BIT-ART: Multicentric Comparison of HDR-brachytherapy, Intensity-modulated Radiotherapy and Tomotherapy for Advanced Radiotherapy in Prostate Cancer

Abstract

Background/Aim: The aim of the study was to evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity in patients with high-or intermediate-risk prostate cancer. Patients and Methods: We evaluated data of patients from three Radiation Oncology Departments (Rome, Lübeck and Perugia). Patients treated in Rome underwent exclusive intensity-modulatedradiotherapy (IMRT) or IMRT plus high-dose-rate interventional radiotherapy (HDR-IRT). IMRT plus two fractions HDR-IRT was performed in Lübeck, while in Perugia Helical Tomotherapy was performed. The Common Toxicity Criteria for Adverse Event (Version 4.03) scale was used to describe acute and late toxicity. Results: At a median follow-up of 28 months, all 51 patients were alive and disease-free. Patients treated by HDR-IRT plus VMAT showed only G1-2 genitourinary-gastrointestinal (GU-GI) acute and late toxicity. Univariate analysis showed a lower risk of acute GU toxicity (p=0.048) in IMRT+HDR-IRT. Conclusion: Low grade and less acute GU toxicity was observed in patients undergoing HDR-IRT boost.

New dosimetric parameters to predict ano-rectal toxicity during radiotherapy treatment

“…Buettner et al showed that the fraction of the circumference of the rectal wall irradiated at high doses is specifically important. Krol et al confirmed that less exposure of the rectal wall to intermediate or high doses of radiations, leads to fewer changes and complications [16,[23][24][25][26][27][28][29].…”

Radiation therapy for prostate cancer: What’s the best in 2021

“…52 Interventional radiotherapy (IRT) often indicated as Brachytherapy, due to its physical properties is capable of delivering a greater amount of dose when compared with the results obtained with EBRT. 53 Regarding the dose rate prostate cancer IRT may be either performed by low-dose rate (LDR) permanent seed interstitial implantation or by temporary high-dose rate (HDR) interstitial delivery; available data from clinical studies about such two different approaches show that they can considered both effective in terms of tumor control. 54 In particular LDR has some potential disadvantages such as the lack of a post implant dosimetric correction which is instead extremely easy in HDR allowing for a better dose distribution according to the dose to the OARs.…”

Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database

“…Though initially utilized as a boost treatment modality to external beam radiation therapy (EBRT), high-dose-rate BT (BT HDR) as a monotherapy proved to be successful in overcoming some limitations of EBRT [ 16 , 17 , 18 ]. BT HDR is advantageous in overcoming overall organ motion and sparing nearby organs with a rapid dose fall-off.…”

“…BT HDR is advantageous in overcoming overall organ motion and sparing nearby organs with a rapid dose fall-off. Coupled with its high dose conformity within the target volume, BT HDR allows for thorough and concise biological planning with minimal dosimetric uncertainty [ 16 ]. There is also a relatively short treatment period with excellent functional outcomes [ 10 ].…”

“…There is also a relatively short treatment period with excellent functional outcomes [ 10 ]. Even though BT is important in treating localized, low-risk prostate cancer, it is utilized neither frequently nor uniformly across nationwide practices [ 16 , 19 , 20 ]. However, its success as a monotherapy in patients with PCa has sparked interest in and clinical justification for the use of other hypo-fractionated radiation therapies, such as stereotactic body radiation therapy (SBRT) [ 17 , 21 ].…”