Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: Practice and outcome analysis in a series of 2237 patients from 11 institutions

Giovanni Fellin, Maria A. Mirri, Luigi Santoro, Barbara Alicja Jereczek, Claudio Divan, Salvatore Mussari, Francesco Ziglio, Beniamino La Face, Fernando Barbera, Michela Buglione, Laura Bandera, Barbara Ghedi, Nadia G. Di Muzio, Andrea Losa, Paola Mangili, Luciano Nava, Renato Chiarlone, Nunzia Ciscognetti, Emilio Gastaldi, Federica CattaniRuggero Spoto, Andrea Vavassori, Francesca R. Giglioli, Alessia Guarneri, Valentina Cerboneschi, Marcello Mignogna, Mauro Paoluzzi, Valentina Ravaglia, Costanza Chiumento, Stefania Clemente, Vincenzo Fusco, Roberto Santini, Marco Stefanacci, Francesco P. Mangiacotti, Marco Martini, Tiziana Palloni, Giuseppe Schinaia, Grazia Lazzari, Giovanni Silvano, Stefano Magrini, Umberto Ricardi, Riccardo Santoni, Roberto Orecchia

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Abstract

Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community andacademic hospitals were treated with iodine- 125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failurefree survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p<0.0001) and V100 (p=0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p=0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

Original languageEnglish
Article number20150981
JournalBritish Journal of Radiology
Volume89
Issue number1065
DOIs
Publication statusPublished - 2016

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Brachytherapy
Italy
Prostatic Neoplasms
Survival
Community Hospital
Palladium
Iodine
Seeds
Multivariate Analysis
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy : Practice and outcome analysis in a series of 2237 patients from 11 institutions. / Fellin, Giovanni; Mirri, Maria A.; Santoro, Luigi; Jereczek, Barbara Alicja; Divan, Claudio; Mussari, Salvatore; Ziglio, Francesco; La Face, Beniamino; Barbera, Fernando; Buglione, Michela; Bandera, Laura; Ghedi, Barbara; Di Muzio, Nadia G.; Losa, Andrea; Mangili, Paola; Nava, Luciano; Chiarlone, Renato; Ciscognetti, Nunzia; Gastaldi, Emilio; Cattani, Federica; Spoto, Ruggero; Vavassori, Andrea; Giglioli, Francesca R.; Guarneri, Alessia; Cerboneschi, Valentina; Mignogna, Marcello; Paoluzzi, Mauro; Ravaglia, Valentina; Chiumento, Costanza; Clemente, Stefania; Fusco, Vincenzo; Santini, Roberto; Stefanacci, Marco; Mangiacotti, Francesco P.; Martini, Marco; Palloni, Tiziana; Schinaia, Giuseppe; Lazzari, Grazia; Silvano, Giovanni; Magrini, Stefano; Ricardi, Umberto; Santoni, Riccardo; Orecchia, Roberto.

In: British Journal of Radiology, Vol. 89, No. 1065, 20150981, 2016.

