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J D Forman

Publications and source records attributed to J D Forman.

At least 55 records · Page 3Linked to original sources
PubMed1996

Hip stiffness following mixed conformal neutron and photon radiotherapy: a dose-volume relationship.

PURPOSE: To determine the relationship between dose, volume, and the incidence of hip stiffness in patients who received conformal neutron irradiation for prostate cancer. METHODS AND MATERIALS: A series of dose-searching studies using neutron irradiation for prostate cancer were performed to determine the optimal dose, fraction size, field size, technique, and proportions of photon and neutron dose. Neutron doses ranged from 9 to 20 Gy and photon doses ranged from 0 to 38 Gy. Data were analyzed by using a hip stiffness grading scale. RESULTS: Hip stiffness was recorded on follow-up examination in 30% of patients (40 out of 132) treated with fast neutrons or mixtures of fast neutron and photon radiation for prostate cancer. Hip stiffness was categorized as none (Grade 0, 92 patients), mild (Grade 1, 24 patients), moderate (Grade 2, 10 patients), or severe (Grade 3, 6 patients). The incidence of hip stiffness differed significantly by dose and volume in the five dose levels studied (p < 0.001). CONCLUSIONS: By using a mixture of conformal neutron and photon irradiation and limiting the total neutron dose to less than 13 Gy, hip stiffness toxicity could be reduced to acceptable levels.

Aged↗
PubMed1996

Enhanced expression of IL-12 associated with Th1 cytokine profiles in active pulmonary sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by the expansion of activated oligoclonal CD4+ T cells and macrophages at sites of disease. To investigate the immunopathogenesis of sarcoidosis, we analyzed patterns of cytokine expression in bronchoalveolar lavage cells and fluid from patients with pulmonary sarcoidosis and idiopathic pulmonary fibrosis and from normal volunteers. We found dominant type 1 cytokine expression, with elevated mRNA and protein levels of IFN-gamma, but not IL-4, in sarcoid lung cells and fluid compared with those in normal samples. To define immunoregulatory mechanisms important to this type 1 response, we analyzed the expression of IL-12 and IL-10 in lung cells and fluid. Using semiquantitative PCR, we found significantly higher mRNA expression of the regulated IL-12 p40 subunit, but not IL-10, in sarcoid compared with normal lung cells. Consistent with these observations, strikingly elevated levels of p40 protein were found in sarcoid compared with normal bronchoalveolar lavage fluid. Unstimulated and Staphylococcus aureus-stimulated sarcoid alveolar macrophages produced greater amounts of IL-12 than normal alveolar macrophages when cultured in vitro. We hypothesize that sarcoidosis is a Th1-mediated disease driven by chronic, dysregulated production of IL-12 at sites of disease.

Adult↗
PubMed1996

Conformal mixed neutron and photon irradiation in localized and locally advanced prostate cancer: preliminary estimates of the therapeutic ratio.

PURPOSE: To determine the incidence of chronic toxicity and the probability of biochemical and histologic complete response among patients with nonmetastatic prostate cancer, treated with three dimensional (3D) conformal mixed neutron and photon irradiation. METHODS AND MATERIALS: Between November 1991 and December 1994, 151 patients with prostate cancer were entered in three prospective dose-finding studies of conformal mixed neutron and photon irradiation. Patients with low stage, low to intermediate grade prostate cancer (T1-2NXM0, Gleason Score < or = 7) received 38 Photon Gy (PhGy) plus 9 (51 patients) or 10 (53 patients) Neutron Gy (NGy) to the prostate and seminal vesicles. Forty-seven patients with locally advanced prostate cancer (T3-4 N0-1 M0 and/or Gleason Score > or = 8) received 15 NGy + 18 PhGy to the prostate and seminal vesicles and 9 NGy + 18 PhGy to the pelvic lymph nodes. RESULTS: The median follow-up was 16 months (range: 3-30 months). There was no Grade 3-5 GI or GU toxicity recorded. At 20 months, the actuarial rates of Grade 2 GI morbidity were 6 and 29% for the 9-10 and 15 NGy protocols, respectively (p = 0.07). At 20 months, the incidences of Grade 2 GU morbidity were 4 and 16%, respectively (p = 0.08). Stiffness in flexing or abducting the hips was seen in 20 and 42% of patients receiving 9-10 and 15 NGy, respectively (p = 0.01). Potency was maintained in 65% of all patients. Among patients with an initial PSA < or = 10, 100% had a 12-month PSA < 2 and 78% < 1 ng/ml. Negative postradiation biopsies were seen in 30% of patients 6 months, 79% at 12 months, and 84% of patients at 18 months. CONCLUSION: The use of conformal mixed neutron and photon irradiation has been well tolerated with no severe bladder or rectal complications observed. However, because of the enhanced toxicity seen with 15 NGy, the current maximum dose levels of neutron irradiation have been limited to 11 NGy.

