Brachytherapy versus external beam radiotherapy boost for prostate cancer: Systematic review with meta-analysis of randomized trials

Kee, D. Lam Cham; Gal, Jocelyn; Falk, Alexander Tuan; Schiappa, Renaud; Chand, Marie-Eve; Gautier, Mathieu; Doyen, J.; Hannoun‐Lévi, Jean‐Michel

doi:10.1016/j.ctrv.2018.10.004

Cited by 48 publications

(39 citation statements)

References 40 publications

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“…Because high conformal dose distribution is achieved, it is an attractive therapeutic strategy [107]. Brachytherapy has been used as monotherapy for patients with low and intermediate-risk prostate cancers, and as an adjuvant to other therapies for higher risk patients [108]. Nevertheless, because it is a very invasive technique where a large number of radioactive seeds need to be implanted in each prostate, adverse effects occur, including swelling and discomfort [109].…”

Section: Nanoparticles As Therapeutic Agents For Internal Radiotherapymentioning

confidence: 99%

Nanoparticles for targeted cancer radiotherapy

Pallares

Abergel

2020

Nano Res.

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Radiotherapy, where ionizing radiation is locally delivered either through an external beam or by surgically implanting radionuclidebased seeds in the tumor, is one of the gold standard treatments for cancer. Due to the non-selective nature of radiation, healthy tissue surrounding the cancerous region is usually affected by the treatment. Hence, new strategies, including targeted alpha therapy, are being studied to improve the selectivity of the treatment and minimize side effects. Several challenges, however, limit the current development of targeted radiotherapy, such as the functionalization of the therapeutic agent with targeting vectors and controlling the release of recoiling daughters. Nanoparticles offer unique opportunities as drug delivery vehicles, since they are biocompatible, enhance the cellular uptake of drugs, and are easily functionalized with targeting molecules. In this review, we examine how nanoparticles can be used for targeted radiotherapy, either as sensitizers of external beams or as delivery vehicles for therapeutic radionuclides. We describe the clinical relevance of different types of nanoparticles, followed by an analysis of how these nanoconstructs can solve some of the main limitations of conventional radiotherapy. Finally, we critically discuss the current situation of nanoparticle-based radiotherapy in clinical settings and challenges that need to be overcome in the future for further development of the field.

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Section: Nanoparticles As Therapeutic Agents For Internal Radiotherapymentioning

confidence: 99%

Nanoparticles for targeted cancer radiotherapy

Pallares

Abergel

2020

Nano Res.

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“…Dose escalation is strongly linked to a reduction of biochemical and clinical failure and metastasis-free survival [7]. However, the benefits of dose escalation must be balanced with the risk of increased radiation dose to the bladder, urethra and in particular, the rectum [8]. The higher the radiation dose received by the rectum the higher the risk of gastrointestinal (GI) toxicity [9,10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Introduction Radiation dose to the rectum in prostate brachytherapy (PBT) can be reduced by the use of polyethylene glycol (PEG) hydrogel spacers. This reduces the rate of rectal toxicity and allows dose escalation to the prostate. Our objectives were to provide an overview of technique for injection of a PEG hydrogel spacer, reduction in rectal dosimetry, gastrointestinal toxicity and potential complications. Methods We systematically reviewed the role of PEG hydrogel spacers in PBT using the Cochrane and PRISMA methodology for all English-language articles from January 2013 to December 2019. Data was extracted for type of radiotherapy, number of patients, type of PEG-hydrogel used, mean prostate-rectum separation, rectal dosimetry, acute and late GI toxicity, procedure-related complications and the technique used for hydrogel insertion. Results Nine studies (671 patients and 537 controls) met our inclusion criteria. Of these 4 used DuraSeal ® and 5 used SpaceOAR ®. The rectal spacing achieved varied between 7.7-16 mm. Failure of hydrogel insertion was seen only in 12 patients, mostly related to failure of hydrodissection in patients undergoing salvage PBT. Where reported, the rectal D2 cc was reduced by between 21.6 and 52.6% and the median rectal V75% cc was reduced by between 91.8-100%. Acute GI complications were mostly limited to grade 1 or 2 toxicity (n = 153, 33.7%) with low levels of grade 3 or 4 toxicity (n = 1, 0.22%). Procedure-related complications were limited to tenesmus (0.14%), rectal discomfort (1.19%), and bacterial prostatitis (0.44%). Conclusions PEG hydrogel spacers are safe to insert. Gel insertion is easy, fast and has a low rate of failure. These studies convincingly demonstrate a significant reduction in rectal dosimetry. Although the results of spacers in reducing rectal toxicity is promising, these need to be confirmed in prospective randomised trial.

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“…BT is considered as monotherapy in low-risk or favorable intermediate-risk prostate cancer patients, and it can also be used in combination with external beam radiation therapy (EBRT) for unfavorable intermediate-and high-risk prostate cancer (7). Dose-escalated BT has also resulted in increasing rectal or gastrointestinal (GI) toxicity (8). Despite advances in radiation therapy techniques and target localization, the rectum remains the primary dose-limiting organ at risk owing to the close proximity of the rectum to the prostate gland.…”

Section: Introductionmentioning

confidence: 99%

Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

Ardekani

Ghaffari

2020

Brachytherapy

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The objective of this overview was to critically evaluate the effect of polyethylene glycol (PEG)-based hydrogel spacers during prostate brachytherapy with regard to dosimetric and clinical benefits, as well as procedure-related toxicity. METHODS AND MATERIALS: A systematic search in the PubMed database was performed. RESULTS: A total of 12 studies, involving 615 patients with PEG hydrogel injection, were included. Overall, patients well tolerated the implantation of PEG hydrogel spacers with an excellent safety profile. However, although there were some procedure-related complications, rates of these complications were very rare. Toxicities related to the spacer were limited to Grade 1 rectal discomfort and pain (9/615 patients), Grade 2 rectal ulceration (1 in 615 patients), perineal abscess (1 in 615 patients), and bacterial prostatitis (2/615 patients) according to Common Terminology Criteria for Adverse Events v4.0 grading scheme. The application of PEG hydrogel spacers significantly reduced radiation doses to the rectum during prostate brachytherapy in the different setting. Although there was no prospective randomized clinical trial, retrospective studies showed that reducing rectal doses by the implantation of PEG hydrogel may result in an improvement in rectal toxicity. CONCLUSIONS: The insertion of hydrogel spacers is safe, resulting in a significant decrease in rectal doses. This may lead to a reduction in rectal or gastrointestinal toxicity. Prospective randomized clinical trials are warranted to confirm the clinical impact of rectal dosimetric improvements.

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Brachytherapy versus external beam radiotherapy boost for prostate cancer: Systematic review with meta-analysis of randomized trials

Cited by 48 publications

References 40 publications

Nanoparticles for targeted cancer radiotherapy

Nanoparticles for targeted cancer radiotherapy

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

Optimization of prostate brachytherapy techniques with polyethylene glycol–based hydrogel spacers: A systematic review

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