[Combination of bilateral pelvic lymphadenectomy, permanent iodine-125 implantation and percutaneous irradiation of localized prostate carcinoma. 1: Methods and results].

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 iodine-125 seeds at the Urologic and Radiotherapeutic Hospital of the University of Erlangen. 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 six patients were initially treated only by interstitial therapy because of severe complications observed in the meantime. After bilateral pelvic staging lymphadenectomy, permanent iodine-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. Eight 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 four weeks to the 90%-isodose was only applied to a spherical surface around the implant. One patient died perioperatively from an embolism due to phlebothrombosis of the thigh. 22 out of the other 24 patients are in complete remission, one patient had a local recurrence in the right seminal vesicle which appeared 28 months after primary therapy, and one 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 one to two years in 28% (5/18) of cases, after a latent time of about 1 1/2 to two 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 four patients presented finally a prostato-rectal fistula.