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A dose-response study for I-125 prostate implants

R G Stock1, N N Stone, A Tabert

  • 1Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.

International Journal of Radiation Oncology, Biology, Physics
|May 20, 1998
PubMed
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This study found that higher doses of I-125 prostate implants (specifically, 140 Gy or more) significantly improve freedom from biochemical failure rates in prostate cancer patients. Optimal I-125 brachytherapy requires delivering 140-160 Gy.

Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • The efficacy of Iodine-125 (I-125) prostate brachytherapy is influenced by the delivered radiation dose.
  • Establishing a clear dose-response relationship is crucial for optimizing treatment outcomes.
  • Previous studies lacked modern dosimetric evaluations and outcome endpoints for I-125 implants.

Purpose of the Study:

  • To investigate the relationship between radiation dose (D90) and treatment outcomes in I-125 prostate implants.
  • To determine the optimal dose range for I-125 brachytherapy in T1-T2 prostate cancer.
  • To evaluate the impact of dose on biochemical failure and biopsy results.

Main Methods:

  • 134 patients with T1-T2 prostate cancer and Gleason scores ≤6 received I-125 implants.

Related Experiment Videos

  • CT-based 3D dosimetry (D90) was performed one month post-implant.
  • Biochemical failure was defined by PSA levels, and post-treatment biopsies were analyzed.

    • Main Results:

    • Increasing D90 levels correlated with improved freedom from biochemical failure (FFBF) rates (p=0.02).
    • Patients receiving D90 ≥140 Gy had significantly higher 4-year FFBF rates (92%) compared to those receiving D90 <140 Gy (68%) (p=0.02).
    • Dose was the most significant predictor of biochemical failure (p=0.001), particularly in patients with PSA >10 ng/ml.

    Conclusions:

    • A clear dose-response relationship was observed, with 140 Gy identified as a critical threshold.
    • Optimal I-125 prostate implants should aim for a D90 dose of 140-160 Gy according to TG43 guidelines.
    • Higher delivered doses are associated with better oncological outcomes in low-risk prostate cancer patients.