Comparison of dose-escalated, image-guided radiotherapy vs. dose-escalated, high-dose-rate brachytherapy boost in a modern cohort of intermediate-risk prostate cancer patients

Marina, Ovidiu; Gustafson, Gary; Kestin, Larry L.; Brabbins, D.; Chen, Peter Y.; Ye, Hong; Martínez, Álvaro; Ghilezan, Michel; Wallace, Michelle; Krauss, Daniel

doi:10.1016/j.brachy.2013.05.004

Cited by 21 publications

(6 citation statements)

References 22 publications

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“…We believe that these better tumour control outcomes for the patients in the combo‐RT group simply reflect a more intense dose escalation that can effectively be achieved with a brachytherapy boost. In one recent retrospective comparison of patients with intermediate‐risk prostate cancer comparing HDR brachytherapy and EBRT with EBRT alone at a dose of 77 Gy, no differences in outcomes were observed . The results of the present study suggest that even ultra‐high doses of IMRT to levels of 86.4 Gy may not be sufficient to eradicate disease for this cohort of patients with intermediate‐risk prostate cancer, and the lower incidence of distant metastases may reflect the better local control accomplished with more intense dose escalation.…”

Section: Discussioncontrasting

confidence: 58%

Comparison of high‐dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate‐risk prostate cancer

et al. 2014

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Objective• To compare tumour control and toxicity outcomes with the use of high-dose intensity-modulated radiation therapy (IMRT) alone or brachytherapy combined with IMRT (combo-RT) for patients with intermediate-risk prostate cancer. Patients and Methods• Between 1997 and 2010, 870 consecutive patients with intermediate-risk prostate cancer were treated at our institution with either 86.4 Gy of IMRT alone (n = 470) or combo-RT consisting of brachytherapy combined with 50.4 Gy of IMRT (n = 400).• Brachytherapy consisted of low-dose-rate permanent interstitial implantation in 260 patients and high-dose-rate temporary implantation in 140 patients.• The median (range) follow-up for the entire cohort was 5.3(1-14) years. Results• For IMRT alone vs combo-RT, 7-year actuarial prostate-specific antigen (PSA)-relapse-free survival (PSA-RFS) rates were 81.4 vs 92.0% (P < 0.001), and distant metastases-free survival (DMFS) rates were 93.0 vs 97.2% (P = 0.04), respectively. • A higher incidence of acute genitourinary (GU) grade 2 (35.8 vs 18.9%; P < 0.01) and acute GU grade 3 (2.3 vs 0.4%; P = 0.03) toxicities occurred in the combo-RT group than in the IMRT-alone group. Most acute toxicity resolved. Late toxicity outcomes were similar between the treatment groups. The 7-year actuarial late toxicity rates for grade 2 gastrointestinal (GI) toxicity were 4.6 vs 4.1% (P = 0.89), for grade 3 GI toxicity 0.4 vs 1.4% (P = 0.36), for grade 2 GU toxicity 19.4 vs 21.2% (P = 0.14), and grade 3 GU toxicity 3.1 vs 1.4% (P = 0.74) for the IMRT vs the combo-RT group, respectively. Conclusions• Enhanced dose escalation using combo-RT was associated with superior PSA-RFS and DMFS outcomes for patients with intermediate-risk prostate cancer compared with high-dose IMRT alone at a dose of 86.4 Gy.• While acute GU toxicities were more prevalent in the combo-RT group, the incidence of late GI and GU toxicities was similar between the treatment groups.

