention.
Twelve patients (5.3%) required catheterization. The median time to onset was 2 days after implantation (range 1-7 days). Univariate analysis demonstrated that pre-implant ultrasound prostate volume, number of seeds, number of needles and neoadjuvant hormonal manipulation were predictive for catheterization. In multivariate analysis, the number of needles and neoadjuvant hormonal manipulation were significant independent predictive factors for catheterization (P = 0.002 and 0.025, respectively). The risk of catheterization in the cluster in which the number of needles was >24 was 4.07 times as high as that in the cluster in which the number of needles was < or =24 [11.3% versus 3.0%, P = 0.020; 95% confidence interval (CI) 1.24-13.36], and the risk in the hormonally manipulated patients was 7.05 times as high as that in the hormone-naïve patients (7.7% versus 1.2%, P = 0.034; 95% CI 0.89-55.64).
Our data suggest that the number of needles and hormonal manipulation might be the strongest predictors for catheterization.
Japanese Journal of Clinical Oncology 06/2006; 36(5):285-9. · 1.78 Impact Factor
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ABSTRACT: This review article aims to overview modern prostate brachytherapy in Japan. Permanent transperineal prostate brachytherapy with I-125 started in September, 2003 in Japan. Brachytherapy has several advantages: the dose is adapted precisely to the tumor shape and size, and the long-lived isotope gives a higher tumor dose with less damage to normal tissue; less-time consuming for patients and staff: long-term results comparable to surgery or external beam series in the USA; and quality of life after brachytherapy also appealing. These advantages have brought about increasing use in Japan as well. Patients with a high probability of organ-confined disease and a low-risk group are appropriately treated with brachytherapy. Brachytherapy candidates with a significant risk of extraprostatic extension should be treated with supplemental external beam radiation therapy. High-dose-rate (HDR) brachytherapy with Ir-192 has preceded seed implants in Japan. HDR has some theoretical advantages. Long-term results of brachytherapy in the USA are comparable with surgery or external beam irradiation so far. We should develop more sophisticated brachytherapy techniques in Japan.
Gan to kagaku ryoho. Cancer & chemotherapy 05/2006; 33(4):424-7.
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ABSTRACT: To report the 3-year treatment results of definitive irradiation by using a temporary interstitial implant with low-dose rate iridium-192 with or without external beam radiotherapy in the treatment of localized prostate cancer.
One-hundred and forty-three patients with pathologically defined prostate carcinoma were treated from December 1997 to April 2003. The patients were classified into a low-risk group (T2, PSA<or=20 ng/mL and Gleason score<or=6) or a high-risk group (T3, PSA>20 ng/mL or Gleason score>or=7). Low-risk patients were treated with low-dose-rate iridium brachytherapy as monotherapy delivering 70 Gy. High-risk patients were treated with the combination of brachytherapy and external beam radiotherapy delivering 40 Gy and 36 Gy, respectively. Kaplan-Meier estimates of prostate-specific antigen (PSA) progression-free survival rate were analysed. To assess the treatment quality in different periods, PSA progression-free survival rates in late era (year of 2000 and after) and in early era (before 2000) were compared. Morbidity was graded according to the Radiation Therapy Oncology Group grading scale.
One hundred and nineteen patients were analysed, of which 86 patients underwent monotherapy with an iridium implant, and 33 were treated with the combination of external beam radiotherapy. Twenty-four patients were excluded from the analysis because the classification of risk group did not suit the criteria. The total (n=119) PSA progression-free survival rate at 3 years was 80.3%. The PSA progression-free survival rate at 3 years for the monotherapy group (n=86) and the combination therapy group (n=33) were 78.2% and 86.9%, respectively. There were 23 patients who were followed for more than 36 to 63 months, and, during this period, only 1 patient who received the monotherapy was diagnosed as PSA failure at 50 months. The 3-year PSA progression-free survival rate of monotherapy in late era was significantly higher than that in early era; however, no significant difference was seen in the combination treatment. Morbidity for the combination treatment was low; however, for the monotherapy, three patients developed severe rectal ulcers, and colostomies were made.
The PSA progression-free survival rate after low-dose rate iridium-192 brachytherapy with or without external beam radiotherapy can be satisfactory and longer follow up is necessary to compare the efficacy of other treatments.
International Journal of Urology 04/2006; 13(3):218-23. · 1.75 Impact Factor
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ABSTRACT: BackgroundTo assess the long-term efficacy and the pattern of failure of concurrent chemoradiotherapy followed by high dose rate (HDR)
brachytherapy for stage T2-3 N0-1 M0 esophageal carcinoma.
MethodsForty-six patients with clinical stage T2-3 N0-1 M0 esophageal cancer received concurrent chemoradiotherapy followed by HDR
brachytherapy. The chemotherapy regimen was a combination of cisplatin 60 mg/m2 on day 1 and fluorouracil 600 mg/m2 continuous infusion from days 1 to 4 during the first and last week of external-beam irradiation. Radiotherapy consisted
of external beam to a total dose of 40–60 Gy (median, 50 Gy) and high dose rate brachytherapy to 8–24 Gy (median, 16 Gy) in
2–4 fractions. External beam was delivered to a field of the primary lesion and the involved nodal lesions. All patients were
followed up for at least 5 years.
