Combination of bilateral pelvic lymphadenectomy, permanent iodine-125 implantation, and percutaneous irradiation of the locally confined prostatic cancer. Pt. 1

Since the beginning of 1981, 32 patients at an age of 52 to 72 years who suffered from a locally confined adenocarcinoma of the prostate were treated by permanent implantation of I-125 seeds. 25 patients were evaluated after a median observation period of 30 months. The first group consisting of 19 patients was submitted to a combined percutaneous and interstitial treatment, the other 6 patients were initially treated only by interstitial therapy because of severe complications observed in the meantime. After bilateral pelvic staging lymphadenectomy, permanent I-125 seeds were implanted into the patients of stage T1, T2, early T3 and pN0-1, in case of microscopic lymph node manifestation without capsular perforation also into patients of stage pN2 and pN4. 8 weeks later the patients received a moving beam irradiation with 10 MV photons at the linear accelerator. The centre of the prostate was faded out by a specially constructed H absorber in such a way that the prescribed target dose of 36 Gy in 4 weeks to the 90%-isodose was only applied to a spherical surface around the implant. 1 patient died perioperatively from an embolism due to phlebothrombosis of the thigh. 22 out of the other 24 patients are in complete remission, 1 patient had a local recurrence in the right seminal vesicle which appeared 28 months after primary therapy, and 1 patient developed skeletal metastases. The objective side effects and late complications of our combined treatment are considerable with respect to their incidence as well as their severity: a slight or medium radioproctitis was found after a latent period of 1 to 2 years in 28% (5/18) of cases, after a latent time of about 1 1/2 to 2 years another 28% (5/18) developed subsequently to a proctitis an urethral stricture and an ulcer situated on the anterior rectum wall facing the prostate, and 4 patients presented finally a prostato-rectal fistula. (orig.)