An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer

Marina, Ovidiu; Warner, J.; Ye, Hong; Grills, I.S.; Shah, Chirag; Wallace, Michelle; Gustafson, Gary; Brabbins, D.; Martínez, Álvaro; Krauss, Daniel

doi:10.1016/j.brachy.2013.10.006

Cited by 8 publications

(3 citation statements)

References 19 publications

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“…Marina et al ( 21 ) used the Common Terminology Criteria for Adverse Events v4 grading system to determine incidence rates of erectile dysfunction 3 years after HDR brachytherapy monotherapy vs. IMRT. Rates of erectile dysfunction requiring medical intervention for both HDR brachytherapy monotherapy and IMRT were low and equivalent.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

et al. 2015

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Purpose There is little information in the literature on health-related quality of life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy monotherapy for prostate cancer.Materials and Methods We conducted a prospective study of HRQOL changes due to HDR brachytherapy monotherapy for low risk or favorable intermediate risk prostate cancer. Sixty-four of 84 (76%) patients who were treated between February 2011 and April 2013 completed 50 questions comprising the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 6 and/or 12 months after treatment.Results Six months after treatment, there was a significant decrease (p<0.05) in EPIC urinary, bowel, and sexual scores, including urinary overall, urinary function, urinary bother, urinary irritative, bowel overall, bowel bother, sexual overall, and sexual bother scores. By one year after treatment, EPIC urinary, bowel, and sexual scores had increased and only the bowel overall and bowel bother scores remained significantly below baseline values.Conclusions HDR brachytherapy monotherapy is well-tolerated in patients with low and favorable intermediate risk prostate cancer. EPIC urinary and sexual domain scores returned to close to baseline 12 months after HDR brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

et al. 2015

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“…Additionally, they are very heterogeneous, which makes it difficult to compare. Indeed, the populations are not comparable; some studies included patients with high-grade CaP non eligible for BT treatment [7,10,15], and others included patients with preoperative ED [16,17] or high percentage of preoperative HT [7]. The methods of treatment were also heterogeneous, with different BT techniques [15,18], dissimilar questionnaires validated or not [17], and adjuvant treatment sometimes not mentioned.…”

Section: Discussionmentioning

confidence: 99%

Prospective four years of evaluation of erectile function after low-dose-rate prostate brachytherapy using baseline IIEF-5 > 16

Schoentgen

Marolleau²,

Delage

et al. 2019

jcb

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Purpose Prostate brachytherapy (BT) is a validated treatment for localized prostate cancer (CaP) and an attractive therapy option for patients seeking to preserve erectile function (EF). The aim of this paper is to prospectively assess EF evolution during 4 years after BT. Material and methods Between February 2007 and July 2012, 179 patients underwent an exclusive Iodine-125 BT, for low-intermediate favorable risk CaP of whom, 102 had an initial international index of erectile function 5 score (IIEF-5) > 16 and were included in the study. Of those, 12.7% received neo-adjuvant hormonotherapy (HT) to decrease the prostate volume. Post-BT intake of phosphodiesterase inhibitors (PDE5i) was not an exclusion criterion. Erectile function was prospectively assessed using a validated questionnaire IIEF-5 before treatment and annually for 4 years. Results At 1-year follow-up, 54% of patients preserved an IIEF-5 > 16 and only 8% suffered from severe ED. During the next 3 years, the results were not statistically different. The mean IIEF-5 lost 4 points during the first year, 17 vs. 21, and remained stable during the following 3 years. We did not find any significant differences in the proportion of patients treated by PDE5i (18-20%). As for patients with a normal preoperative IIEF-5 (> 21) ( n = 52), 35-42% preserved a normal EF and 71-77% maintained an IIEF-5 > 16, including 13-19% of patients who needed PDE5i. Those results were stable for over 4 years. Conclusions During the first 4 years after BT, more than half of patients maintained an IIEF-5 > 16, and EF results remained stable. Severe erectile dysfunction (ED) was very rare.

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“…Although a clear etiology of ED after radiation treatment remains elusive, reasonable hypotheses center on total radiation dose to the neurovascular bundles, penile structures including the penile bulb and corpus cavernosa and their vascular supply, and yet to be implicated structures. New or worsening ED after radiation treatment occurs regardless of treatment modality and remains a concern even with prophylactic or posttreatment medical therapy (23). We found it difficult to model whether any of the less than WG approaches might improve rates of developing ED as we did not have a structure that we could contour.…”

Section: Sexual Toxicitymentioning

confidence: 98%

From whole gland to hemigland to ultra-focal high-dose-rate prostate brachytherapy: A dosimetric analysis

et al. 2015

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PURPOSE: To assess the magnitude of dosimetric reductions of a focal and ultra-focal high-doserate (HDR) prostate brachytherapy treatment strategy relative to standard whole gland (WG) treatment. METHODS AND MATERIALS: HDR brachytherapy plans for five patients treated with WG HDR monotherapy were optimized to assess different treatment strategies. Plans were generated to treat the hemigland (HG), one-third gland (1/3G), and one-sixth gland (1/6G), as well as to assess treating the WG with a boost to one of those sub-volumes (WG þ HG, WG þ 1/3G, WG þ 1/6G). Dosimetric parameters analyzed included Target D90%, V100%, V150%, Bladder (B), Rectal (R), Urethral (U) D0.1, 1 and 2cc, Urethral V75%, and the V50% to the contralateral HG. Two-tailed t tests were used for comparison of means, and p-values less than 0.05 were considered statistically significant. RESULTS: Target objectives (D90 O 100% and V100 O 97%) were met in all cases. Significant organs at risk dose reductions were achieved for all approaches compared with WG plans. 1/6G vs WG plans resulted in the greatest reduction in dose with a mean bladder D2cc 24.7 vs 64.8%, rectal D2cc 32.8 vs 65.3%, urethral D1cc 52.1 vs 103.8%, and V75 14.5 vs 75% ( p ! 0.05 for all comparisons). CONCLUSION: Significant dose reductions to organs at risk can be achieved using HDR focal brachytherapy. The magnitude of the reductions achievable with treating progressively smaller sub-volumes suggests the potential to reduce morbidity, but the clinical impact on morbidity and tumor control remain to be investigated. Ó

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An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer

Cited by 8 publications

References 19 publications

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

Prospective four years of evaluation of erectile function after low-dose-rate prostate brachytherapy using baseline IIEF-5 > 16

From whole gland to hemigland to ultra-focal high-dose-rate prostate brachytherapy: A dosimetric analysis

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