ResultsThe 5-year overall survival rate was 28%. The median survival duration was 22 months. The 5-year cause-specific survival rate
was 34% and the median was 22 months. Persistent disease was found in 7 of 46 patients (15%). Of the 39 patients with initial
complete tumor disappearance, locoregional failure occurred ultimately in 13 patients. The ultimate local control rate was
57% (26/46). Three patients were salvaged successfully with surgery. Four patients (9%) had regional recurrence out of the
irradiated fields as first failure site. Four patients (9%) had recurrence 3 years or longer after treatment. Twelve patients
had transient ulcers, which healed spontaneously within a few months. Massive esophageal bleeding, thought to be treatment
related, occurred in 2 patients, leading to death. Severe late toxicity with esophageal ulceration was found in patients receiving
a dose of 16–24 Gy via brachytherapy.
ConclusionsConcurrent chemoradiotherapy followed by HDR brachytherapy achieved long-term effective and curative results for stage T2-3
N0-1 M0 esophageal carcinoma. However, severe late toxicity was observed with 16–24 Gy via brachytherapy. We recommend a dose
via HDR brachytherapy should be 12 Gy or less following concurrent chemoradiotherapy.
Esophagus 03/2006; 3(1):1-5. · 0.66 Impact Factor
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ABSTRACT: We report here our experience of brachytherapy using I-125 seeds for localized prostate cancer in 100 patients.
We carried out brachytherapy with I-125 seed permanent implants in 100 patients with localized prostate cancer between September 2003 and October 2004. Preplanning dosimetry was done using transrectal ultrasonic images obtained three or four weeks prior to treatment. Using transrectal ultrasound, we inserted I-125 seeds in the prostate through needles according to the preplanning diagram. We then examined the results on prostate CT performed one month later.
It was necessary to describe transrectal ultrasonic image such as preplanning. There were several cases in which the source arrangement of the schedule was corrected immediately before the operation. In the examination after one month, the numerical value at the start of treatment initially was not satisfactory, but we eventually obtained a result that could to be evaluated.
We carried out permanent implant brachytherapy for localized prostate cancer using I-125 seeds and reported our experience.
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 11/2005; 65(4):432-7.
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ABSTRACT: The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP.
European Radiology 11/2005; 15(10):2140-5. · 3.22 Impact Factor
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ABSTRACT: In Japan, iodine-125 (I-125) prostate brachytherapy has been legally approved since July 2003, and this method is becoming more popular. The purpose of the present study was to assess acute urinary morbidity within the first 6 months after I-125 prostate brachytherapy.
A group of 130 consecutive patients with localized prostate cancer was treated with I-125 prostate brachytherapy between September 2003 and June 2004,either alone (monotherapy; 66 patients) or in combination with external-beam radiotherapy (combined therapy; 64 patients). Urinary morbidity was evaluated using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0.
During the follow-up, 111 patients (85.4%) developed some degree of urinary symptoms such as frequency, retention, dysuria, incontinence, or hematuria. Urinary frequency (73.1%) and retention (66.9%) were the most common, and showed no significant differences between the monotherapy group and combined therapy group (P = 0.352 and P = 0.630, respectively). Six patients (4.6%) required catheterization for urinary obstruction; the median time to onset was 1.5 days (range, 1-192 days). Five of these 6 patients received monotherapy and the other received combined therapy.
Manifestations of acute urinary morbidity, especially frequency and retention, are relatively common but acceptable events after I-125 prostate brachytherapy.
International Journal of Clinical Oncology 09/2005; 10(4):262-8. · 1.41 Impact Factor
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ABSTRACT: This study describes our experience with seed loss and retrieval through the urinary tract following seed implants for prostate cancer, and offers Japanese guidelines for safety and management. Two hundred consecutive patients were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with a Mick applicator under ultrasound guidance. All patients were instructed to return excreted seeds, if any, to our center. Seed loss occurred in 6% of patients and 0.13% of seeds. Seed loss tended to occur in the early period through either urine or ejaculation.
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 08/2005; 65(3):263-5.
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ABSTRACT: One year has passed since we started brachytherapy with radioactive iodine-125 seeds for carcinoma of the prostate. During the follow-up of patients, we have relatively frequently found migrated seeds in the lungs. Migrated seeds are reported to reach mainly the pulmonary artery and cause embolization without clinical symptoms. We counted the embolized seeds and determined the proportion of migrating seeds on chest X-ray exam. We found 47 cases of pulmonary embolization in our initial 100 cases. Less than half of the embolization were found in the chest X-ray exam performed on the next day after the implantation. We found more migrated seeds in the lower lung fields than in the upper and middle lung fields. Pulmonary embolization of implanted iodine-125 seeds is not unusual, and cases of prostate brachytherapy are likely to increase in Japan. We will have increased opportunities to observe chest X-ray films with migrated seeds in the future.
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 05/2005; 65(2):121-3.
