Korean J Urol.  2014 May;55(5):309-314. 10.4111/kju.2014.55.5.309.

Pulmonary Metastases After Low-Dose-Rate Brachytherapy for Localized Prostate Cancer

• Kido M
• Kuruma H
• Sasaki H
• Miki K
• Aoki M
• Kimura T
• Takahash H
• Kanehira C
• Egawa S

• KMID: 1988407
• DOI: http://doi.org/10.4111/kju.2014.55.5.309

Abstract

PURPOSE
To analyze unusual events and focus discussion on pulmonary metastasis in particular after low-dose-rate brachytherapy (LDR-BT) for prostate cancer (PCa).
MATERIALS AND METHODS
A total of 616 consecutive patients who had undergone LDR-BT for clinically localized PCa at Jikei University Hospital between October 2003 and April 2010 were enrolled in this study. Follow-up information was summarized, and patterns of biochemical recurrence and clinical outcome were investigated.
RESULTS
Disease risk was stratified as low-risk in 231 patients, intermediate-risk in 365, and high-risk in 20, respectively. Of these patients, 269 (43.7%) had received hormonal therapy (HT) in combination with LDR-BT, and 80 (13.0%) had received external beam radiotherapy (EBRT). Average dosimetric parameter values with and without EBRT were 95.3% and 94.2% for V100, 132.8 Gy and 164.2 Gy for D90, and 180.6 Gy2 and 173.7 Gy2 for the biologically effective dose. Biochemical recurrence was noted in 14 patients (6.1%) in the low-risk group, 25 patients (6.8%) in the intermediate-risk group, and 6 patients (30.0%) in the high-risk group, respectively. In these cases of biochemical recurrence, 9 (64.3%), 13 (52.0%), and 4 patients (66.7%) in each respective risk group showed signs of clinical recurrence. Five patients (19.2%) with clinical recurrence developed pulmonary metastases, of which 4 were isolated lesions. All tumors responded favorably to subsequent HT.
CONCLUSIONS
LDR-BT for biologically aggressive PCa may be linked to possible pulmonary metastasis owing to tumor dissemination during seed implantation. This information is important in planning adequate treatment for these patients.

Keyword

Brachytherapy; Neoplasm metastasis; Prostate neoplasms

MeSH Terms

Brachytherapy*
Follow-Up Studies
Humans
Neoplasm Metastasis*
Passive Cutaneous Anaphylaxis
Prostatic Neoplasms*
Radiotherapy
Recurrence

Figure

• 

  FIG. 1 (A, B) Pulmonary masses regressed dramatically after salvage (arrow). Regressed masses were considered pulmonary metastases of prostate cancer. HT, hormonal therapy.

Reference

1. Oliver SE, Gunnell D, Donovan JL. Comparison of trends in prostate-cancer mortality in England and Wales and the USA. Lancet. 2000; 355:1788–1789.

2. Taira AV, Merrick GS, Butler WM, Galbreath RW, Lief J, Adamovich E, et al. Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2011; 79:1336–1342.

3. D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280:969–974.

4. Machtens S, Baumann R, Hagemann J, Warszawski A, Meyer A, Karstens JH, et al. Long-term results of interstitial brachytherapy (LDR-Brachytherapy) in the treatment of patients with prostate cancer. World J Urol. 2006; 24:289–295.

5. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014; 65:124–137.

6. Iyer RV, Hanlon AL, Pinover WH, Hanks GE. Outcome evaluation of the 1997 American Joint Committee on Cancer staging system for prostate carcinoma treated by radiation therapy. Cancer. 1999; 85:1816–1821.

7. Patel A, Dorey F, Franklin J, deKernion JB. Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol. 1997; 158:1441–1445.

8. Miki K, Kiba T, Sasaki H, Kido M, Aoki M, Takahashi H, et al. Transperineal prostate brachytherapy, using I-125 seed with or without adjuvant androgen deprivation, in patients with intermediate-risk prostate cancer: study protocol for a phase III, multicenter, randomized, controlled trial. BMC Cancer. 2010; 10:572.

9. Narita H. Radiation safety control of an implant source and the issue. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2009; 65:647–658.

10. Stock RG, Stone NN, Cesaretti JA, Rosenstein BS. Biologically effective dose values for prostate brachytherapy: effects on PSA failure and posttreatment biopsy results. Int J Radiat Oncol Biol Phys. 2006; 64:527–533.

11. Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006; 65:965–974.

12. Fabozzi SJ, Schellhammer PF, el-Mahdi AM. Pulmonary metastases from prostate cancer. Cancer. 1995; 75:2706–2709.

13. Saitoh H, Hida M, Shimbo T, Nakamura K, Yamagata J, Satoh T. Metastatic patterns of prostatic cancer. Correlation between sites and number of organs involved. Cancer. 1984; 54:3078–3084.

14. Forman JD, Order SE, Zinreich ES, Lee DJ, Wharam MD, Mellits ED. The correlation of pretreatment transurethral resection of prostatic cancer with tumor dissemination and disease-free survival: a univariate and multivariate analysis. Cancer. 1986; 58:1770–1778.

15. Meacham RB, Scardino PT, Hoffman GS, Easley JD, Wilbanks JH, Carlton CE Jr. The risk of distant metastases after transurethral resection of the prostate versus needle biopsy in patients with localized prostate cancer. J Urol. 1989; 142(2 Pt 1):320–325.

16. Bastacky SS, Walsh PC, Epstein JI. Needle biopsy associated tumor tracking of adenocarcinoma of the prostate. J Urol. 1991; 145:1003–1007.

17. Stone NN, Stock RG. Reduction of pulmonary migration of permanent interstitial sources in patients undergoing prostate brachytherapy. Urology. 2005; 66:119–123.

18. Eshleman JS, Davis BJ, Pisansky TM, Wilson TM, Haddock MG, King BF, et al. Radioactive seed migration to the chest after transperineal interstitial prostate brachytherapy: extraprostatic seed placement correlates with migration. Int J Radiat Oncol Biol Phys. 2004; 59:419–425.

19. Taussky D, Moumdjian C, Larouche R, Beliveau-Nadeau D, Boudreau C, Hervieux Y, et al. Seed migration in prostate brachytherapy depends on experience and technique. Brachytherapy. 2012; 11:452–456.

20. Hunter KW, Crawford NP, Alsarraj J. Mechanisms of metastasis. Breast Cancer Res. 2008; 10:Suppl 1. S2.

21. Han KR, Seligson DB, Liu X, Horvath S, Shintaku PI, Thomas GV, et al. Prostate stem cell antigen expression is associated with gleason score, seminal vesicle invasion and capsular invasion in prostate cancer. J Urol. 2004; 171:1117–1121.

22. Forsythe K, Burri R, Stone N, Stock RG. Predictors of metastatic disease after prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2012; 83:645–652.