Adenocarcinoma↗
PubMed1996

Clinical results of computerized tomography-based simulation with laser patient marking.

PURPOSE: Accuracy of a patient treatment portal marking device and computerized tomography (CT) simulation have been clinically tested. METHODS AND MATERIALS: A CT-based simulator has been assembled based on a commercial CT scanner. This includes visualization software and a computer-controlled laser drawing device. This laser drawing device is used to transfer the setup, central axis, and/or radiation portals from the CT simulator to the patient for appropriate patient skin marking. A protocol for clinical testing is reported. Twenty-five prospectively, sequentially accessioned patients have been analyzed. RESULTS: The simulation process can be completed in an average time of 62 min. Under many cases, the treatment portals can be designed and the patient marked in one session. Mechanical accuracy of the system was found to be within +/- 1mm. The portal projection accuracy in clinical cases is observed to be better than +/- 1.2 mm. Operating costs are equivalent to the conventional simulation process it replaces. CONCLUSION: Computed tomography simulation is a clinical accurate substitute for conventional simulation when used with an appropriate patient marking system and digitally reconstructed radiographs. Personnel time spent in CT simulation is equivalent to time in conventional simulation.

Computer Simulation↗
PubMed1996

Hyperfractionated conformal radiotherapy in locally advanced prostate cancer: results of a dose escalation study.

PURPOSE: This study was initiated to assess the incidence of chronic complications and histologic and biochemical control following hyperfractionated conformal radiotherapy in patients with locally advanced prostate cancer. METHODS AND MATERIALS: Between October 1991 and October 1994, 49 patients with locally advanced prostate cancer were entered on the first two dose levels of a prospective dose-escalation study using hyperfractionated three dimensional conformal radiotherapy. The first 25 patients received a minimum tumor dose of 78 Gy to the prostate and seminal vesicles in 6 weeks at 1.3 Gy, b.i.d. No increase in chronic toxicity compared with conventional radiotherapy was noted; therefore, an additional 24 patients were treated to a minimum tumor dose of 82.8 Gy to the prostate and seminal vesicles in 7 weeks at 1.15 Gy, b.i.d. Toxicity was scored according to the Radiation Therapy Oncology Group morbidity grading scale. Efficacy was assessed through scheduled postradiation prostate specific antigen values and ultrasound-guided biopsies. The median follow-up for the entire group was 20 months. RESULTS: The hyperfractionated external radiation was well tolerated with minimal acute morbidity. At 30 months, the actuarial probability of Grade 2 gastrointestinal toxicity was 17%. At 30 months, the actuarial probability of Grade 2 genitourinary toxicity was 16%. There was no statistically significant difference between the two dose levels. No Grade 3 or 4 gastrointestinal or genitourinary toxicity was noted. At 12 months, 84% of patients had a prostate specific antigen < or = 4; and 53% < or = 1 ng/ml. At 12 months, 71% of patients had post radiation biopsies that were either negative (55% or showed a marked therapeutic effect (16%). CONCLUSION: The use of hyperfractionated conformal radiotherapy facilitated dose escalation with no increase in chronic toxicity compared to standard doses. The initial tumor response based on prostate specific antigen measurements and postradiation biopsies is highly encouraging. Based on these results, an increase in dose to 87.4 Gy has been planned according to the schema of this ongoing dose escalation study.

Acid Phosphatase↗
PubMed1996

A multirod collimator for neutron therapy.

