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

Gianni Fellin, Maria Mirri, Luigi Santoro, Barbara Alicja Jereczek-Fossa, Claudio Divan, Salvatore Mussari, Francesco Ziglio, Beniamino La Face, F. Barbera, Michela Buglione, Laura Bandera, Barbara Ghedi, Nadia Di Muzio, Andrea Losa, Paola Mangili, L. 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, C. Chiumento, Stefania Clemente, Vincenzo Fusco, Roberto Santini, M. Stefanacci, Francesco P. Mangiacotti, Marco Martini, Tiziana Palloni, Giuseppe Schinaia, G. Lazzari, Giovanni Silvano, S. M. Magrini, Umberto Ricardi, Riccardo Santoni, Roberto Orecchia

Research output: Contribution to journalArticlepeer-review


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
Issue number1065
Publication statusPublished - 2016

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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