10-year experience with I-125 prostate brachytherapy at the Princess Margaret Hospital: results for 1,100 patients.

PURPOSE: To report outcomes for 1,111 men treated with iodine-125 brachytherapy (BT) at a single institution. METHODS AND MATERIALS: A total of 1,111 men (median age, 63) were treated with iodine-125 prostate BT for low- or intermediate-risk prostate cancer between March 1999 and November 2008. Median prostate-specific antigen (PSA) level was 5.4 ng/ml (range, 0.9-26.1). T stage was T1c in 66% and T2 in 34% of patients. Gleason score was 6 in 90.1% and 7 or 8 in 9.9% of patients. Neoadjuvant hormonal therapy (2-6 months course) was used in 10.1% of patients and combined external radiotherapy (45 Gy) with BT (110 Gy) in 4.1% (n = 46) of patients. Univariate and multivariate Cox proportional hazards were used to determine predictors of failure. RESULTS: Median follow-up was 42 months (range, 6-114), but for biochemical freedom from relapse, a minimum PSA test follow-up of 30 months was required (median 54; n = 776). There were 27 failures, yielding an actuarial 7-year disease-free survival rate of 95.2% (96 at risk beyond 84 months). All failures underwent repeat 12-core transrectal ultrasound -guided biopsies, confirming 8 local failures. On multivariate analysis, Gleason score was the only independent predictor of failure (p = 0.001; hazard ratio, 4.8 (1.9-12.4). Median International Prostate Symptom score from 12 to 108 months ranged between 3 and 9. Of the men reporting baseline potency, 82.8% retained satisfactory erectile function beyond 5 years. CONCLUSION: Iodine-125 prostate BT is a highly effective treatment option for favorable- and intermediate-risk prostate cancer and is associated with maintenance of good urinary and erectile functions.

Evaluation of late toxicities of patients with carcinoma of the cervix treated with radical radiotherapy: an audit from India.

AIMS: To evaluate the incidence of, and factors affecting, late toxicities of women with carcinoma of the cervix treated with radical radiotherapy. MATERIALS AND METHODS: Between 1996 and 2001, 1069 women with carcinoma of the cervix (stage I-IVA) were treated at our centre with external-beam radiotherapy (EBRT) and intra-cavitary radiotherapy (ICRT) (n = 871) or EBRT alone (n = 198). Median follow-up was 34 months. Median dose to point A was 81 Gy. RESULTS: Five-year actuarial incidence of overall (all grades) and severe (grade 3/4) late toxicities in the rectum, bladder, small intestine and subcutaneous tissue were 12.3% and 1.1%, 11.2% and 1.2%, 9.2% and 0.2%, and 23.1% and 1.2%, respectively. Vaginal adhesions were seen in 29.6% of cases and stenosis in 33.9% of cases. On multivariate analysis, factors adversely affecting overall incidence of proctitis were anterior-posterior (AP) separation of patient more than 18 cm and presence of comorbid diseases. Presence of comorbid diseases was the only factor affecting the incidence of severe proctitis (grade 3/4). AP separation more than 18 cm adversely affected the incidence of cystitis, both overall and severe. Late toxicities (all grades) in small bowel were increased in subsets, like women younger than 50 years and women with comorbid diseases, but no factor emerged as significant for incidence of severe toxicities. Subcutaneous fibrosis was significantly higher in patients with AP separation over 18 cm, those treated by cobalt machines and those who received EBRT only. Severe subcutaneous fibrosis was influenced by the use of EBRT alone. Overall incidence of vaginal toxicity was higher in women whose overall treatment time (OTT) was shorter and in women who received ICRT. Vaginal stenosis was higher in elderly women and in women who received ICRT by low dose rate. CONCLUSIONS: Even with telecobalt machines, impressive results with acceptable late toxicity can be achieved in the treatment of cancer of the cervix using an ideal combination of EBRT with ICRT.

Results of external-beam radiotherapy alone in invasive cancer of the uterine cervix: a retrospective analysis.

AIMS: In this retrospective audit, we describe the results of external-beam radiotherapy (EBRT) alone in patients with invasive cancer of the cervix treated at our centre. MATERIAL AND METHODS: We included 146 patients with invasive cancer of the cervix who were treated with EBRT to a total dose of 60-66 Gy between January 1996 and December 2001. None of these patients were suitable for intracavitary radiotherapy (ICRT) after a median dose of 46 Gy. A boost dose of 14-20 Gy was given after a gap of 2-4 weeks. Most patients belonged to stage IIIB (n = 124). RESULTS: Follow-up of patients at risk ranged from 19 to 89 months (median 48 months). One hundred and thirty-six patients (93.2%) received EBRT to a dose of 66 Gy, and 10 patients (6.8%) received 60 Gy. Overall treatment time (OTT) ranged from 56 to 160 days (median 78 days). At completion of 46 Gy of EBRT, 63 patients achieved partial response and 83 patients had stable disease. Five-year overall survival, disease-free survival (DFS) and pelvic control were 15.1% (median 9 months), 11.6% (median 5 months) and 21.9% (median 6 months), respectively. Factors found to affect 5-year pelvic control in univariate analysis by Kaplan-Meier method were response to EBRT at 46 Gy (partial response 36.5% and stable disease 10.8%), age (> or = 50 years 28.8% and < 50 years 13.6%) and OTT (< 90 days 26.5% and > or = 90 days 12.5%). For DFS and overall survival, response to EBRT was the only factor that was significant in univariate analysis. In multivariate analysis by Cox's proportional hazard model, response to EBRT was the only factor to influence pelvic control (P = 0.007), DFS (P = 0.01) and overall survival (P < 0.001). CONCLUSIONS: Overall outcome of patients in whom ICRT was not given remains less than satisfactory. Response to EBRT emerged as the most important factor to predict all clinical outcomes. To improve upon the dismal results of EBRT alone, we will have to decrease the OTT and consider concurrent chemo-radiation with cisplatin.

Results of radiotherapy alone in the treatment of carcinoma of uterine cervix: a retrospective analysis of 1069 patients.

Carcinoma of the uterine cervix is the most common malignancy affecting women in developing countries like India. This retrospective study was made to analyze our results of radiotherapy alone in the treatment of carcinoma cervix. Between January 1996 and December 2001, 1069 patients of carcinoma cervix were treated at our center with external beam radiotherapy (EBRT) and intracavitary radiotherapy (871) or EBRT alone (198). The median dose to point A was 81 Gy. Overall survival (OS), disease-free survival (DFS), and pelvic control at 5 years were 51.8%, 49.4%, and 63.9%, respectively. For the patients who could receive intracavitary radiotherapy (871), the OS, DFS, and pelvic control rates were 60.7%, 58.6%, and 73.5%, respectively. On multivariate analysis, bulk, overall treatment time (OTT) and response to EBRT were found to affect OS and DFS independently. Similarly, OTT, response to EBRT, stage, and age were the factors that influenced pelvic control. Incidence of severe late toxicities (grade 3/4) in the rectum, bladder, small intestine, and skin were 1.1%, 1.2%, 0.2%, and 1.2%, respectively. In developing countries like India, where chemoradiation can be afforded by a minority only, judicious use of radiotherapy still produces satisfactory results with acceptable toxicity. The addition of chemotherapy may be beneficial in patients with adverse prognostic factors.