PURPOSE: To design, construct, and commission a multirod collimator for producing irregularly shaped fields in neutron radiation therapy. To demonstrate the reliability and applicability of this device to routine use with a superconducting cyclotron for neutron therapy. METHODS AND MATERIALS: A multirod collimator has been designed, constructed, and thoroughly tested to investigate its radiological properties; neutron transmission characteristics, beam profiles, and penumbral widths as a function of field size and depth in a phantom, and the spatial resolution of the rod array, have been measured. A wide variety of irregularly shaped fields, used routinely in neutron radiation therapy, have been produced, including fields that incorporate partial transmission blocks. The performance of the collimator has been closely monitored over a period of 20 months to accurately assess reliability. RESULTS: The multirod collimator has been in routine use for 32 months, and during this time a total of 7025 neutron fields has been treated. For the latter 20 months of this period, detailed performance records show that collimator failure has caused 28.4 h of downtime during the patient treatment day. Only 5.25 h of this downtime was experienced in the last 12 months (0.22% of the available treatment time). The results of collimator attenuation and beam profile measurements show that the radiological properties of the collimator are comparable to those of other collimator systems used for neutron radiation therapy. Isodose measurements in a water phantom show that the spatial resolution of the rods is superior to that of the leaves used in neutron multileaf collimators. The ability of the multirod collimator to produce many irregularly shaped fields commonly encountered in neutron radiation therapy has been demonstrated. Shaped fields for prostate, head and neck, soft tissue sarcomas, lung, thyroid, rectum, bladder, colon, breast, pancreas, and gynecological tumors have been produced. For some prostate cases, the device has been used to produce partial transmission blocks. CONCLUSIONS: A novel multirod collimator has been designed, constructed, and successfully applied in the routine treatment of neutron radiation therapy patients.

Cyclotrons↗
PubMed1996

Comparison of hyperfractionated conformal photon with conformal mixed neutron/photon irradiation in locally advanced prostate cancer.

In an attempt to improve the probability of complication-free local control for patients with locally advanced prostate cancer, a series of dose-finding studies have been conducted at Wayne State University using conformal neutron and hyperfractionated photon irradiation. In total, 96 patients with locally advanced prostate cancer (T3/T4 N0/N1 M0, and/or Gleason score > or = 8) were treated in two prospective studies. Forty-seven patients received conformal neutron/photon (15 NGy + 18 PhGy) and 49 patients were treated in a dose-escalation study using conformal photons (25 patients/78 Gy and 24 patients/83 Gy minimum dose). The median follow-up for both studies was 20 months (range 6-36 months). There was no significant difference in the rate of chronic gastrointestinal (GI) or gastrourinary (GU) morbidity between the two groups. However, the neutron treated patients had a significantly higher rate of moderate (14%) and severe (12%) hip stiffness. The rates of prostate-specific antigen (PSA) decline and 12-month negative biopsy were comparable. In conclusion, the therapeutic gain of neo-adjuvant hormonal therapy in combination with photon hyperfractionation to 83 Gy appears identical to that seen with the mixed neutron-photon dose of 15 NGy + 18 PhGy. Further efforts at improving the therapeutic ratio of radiotherapy for patients with locally advanced prostate cancer should be undertaken.

Adenocarcinoma↗
PubMed1996

The application of a multirod collimator in fast neutron therapy.

The application of a novel multirod collimator in fast neutron therapy to produce irregularly shaped fields with partial transmission and fully blocked areas is discussed. The transmission through the tungsten rods is measured in free space in broad beam geometry. A model based on scatter analysis is applied in calculating the thickness of the rods required to produce partially blocked areas. The effect of a full beam block is also measured. Measurements have been made in a water phantom to confirm the computational model. The good agreement between the measured and calculated values demonstrates that the scatter model can be safely applied to fast neutron beam dose computations.

Cyclotrons↗
PubMed1996

Predicting the need for adjuvant systemic therapy in patients receiving postprostatectomy irradiation.

OBJECTIVES: This study was initiated to determine if clinical, pathologic, or biochemical variables available in patients receiving postprostatectomy irradiation could be predictive of treatment outcomes, including the need for subsequent systemic therapy. METHODS: Between January 1992 and January 1995, 50 patients received external beam irradiation for a nonzero or rising postprostatectomy prostate-specific antigen (PSA) level. The median PSA values preoperatively and preradiation were 24 and 2.7 ng/mL, respectively. At the time of treatment, no patient had evidence of disseminated disease. The patients received a combination of axial and noncoplanar irradiation to an average total dose of 65 Gy at 1.8 Gy fractions. Univariate analysis and multivariate logistic regression were performed to identify factors predictive of outcome. RESULTS: Treatment was well tolerated with no grade 3 or higher gastrointestinal or genitourinary complications. A decline in the serum PSA during irradiation occurred in 82% of the patients. During radiation, 13 patients (26%) had a complete response (PSA less than 0.05 ng/mL), 56% had a partial response, and 18% had a rise in their PSA level. With a median follow-up of 16 months, 50% of all patients have an undetectable level of PSA. Twenty-six percent of patients have had evidence of biochemical progression. Seventeen percent of responding patients and 67% of nonresponders have evidence of progression (P= 0.002). On univariate analysis, other significant prognostic factors included clinical stage (P < 0.01), the preradiation PSA level (P < 0.05), and N stage (P < 0.01). On stepwise multivariate logistic analysis, a predictive model was generated from which treatment outcome could be predicted with 80% accuracy (percent correct classification) and an 85% sensitivity. CONCLUSIONS: The outcome of patients with an elevated postprostatectomy PSA level who receive irradiation can be accurately predicted using a combination of clinical stage, preradiation PSA value, Gleason score, and the response to treatment. In this way, patients who do not require additional treatment (that is, hormonal) will avoid the unnecessary cost and toxicity.