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Section: Discussioncontrasting

confidence: 58%

Comparison of high‐dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate‐risk prostate cancer

et al. 2014

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“…This is especially clear when compared to the benefit that higher doses with brachytherapy alone (or as a boost) can provide for men with unfavorable risk intermediate-risk prostate cancer, who are more likely to have larger tumors as shown by this study. This hypothesis is supported by a study comparing doseescalated radiotherapy with external beam alone to doseescalation with a high-dose-rate brachytherapy boost for men with intermediate-risk disease, which showed improved disease-free survival and overall survival for brachytherapy patients (20). Men with >50% cores positive, perineural invasion, or cT2b-c disease had a superior 5-year biochemical control of 96% when treated with a brachytherapy boost compared to 87% when treated with dose-escalated external beam radiotherapy alone.…”

Section: Resultsmentioning

confidence: 88%

Imaging and Pathology Correlations for Different Risk Stratification Models for Intermediate-risk Prostate Cancer

Ellis-Caleo

Hegde

Batth

et al. 2017

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“…8 With acceptable biologic effective dose, 17 biochemical failure-free survival for low-risk prostate cancer was >95% while treated with HDR as monotherapy [18][19][20][21][22] ; biochemical failure-free survival for intermediate-and high-risk prostate cancer was 81% to 98% and 66% to 94% while treated with HDR as a boost, respectively. [23][24][25][26][27][28][29][30][31][32][33][34] The incidence of late grade 3 or higher GU and GI toxicity was 0% to 14% and 0% to 4%, respectively. More recently, Astrom beam radiation and HDR boost.…”

Section: Discussionmentioning

confidence: 98%

Building a High-Dose-Rate Prostate Brachytherapy Program With Real-Time Ultrasound-Based Planning: Initial Safety, Quality, and Outcome Results

Zhang

Kang

Ali

et al. 2020

Advances in Radiation Oncology

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Purpose: Growing evidence supports the efficacy and safety of high-dose-rate (HDR) brachytherapy as a boost or monotherapy in prostate cancer treatment. We initiated a new HDR prostate brachytherapy practice in April 2014. Here, we report the learning experiences, short-term safety, quality, and outcome. Methods and Materials: From April 2014 to December 2017, 164 men were treated with HDR brachytherapy with curative intent. Twenty-eight men (17.1%) underwent HDR brachytherapy as monotherapy, receiving 25 to 27 Gy in 2 fractions. Men treated with HDR brachytherapy as a boost received 19 to 21 Gy in 2 fractions. Fifty-two men (31.7%) had high-risk disease. HDR procedure times, dosimetry, and response were recorded and analyzed. Genitourinary (GU) and gastrointestinal (GI) toxicities were recorded according to the toxicity criteria of the Radiation Therapy Oncology Group. Results: Mean HDR procedure times decreased yearly from 179 minutes in 2014 to 115 minutes in 2017. Median follow-up was 18.6 months (range, 3-55 months). At last review, 79% of patients reported returning to baseline GU status, and 100% of patients noted no change in GI status from their baseline. Four patients experienced acute urinary retention. Treatment planning target volume (PTV) was defined as prostate with margins. Dosimetrically, 97.5% of all HDR implants had PTV D90 100%, 81.5% had PTV V100 95%, 73.6% had maximal urethral doses 120%, and 77.5% had rectal 1 mL dose 70% (all but one 10.8 Gy). The estimated 3-year overall survival was 98.7% (95% confidence interval, 91.4%-99.8%), and disease-free survival was 96.2% (95% confidence interval, 89.5%-98.7%). Conclusions: The low incidence of GU and GI complications in our cohort demonstrates that a HDR brachytherapy program can be successfully developed as a treatment option for patients with localized prostate cancer.

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Comparison of dose-escalated, image-guided radiotherapy vs. dose-escalated, high-dose-rate brachytherapy boost in a modern cohort of intermediate-risk prostate cancer patients

Cited by 21 publications

References 22 publications

Comparison of high‐dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate‐risk prostate cancer

Comparison of high‐dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate‐risk prostate cancer

Imaging and Pathology Correlations for Different Risk Stratification Models for Intermediate-risk Prostate Cancer

Building a High-Dose-Rate Prostate Brachytherapy Program With Real-Time Ultrasound-Based Planning: Initial Safety, Quality, and Outcome Results

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