Research output: Contribution to journalArticle

Fellin, G, Mirri, MA, Santoro, L, Jereczek, BA, Divan, C, Mussari, S, Ziglio, F, La Face, B, Barbera, F, Buglione, M, Bandera, L, Ghedi, B, Di Muzio, NG, Losa, A, Mangili, P, Nava, L, Chiarlone, R, Ciscognetti, N, Gastaldi, E, Cattani, F, Spoto, R, Vavassori, A, Giglioli, FR, Guarneri, A, Cerboneschi, V, Mignogna, M, Paoluzzi, M, Ravaglia, V, Chiumento, C, Clemente, S, Fusco, V, Santini, R, Stefanacci, M, Mangiacotti, FP, Martini, M, Palloni, T, Schinaia, G, Lazzari, G, Silvano, G, Magrini, S, Ricardi, U, Santoni, R & Orecchia, R 2016, 'Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: Practice and outcome analysis in a series of 2237 patients from 11 institutions', British Journal of Radiology, vol. 89, no. 1065, 20150981. https://doi.org/10.1259/bjr.20150981
Fellin, Giovanni ; Mirri, Maria A. ; Santoro, Luigi ; Jereczek, Barbara Alicja ; Divan, Claudio ; Mussari, Salvatore ; Ziglio, Francesco ; La Face, Beniamino ; Barbera, Fernando ; Buglione, Michela ; Bandera, Laura ; Ghedi, Barbara ; Di Muzio, Nadia G. ; Losa, Andrea ; Mangili, Paola ; Nava, Luciano ; Chiarlone, Renato ; Ciscognetti, Nunzia ; Gastaldi, Emilio ; Cattani, Federica ; Spoto, Ruggero ; Vavassori, Andrea ; Giglioli, Francesca R. ; Guarneri, Alessia ; Cerboneschi, Valentina ; Mignogna, Marcello ; Paoluzzi, Mauro ; Ravaglia, Valentina ; Chiumento, Costanza ; Clemente, Stefania ; Fusco, Vincenzo ; Santini, Roberto ; Stefanacci, Marco ; Mangiacotti, Francesco P. ; Martini, Marco ; Palloni, Tiziana ; Schinaia, Giuseppe ; Lazzari, Grazia ; Silvano, Giovanni ; Magrini, Stefano ; Ricardi, Umberto ; Santoni, Riccardo ; Orecchia, Roberto. / Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy : Practice and outcome analysis in a series of 2237 patients from 11 institutions. In: British Journal of Radiology. 2016 ; Vol. 89, No. 1065.
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title = "Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: Practice and outcome analysis in a series of 2237 patients from 11 institutions",
abstract = "Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community andacademic hospitals were treated with iodine- 125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7{\%} of the patients: the mean dose received by 90{\%} of target volume was 145Gy; the mean target volume receiving 100{\%} of prescribed dose (V100) was 91.1{\%}. Biochemical failurefree survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98{\%}, 94 and 89{\%}, and 92 and 88{\%}, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p<0.0001) and V100 (p=0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p=0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.",
author = "Giovanni Fellin and Mirri, {Maria A.} and Luigi Santoro and Jereczek, {Barbara Alicja} and Claudio Divan and Salvatore Mussari and Francesco Ziglio and {La Face}, Beniamino and Fernando Barbera and Michela Buglione and Laura Bandera and Barbara Ghedi and {Di Muzio}, {Nadia G.} and Andrea Losa and Paola Mangili and Luciano Nava and Renato Chiarlone and Nunzia Ciscognetti and Emilio Gastaldi and Federica Cattani and Ruggero Spoto and Andrea Vavassori and Giglioli, {Francesca R.} and Alessia Guarneri and Valentina Cerboneschi and Marcello Mignogna and Mauro Paoluzzi and Valentina Ravaglia and Costanza Chiumento and Stefania Clemente and Vincenzo Fusco and Roberto Santini and Marco Stefanacci and Mangiacotti, {Francesco P.} and Marco Martini and Tiziana Palloni and Giuseppe Schinaia and Grazia Lazzari and Giovanni Silvano and Stefano Magrini and Umberto Ricardi and Riccardo Santoni and Roberto Orecchia",
year = "2016",
doi = "10.1259/bjr.20150981",
language = "English",
volume = "89",
journal = "British Journal of Radiology",
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TY - JOUR

T1 - Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy

T2 - Practice and outcome analysis in a series of 2237 patients from 11 institutions

AU - Fellin, Giovanni

AU - Mirri, Maria A.

AU - Santoro, Luigi

AU - Jereczek, Barbara Alicja

AU - Divan, Claudio

AU - Mussari, Salvatore

AU - Ziglio, Francesco

AU - La Face, Beniamino

AU - Barbera, Fernando

AU - Buglione, Michela

AU - Bandera, Laura

AU - Ghedi, Barbara

AU - Di Muzio, Nadia G.

AU - Losa, Andrea

AU - Mangili, Paola

AU - Nava, Luciano

AU - Chiarlone, Renato

AU - Ciscognetti, Nunzia

AU - Gastaldi, Emilio

AU - Cattani, Federica

AU - Spoto, Ruggero

AU - Vavassori, Andrea

AU - Giglioli, Francesca R.

AU - Guarneri, Alessia

AU - Cerboneschi, Valentina

AU - Mignogna, Marcello

AU - Paoluzzi, Mauro

AU - Ravaglia, Valentina

AU - Chiumento, Costanza

AU - Clemente, Stefania

AU - Fusco, Vincenzo

AU - Santini, Roberto

AU - Stefanacci, Marco

AU - Mangiacotti, Francesco P.

AU - Martini, Marco

AU - Palloni, Tiziana

AU - Schinaia, Giuseppe

AU - Lazzari, Grazia

AU - Silvano, Giovanni

AU - Magrini, Stefano

AU - Ricardi, Umberto

AU - Santoni, Riccardo

AU - Orecchia, Roberto

PY - 2016

Y1 - 2016

N2 - Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community andacademic hospitals were treated with iodine- 125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failurefree survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p<0.0001) and V100 (p=0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p=0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

AB - Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community andacademic hospitals were treated with iodine- 125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failurefree survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p<0.0001) and V100 (p=0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p=0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

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