Aged↗
PubMed1995

Evaluation of changes in the size and location of the prostate, seminal vesicles, bladder, and rectum during a course of external beam radiation therapy.

PURPOSE: To document the size and location of the prostate, seminal vesicles, bladder, and rectum throughout the course of external beam radiotherapy. The frequency and range of motion of these organs are quantified. METHODS AND MATERIALS: Ten patients with localized carcinoma of the prostate had conventional simulation followed immediately by a treatment planning computed tomography scan (TPCT0). Once treatment was initiated, each patient had a weekly CT (TPCT1-N) before or after his daily treatment. Anatomical structures from CT were delineated on a computer workstation for analysis. The serial CT sets were spatially registered to the initial scan using image correlation software that brings into congruence the bony pelvis of the different scans. The location of the prostate, seminal vesicles, bladder, and rectum on subsequent scans were compared to TPCT0, as well as to each other. RESULTS: Prostate volumes were observed to vary by an average of +/- 10% during the course of radiation therapy, while the seminal vesicle volumes varied by as much as 100%. Bladder and rectal volumes varied by +/- 30%. Compared to TPCT0, movement of the prostate was demonstrated in all patients. Quantitation of the center-of-mass (CM) showed motion of less than 1 mm in the left-right direction, while motion ranging from 0 to +/- 1 cm was observed in the anterior-posterior and superior-inferior directions. The individual standard deviations of these motions varied from approximately 1-5 mm. These variations were correlated to changes in the dimensions of the bladder and rectum. CONCLUSIONS: Changes in the location of the prostate, seminal vesicles, and normal tissue volumes during the course of radiation therapy occur and have dosimetric consequences that may impact tumor control and normal tissue complication probabilities. Conformal therapy for prostate cancer will require the incorporation of knowledge of the anatomic relationships of these structures as a function of time. Therefore, these uncertainties must be taken into account when designing treatment plans and in considering dose escalation trials.

Humans↗
PubMed1995

Selection of oligoclonal V beta-specific T cells in the intradermal response to Kveim-Siltzbach reagent in individuals with sarcoidosis.

Sarcoidosis is a multiorgan granulomatous disorder of unknown etiology characterized by noncaseating granulomas in involved tissues. A positive Kveim-Siltzbach reaction is a granulomatous response to an intradermal injection of a suspension of sarcoid tissue extract in individuals with sarcoidosis. The protracted time course and granulomatous features of this reaction have a striking resemblance to the Mitsuda reaction in tuberculous leprosy, which suggests that the Kveim-Siltzbach reaction is a response to an unknown Ag(s). To evaluate whether this reaction is Ag-driven, an analysis of the TCR V beta repertoire in 15 Kveim-Siltzbach reaction sites was performed using a PCR technique and primers specific for 20 V beta gene families. Results of this analysis demonstrated a pattern of V beta expression dominated by expression of V beta 2, V beta 3, V beta 6, or V beta 8 to levels > 20% of total V beta gene expression in nine of 15 individuals. Analysis of paired biopsy and blood specimens revealed a preferential expression of specific V beta genes, such as V beta 3, V beta 5, and V beta 8, at sites of Kveim-Siltzbach reactions to levels four to seven times that of the corresponding peripheral blood. Sequence analysis demonstrated that preferential expression of specific V beta genes at Kveim-Siltzbach reaction sites is oligoclonal. Furthermore, the dominant V beta 8 sequence present at one of the reaction sites contained a sequence motif in the variable-diversity-joining junctional region previously identified in sarcoid lung and blood T cell populations. These results suggest that the Kveim-Siltzbach reaction is characterized by a limited TCR beta-chain repertoire consistent with an Ag-driven T cell immune response.

