Four year clinical statistics of iridium-192 high dose rate brachytherapy

Background: We evaluated the efficacy and complications of high dose rate (HDR) brachytherapy using iridium-192 (Ir-192) combined with external beam radiotherapy (EBRT) in patients with prostate cancer. Methods: Ninety-seven patients underwent Ir-192 HDR brachytherapy combined with EBRT at our institution between February 1999 and December 2003. Of these, 84 patients were analysed in the present study. Ir-192 was delivered three times over a period of 2 days, 6 Gy per time, for a total dose of 18 Gy. Interstitial application was followed by EBRT at a dose of 44 Gy. Progression was defined as three consecutive prostate-specific antigen (PSA) rises after a nadir according to the American Society for Therapeutic Radiology and Oncology criteria. The results were classified into those for all patients and for patients who did not undergo adjuvant hormone therapy. Results: The 4-year overall survival of all patients, the nonadjuvant hormone therapy group (NAHT) and the adjuvant hormone therapy group (AHT) was 87.2%, 100%, and 70.1%, respectively. The PSA progression-free survival rate of all patients, NAHT, and AHT was 82.6%, 92.0%, and 66.6%, respectively. Of all patients, the 4-year PSA progression-free survival rates of PSA < 20 and PSA >= 20 groups were 100%, and 46.8%, respectively. According to the T stage classification, PSA progression-free survival rates of T1c, T2, T3, and T4 were 100%, 82.8%, 100%, and 12.1%, respectively. Prostate-specific antigen progression-free survival rates of groups with Gleason scores (GS) < 7 and GS >= 7 were 92.8% and 60.1%, respectively. Of NAHT, PSA progression-free survival of PSA < 20 was 100% vs 46.8% for PSA >= 20, that of T1c was 100% vs 75% for T2, and that of GS < 7 was 100% vs 75% for GS >= 7. No significant intraoperative or postoperative complications requiring urgent treatment occurred except cerebellum infarction. Conclusions: Ir-192 HDR brachytherapy combined with EBRT was as effective as radical prostatectomy and had few associated complications.