PREOPERATIVE EXTENDED FIELD RADIATION WITH I-125 SEED IMPLANT IN PROSTATIC-CANCER - PRELIMINARY-REPORT OF A RANDOMIZED STUDY

This study began in 1972, when randomly allocated patients received preoperative x-ray therapy to the pelvis and para-aortic areas to a dose of 3000 rad in 14 fractions; following this treatment retropubic extraperitoneal exposure of the prostate and node dissection were performed. Iodine-125 seeds were implanted in the prostate. Patients with positive nodes received postoperative radiation therapy to tolerance doses while those with negative nodes were only observed with no further therapy. In the alternate arm, the patients underwent straight retropubic extraperitoneal exposure of the prostate, node dissection, and Iodine-125 seed implant. If the nodes were positive, the patients received en bloc pelvic and para-aortic radiation to tolerance. Patients in this arm with negative nodes again received no further therapy. The aggregate dose was 5400 rad to the pelvis and was about 4400 rad to para-aortic nodes in both arms where the nodes were found to be metastatic. Thirty-two patients were evaluable for minimum of follow-up of two years with equal numbers in each group. Eight of 17 patients who had positive nodes in both the arms and who received extended field x-ray therapy, were disease-free with median survival of 3 1 2 years. Two patients in the preoperative radiation group and six in the alternate group had local failures. The pattern of survival and dissemination, otherwise were similar as of this writing. © 1979.