Amino Acid Sequence↗
PubMed1995

Description of a 3D conformal neutron and photon radiotherapy technique for prostate cancer.

Several methods have been described to improve the therapeutic ratio of radiotherapy in patients with locally advanced carcinoma of the prostate (LACaP). Studies have shown improved survival and local control in patients treated with neutron irradiation as opposed to photons alone. However, an increased complication rate was observed when conformal field design was not utilized. A 3D conformal mixed neutron/photon technique for LACaP has been developed at this institution. Field shaping for the neutron component is achieved with a multirod collimator. Prior to treatment, all patients undergo a conventional simulation followed by a treatment planning computed tomography (CT) scan. Contours of target and normal structures are entered into the 3D treatment planning system. Beam apertures are designed utilizing beam's eye view display. The photon dose is given in 10 fractions at 1.8 Gy each to the prostate and seminal vesicles (PSVs) and pelvic lymph node (PLN) volumes. The neutron dose is given in 15 fractions at 1.0 Gy per fraction to the PSV volume and 0.6 Gy to the PLN volume. The neutron portion includes a partial transmission block to achieve this dose differential. The treatment planning process, including beam weighting and custom block design, is described. Using these techniques, the neutron dose distributions to the target volumes, bladder, and rectum were comparable to those seen with four-field conformal photon irradiation.

Humans↗
PubMed1995

Alternating conformal neutron and photon irradiation for locally advanced adenocarcinoma of the prostate.

The substantial local failure rate for patients with locally advanced carcinoma of the prostate (LACaP) following photon irradiation, the association of local failure with a poor prognosis, and the promising results of mixed neutron/photon (40%/60%) radiotherapy supplied the rationale for this study. The purpose of this study was to evaluate the combined advantages of mixed neutron/photon (75%/25%) irradiation, 3D treatment planning, as well as fully conformal beam shaping capabilities in reducing the morbidity associated with neutron irradiation. The first 35 patients treated with this technique are the basis for this analysis. After CT stimulation and treatment planning, the normal tissue and target structures were entered into the 3D planning system. The neutron dose was delivered in 15 fractions at 1.0 Gy/fraction (NGy) to the prostate and seminal vesicles (PSV) and 0.6 NGy/fraction to the pelvic lymph nodes (LN). The photon dose was given in 10 fractions of 1.8 Gy each to both the PSV and LN volumes. Neutron and photon dose-volume histograms (DVHs) were generated in each patient for the prostate, seminal vesicles, lymph nodes, bladder, and rectum. The adequacy of the neutron and photon components of the treatment were compared with respect to target volume and normal tissue irradiation. Based on the DVH analysis, the prostate and seminal vesicles received the prescribed dose with both neutrons (99% +/- 2%) and photons (99% +/- 2%). There was no significant difference in the dose to the bladder and rectum for both the neutrons and photons. The acute treatment related reactions have been mild, with only one grade III bladder reaction. The 3D conformal technology utilized in this study has been shown to allow for the delivery of neutron irradiation with no increase in dose to the adjacent normal tissues compared with that achieved with conformal photon treatment. Further follow-up will reveal whether the dosimetric advantage demonstrated by this technique translates into an improved therapeutic ratio.

Adenocarcinoma↗
PubMed1995

Neoadjuvant hormonal downsizing of localized carcinoma of the prostate: effects on the volume of normal tissue irradiation.

A prospective evaluation of neoadjuvant hormonal downsizing in patients with localized carcinoma of the prostate was undertaken to assess its effect on normal tissue irradiation. Twenty patients with stage T1 or T2 (A, B) carcinoma of the prostate received 3 months of Lupron prior to definitive radiotherapy. The volumes of the prostate, seminal vesicles, bladder, and rectum from both the pre- and posthormone treatment planning CT were entered onto a 3-D treatment-planning system. The treatment planning parameters were standardized to facilitate comparison of the pre- and posthormonal volumes. Following the three monthly injections of Lupron, the average volume of the prostate was reduced by 37%. As a consequence, the volume of the bladder receiving at least 40, 52, and 64 Gy was reduced by an average of 15, 18, and 20%, respectively. In addition, the volume of the rectum receiving at least 40, 52, and 64 Gy was reduced by an average of 13, 20, and 34%, respectively. In conclusion, in patients with localized prostate cancer, downsizing of the prostate resulted in a reduction in the volume of bladder and rectum receiving high radiation doses. This approach may result in an improvement in the therapeutic ratio by reducing the morbidity of treatment.

