RESUMO
Nikolai Alekseevich Lopatkin, Academician of the Russian Academy of Medical Sciences, has contributed much to development of prostatic cancer (PC) diagnosis and treatment in the Russian Federation. N. A. Lopatkin headed specialists from the Research Institute of Urology who were the first in Russia to introduce into clinical practice the method of interstitial radiotherapy (brachitherapy) of local prostatic cancer (PC). A total of 58 PC patients 42 to 76 years of age were treated. They had stages T1bN0M0 (n = 5), T2aN0M0 (n = 36), T2bN0M0 (n = 11), T3aN0M0 (n = 6). Staging was made by the data of finger rectal examination, transrectal ultrasonography, NMR tomography, radionuclide osteoscintigraphy. Mean PSA was 2.5-36 ng/ml in the size of the prostatic gland 14.96-52.76 cm3. All the patients received neoadjuvant hormone therapy. Four patients one year or more before the radiotherapy had TUR of the prostate. Brachytherapy was made under peridural anesthesia which allowed implantation of 40-120 sources with activity of 0.38-0.35 mCi for 20-45 min. A total dose was 120-160 Gy. Mean hospital stay was 4 days. Spontaneous urination recovered within 6 postoperative hours. The procedure was well tolerated, complications arose on postimplantation day 2-8. We attribute complications to inadequate calculation of the doses at the stage of the method introduction. A short follow-up (3 years) is not long enough to allow conclusions about the efficacy of the method. Within 3 years biochemical recurrence occurred in 4 (6.9%) patients on months 14-26 (stage T2b and 2-T3). Four patients were lost for follow-up. Thus, brachytherapy efficacy depended much on adequate selection of the patients and planning of the procedure by the results of previous volumetry. The procedure is safe and reproducible. The studies will be continued.
