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• W2076758847 abstract "No AccessJournal of UrologyOriginal Articles1 Dec 2004PROSPECTIVE OUTCOMES ASSOCIATED WITH MIGRATION FROM PREOPERATIVE TO INTRAOPERATIVE PLANNED BRACHYTHERAPY: A SINGLE CENTER REPORT JEFFREY WOOLSEY, ERIC BISSONETTE, BERNARD F. SCHNEIDER, and DAN THEODORESCU JEFFREY WOOLSEYJEFFREY WOOLSEY More articles by this author , ERIC BISSONETTEERIC BISSONETTE More articles by this author , BERNARD F. SCHNEIDERBERNARD F. SCHNEIDER More articles by this author , and DAN THEODORESCUDAN THEODORESCU More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000144200.48725.e2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Brachytherapy (BT) for prostate cancer can be performed with either preoperative (PO) or intraoperative (IO) planned dosimetry. Potential benefits of intraoperative include fewer procedures for the patient, cost savings and improved accuracy of seed implantation leading to improved tumor control and urinary side effect profile. We report our experience with transition to IO planned BT after performing more than 600 PO planned implants since 1997. Materials and Methods: From September 2001 to February 2003, 46 consecutive patients with T1-3N0M0 adenocarcinoma of the prostate underwent BT. IO dosimetry was performed in 23 patients, while PO dosimetry was used in 23 immediately before changing to IO. American Urological Association (AUA) symptom index questionnaires were administered preoperatively and postoperatively. All patients underwent postoperative dosimetry by computerized tomography. Total, irritative and obstructive AUA scores were compared in the 2 groups using analysis of covariance. Models were adjusted for pretreatment variables of symptom scores, type of procedure and time since procedure. Results: Median followup was 47 and 45 days for PO and IO dosimetry, respectively. No differences were observed in seed, needle numbers or prostate size in the 2 groups. Average operative times were higher (47 vs 79 minutes, p <0.01) in the IO group but they decreased to nearly the same levels as PO implants in the first 23 cases so treated. Slopes of operative time over date of procedure differed significantly between methods (p <0.01). Comparing PO to IO dosimetry adjusted estimate of difference was −1.96 for total (95% CI −6.4, 2.5), −0.48 for obstructive (95% CI −3.3, 2.3) and −1.78 for irritative (95% CI −3.9, 0.31) AUA score. These differences were neither statistically nor clinically significant. Conclusions: Our experience indicates that intraoperative planned BT is easily implemented in clinical practice as a result of a short learning curve. In addition, the approach is not associated with any changes in early postoperative voiding symptoms and, due to only marginally longer operative times, may have a cost advantage by eliminating the preplanning visit and ultrasound. References 1 : Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys2000; 46: 839. Google Scholar 2 : Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma. Cancer1998; 83: 989. Google Scholar 3 : Transperineal 125iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity. Int J Radiat Oncol Biol Phys1999; 43: 565. Google Scholar 4 : Retrospective comparison of radical retropubic prostatectomy and 125iodine brachytherapy for localized prostate cancer. J Urol1999; 161: 1212. 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Google Scholar 10 : Quality-of-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer. Urology2000; 55: 736. Google Scholar 11 : Acute urinary morbidity following I-125 interstitial implantation of the prostate gland. Radiat Oncol Invest1998; 6: 135. Google Scholar 12 : Urinary morbidity with a modified peripheral loading technique of transperineal (125)i prostate implantation. Int J Radiat Oncol Biol Phys2000; 47: 353. Google Scholar 13 : Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma: comparison of radical prostatectomy to hormonobrachytherapy with and without external beam radiotherapy. Cancer2001; 91: 2046. Google Scholar 14 : Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer. J Urol2001; 165: 436. Link, Google Scholar 15 : Short-term sexual function after prostate brachytherapy. Int J Cancer2001; 96: 313. Google Scholar 16 : Prostate cancer with large glands treated with 3-dimensional computerized tomography guided pararectal brachytherapy: up to 8 years of followup. J Urol2003; 169: 1331. Link, Google Scholar 17 : Real-time magnetic resonance imaging-guided brachytherapy in the treatment of selected patients with clinically localized prostate cancer. J Endourol2000; 14: 367. Google Scholar 18 : Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: a prospective comparison of two seed implant methods—preplanning and intraoperative planning. Urology2003; 62: 497. Google Scholar 19 : Is intraoperative nomogram-based overplanning of prostate implants necessary?. Int J Radiat Oncol Biol Phys2003; 56: 462. Google Scholar 20 : Intraoperative dynamic dose optimization in permanent prostate implants. Int J Radiat Oncol Biol Phys2003; 56: 854. Google Scholar From the Departments of Urology (JW, DT), Health Evaluation Sciences, Division of Biostatistics and Epidemiology (EB) and Radiation Oncology (BFS), University of Virginia Health Sciences Center, Charlottesville, Virginia© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 6 Part 2December 2004Page: 2528-2531 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsbrachytherapyprostatic neoplasmsMetricsAuthor Information JEFFREY WOOLSEY More articles by this author ERIC BISSONETTE More articles by this author BERNARD F. SCHNEIDER More articles by this author DAN THEODORESCU More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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