A comparison of outcomes for patients with intermediate and high risk prostate cancer treated with low dose rate and high dose rate brachytherapy in combination with external beam radiotherapy

Abstract

Low dose rate brachytherapy High dose rate brachytherapy External beam radiotherapy a b s t r a c t Introduction: There is evidence to support use of external beam radiotherapy (EBRT) in combination with both low dose rate brachytherapy (LDR-EBRT) and high dose rate brachytherapy (HDR-EBRT) to treat intermediate and high risk prostate cancer. Methods: Men with intermediate and high risk prostate cancer treated using LDR-EBRT (treated between 1996 and 2007) and HDR-EBRT (treated between 2007 and 2012) were identified from an institutional database. Multivariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS).Results: 116 men were treated with LDR-EBRT and 171 were treated with HDR-EBRT. At 5 years, bPFS was estimated to be 90.5% for the LDR-EBRT cohort and 77.6% for the HDR-EBRT cohort. On multivariable analysis, patients treated with HDR-EBRT were more than twice as likely to experience biochemical progression compared with LDR-EBRT (HR 2.33, 95% CI 1.12-4.07). Patients with Gleason 8 disease were more than five times more likely to experience biochemical progression compared with Gleason 6 disease (HR 5.47, 95% CI 1.26-23.64). Cumulative incidence of grade 3 genitourinary and gastrointestinal toxicities for the LDR-EBRT and HDR-EBRT cohorts were 8% versus 4% and 5% versus 1% respectively, although these differences did not reach statistical significance. Conclusion: LDR-EBRT may provide more effective PSA control at 5 years compared with HDR-EBRT. Direct comparison of these treatments through randomised trials are recommended to investigate this hypothesis further.

Low-/high-dose-rate brachytherapy boost in patients with intermediate-risk prostate cancer treated with radiotherapy: long-term results from a single institution team experience

“…At present, there are only two published studies comparing LDR vs. HDR boost in prostate cancer, both including patients of intermediate- and high-risk [ 24 , 25 ]. In King et al .…”

“…In a series of Slevin et al . [ 25 ] (287 patients of an institutional database), HDR boost was more than twice as likely to experience biochemical progression compared with LDR boost. At 5 years, bPFS was estimated to be 90.5% for the LDR-EBRT cohort, and 77.6% for the HDR-EBRT cohort.…”

Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique

“…HDR-BT (initially at a dose of 18 Gy in 3 fractions, subsequently 16 Gy in 2 fractions following a change in departmental protocol), was followed by EBRT within 2 weeks using IMRT (50. 4 Gy in 28 fractions). The results of this study showed that there was a significant decrease in radiation dose to the rectum throughout all rectal volumes, including expressed as an absolute volume (cc) or as a percentage of the contoured organ at risk.…”

“…Prostate brachytherapy (PBT) is a definitive treatment for prostate cancer [1,2]. Low-dose-rate (LDR) or highdose-rate (HDR) PBT can be used alone or in combination external beam radiotherapy (EBRT) to treat low, intermediate and high-risk prostate cancer [3][4][5][6]. Dose escalation is strongly linked to a reduction of biochemical and clinical failure and metastasis-free survival [7].…”

Unexpected lower biochemical control of high-dose-rate brachytherapy boost than low-dose-rate brachytherapy boost for clinically localized prostate cancer

“…With great interest, we read the article by Slevin F et al published recently in the Clin Transl Radiat Oncol journal [1]. They compared the outcome between LDR boost and HDR boost for men with intermediate and high risk prostate cancer.…”