Adenocarcinoma↗
PubMed1994

Comparison of a conformal nonaxial boost with a four-field boost technique in the treatment of adenocarcinoma of the prostate.

PURPOSE: A comparative study of a standard four-field boost technique and a customized nonaxial external beam technique for the treatment of adenocarcinoma of the prostate was performed to quantify rectal and bladder sparing. METHODS AND MATERIALS: Sixteen patients with localized carcinoma of the prostate who underwent simulation and treatment planning computed tomography formed the basis of this study. The prostate, seminal vesicles, lymph node, pelvic bones, rectum, bladder, and skin volumes were contoured from the CT slices to the three-dimensional treatment planning system. Each patient was planned for both standard four-field and nonaxial techniques to a boost treatment dose of 24 Gy to the prostate. Isodose plans were chosen on the basis of adequate tumor coverage and normal tissue sparing. RESULTS: The volumes of the prostate, rectum, and bladder ranged from 46-148 cc, 25-196 cc, and 50-378 cc, respectively. Data analysis demonstrated a statistically significant reduction (p < 0.01) in normal tissue irradiation with the nonaxial external beam technique at dose levels of 15 and 20 Gy. CONCLUSION: The nonaxial four-field external beam technique appears to be superior to the standard four-field approach in reducing the volume of high dose irradiation to the adjacent rectum and bladder.

Adenocarcinoma↗
PubMed1994

Selective activation and accumulation of oligoclonal V beta-specific T cells in active pulmonary sarcoidosis.

Sarcoidosis is a granulomatous disease in which activated T cells, responding to an unidentified stimulus, accumulate at sites of disease such as the lung. To evaluate the hypothesis that active sarcoidosis is characterized by a selective activation and expansion of a limited repertoire of T cell receptor (TCR) specific T cells, we analyzed TCR V beta gene expression in lung and blood T cells of patients with active sarcoidosis and, for comparison, normal individuals using polymerase chain reaction amplification of 20 V beta gene families. Analysis of normal bronchoalveolar lavage T cells revealed TCR V beta distributions similar to that of normal blood, providing evidence for a lack of generalized skewing of the T cell repertoire in the normal, noninfected lung. Compared to normal lung and blood, subgroups of individuals with sarcoidosis demonstrated biased expression of one or more V beta genes in either the lung or blood. Five V beta gene families (V beta 5, V beta 8, V beta 15, V beta 16, and V beta 18) were most frequently utilized in a biased fashion by sarcoid lung or blood T cells. Furthermore, dramatic skewing of the T cell repertoire was apparent when sarcoid lung and blood T cells were expanded by short-term culture with IL-2. Sequence analysis demonstrated a bias in V beta gene expression was usually due to expansion of select V beta-specific clones, some of which contained a similar V(D)J junctional region motif. These observations provide evidence for a selective activation and accumulation of antigen-specific V beta-expressing T cells in sarcoidosis.

Adult↗
PubMed1993

Prostate brachytherapy. An overview.

BACKGROUND: Prostate brachytherapy represents one of the oldest techniques of using radiation therapy to treat prostate cancer. Over the past 10 years, there have been major changes in the types of prostate brachytherapy that can be performed with the introduction of new radioactive isotopes, new afterloading techniques, and an improved understanding of the radiobiology associated with differing dose rates. METHODS: Prostate brachytherapy can be divided into temporary implantation using high activity sources such as iridium-192, or permanent brachytherapy using the interstitial implantation of iodine-125 or palladium-103 sources. There are various techniques that can be used to actually insert the radioactive material into the prostate. This can be done as an open or closed procedure and can be performed via a suprapubic or a perineal retropubic approach. The use of remote afterloading has substantially reduced the radiation protection problems associated with manually loaded radioactive sources. RESULTS: Results using brachytherapeutic isotopes in the treatment of prostate cancer have been variable, but it appears that using the higher dose rate sources and delivering a high relative integral dose to the prostate can result in improved histologic control of prostate cancer. In patients with aggressive prostate cancer, the use of iodine-125 permanent implantation has not been successful. CONCLUSIONS: The role of brachytherapy in the treatment of prostate cancer remains an exciting alternative in the management of prostate cancer. Its role is becoming more defined in the treatment of large, bulky prostatic neoplasms as a way of improving the dose distribution achieved between normal and tumor tissue.

Brachytherapy↗