林育鴻1 黃奎綱2 莊和達3 鄭鴻鈞2 張樹人1
辜公亮基金會和信治癌中心醫院 1泌尿科 2放射腫瘤科 3醫學物理科
Brachytherapy Using I-125 Implant in the Treatment of Localized Prostate Cancer: KFSYSCC Initial Experience
Yu-Hung Lin1, Kuei-Kang Huang2, Ho-Da Chuang3, Hung-Chun Skye Cheng2, Shu-Jen Chang1
1Department of Urology, 2Department of Radiation Oncology, 3Department of Medical Physics, Koo-Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Brachytherapy with permanent implant of radioactive seeds is one of the first-line treatments of localized prostate cancer. In Taiwan, this treatment hasn't been provided in the past years. We conducted a Phase I clinical trial to observe if we can preform it in good quality.
Materials & Methods
The clinical trial was conducted in KFSYSCC. Inclusion criteria were: Patients with histologically confirmed, localized adenocarcinoma of the prostate, clinical stage T1c-2bN0M0, PSA < 20 ng/ml, Gleason Score < 7, Karnofsky Performance Status > 70, No significant obstructive symptoms, No hip prosthesis, No prior transurethral prostate surgery, No prior chemotherapy or radiotherapy or hormonal therapy, prostate volume by trans-rectal ultrasound < 45 cc. Permanent implant of I-125 seeds with prescription dose of 145Gy were given under general anesthesia. PSA, IPSS score and IIEF score were recorded in 1, 3, 6, 9, 12 and every 6 months after treatment.
From May 2013 to April 2014, a total of 11 patients received I-125 seed implant brachytherapy. Clinical stages were T1c, T2a, T2b in 3, 7 and 1 patients each. Gleason Scores were 3+3 in 9 patients and 3+4 in 2 patients. Pre-treatment PSA was less than 10ng/ml in 7 patients, and between 10-20ng/ml in 4 patients. Clinical risk groups were low-risk in 7 patients and intermediate-risk in 5 patients. Complications included 3 patients with transient urine retention. At 1 year after seed implant, PSA declined to <1, 1-2, >2 in 6, 2, 3 patients each. IPSS returned to baseline level in 6-9 months. IIEF returned to baseline level in 6 of 9 sexually active patients in 1 year.
Seed implant brachytherapy can be done in good quality for the treatment of prostate cancer in Taiwan.