Five-Year Outcomes of a Single-Institution Prospective Trial of 19-Gy Single-Fraction High-Dose-Rate Brachytherapy for Low- and Intermediate-Risk Prostate Cancer

Siddiqui, Z.A.; Gustafson, Gary; Ye, Hong; Martínez, Álvaro; Mitchell, Beth; Sebastian, Evelyn; Limbacher, Amy; Krauss, Daniel

doi:10.1016/j.ijrobp.2019.02.010

Cited by 52 publications

(42 citation statements)

References 21 publications

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“…Gastrointestinal and genitourinary toxicities in these studies were generally mild, with toxicities greater than grade 2 (variously according to RTOG and CTCAE criteria) very rarely observed. Whilst single fraction OAR dosimetric constraints are well-tolerated, evidence published since initiating the present study has shown poorer efficacy for a single dose of 19 Gy to the prostate, particularly for intermediate-and high-risk patients [11,12], therefore is not currently recommended for clinical implementation. We posit that the dosimetric constraints utilised in the present study for two fraction prostate SBRT are well-supported by the available clinical evidence and represent a suitable framework for future clinical trials.…”

Section: Discussionmentioning

confidence: 92%

“…As such, we propose that these two structures are propagated to the daily MR from imaging data previously delineated, via soft-tissue based rigid registration. Single HDR treatments have been proven to result in poorer biochemical relapse-free survival than would be achieved with standard fractionation [11,12]. Therefore, at present, single fraction SBRT no longer presents a promising line of study.…”

Section: Discussionmentioning

confidence: 99%

“…Single HDR treatments have been proven to result in poorer biochemical relapse-free survival than would be achieved with standard fractionation [11] , [12] . Therefore, at present, single fraction SBRT no longer presents a promising line of study.…”

Section: Discussionmentioning

confidence: 99%

“…More extreme hypofractionation has been tested with high dose rate (HDR) brachytherapy, down to 3, 2 or even a single fraction [7] , [8] , [9] with limited experience with similar fractionations delivered with external beam radiotherapy [10] . However, recently reported poor PSA control rates with single fraction HDR have significantly tempered enthusiasm for this approach [11] , [12] , [13] .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Mohajer

Dunlop

Mitchell

et al. 2021

Clinical and Translational Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Mohajer

Dunlop

Mitchell

et al. 2021

Clinical and Translational Radiation Oncology

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“…It is uncertain what the optimum dose/fractionation schedule is for focal salvage HDR brachytherapy. In the primary disease setting, there is concern that HDR monotherapy using 19 Gy in a single fraction provides insufficient disease control in comparison to fractionated regimens such as 27 Gy in 2 fractions [8,[52][53][54]. Despite its convenience, there has to be concern that single fraction treatments could also be inadequate in the setting of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer

Slevin

Hodgson

Rodda

et al. 2020

Clinical and Translational Radiation Oncology

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Introduction: Isolated local recurrence of prostate cancer following primary radiotherapy or brachytherapy may be treated with focal salvage high dose rate brachytherapy, although there remains an absence of high quality evidence to support this approach. Methods: Men with prostate cancer treated consecutively between 2015 and 2018 using 19 Gy in a single fraction high dose rate brachytherapy (HDR) for locally recurrent prostate cancer were identified from an institutional database. Univariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS). Results: 43 patients were eligible for evaluation. Median follow up duration was 26 months (range 1-60). Median bPFS was 35 months (95% confidence interval 25.6-44.4). Kaplan-Meier estimates for bPFS at 1, 2 and 3 years post salvage were 95.2%, 70.6% and 41.8% respectively. On univariable Cox regression analysis, only nadir PSA was significantly associated with bPFS although the majority of patients were also treated with androgen deprivation therapy. Only one late grade 3 genitourinary toxicity was observed. Conclusion: Focal salvage HDR brachytherapy may provide good biochemical control with a low risk of severe toxicity. Further evaluation within clinical trials are needed to establish its role in the management of locally recurrent prostate cancer.

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High‐dose‐rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome

et al. 2021

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Background: High-dose-rate brachytherapy (HDR BRT) has been enjoying rapid acceptance as a treatment modality offered to selected prostate cancer patients devoid of risk group, employed either in monotherapy setting or combined with external beam radiation therapy (EBRT) and is currently one of the most active clinical research areas.Recent findings: This review encompasses all the current evidence to support the use of HDR BRT in various clinical scenario and shines light to the HDR BRT rationale, as an ultimately conformal dose delivery method enabling safe dose escalation to the prostate. Conclusion:Valid long-term data, both in regard to the oncologic outcomes and toxicity profile, support the current clinical indication spectrum of HDR BRT. At the same time, this serves as solid, rigid ground for emerging therapeutic applications, allowing the technique to remain in the spotlight alongside stereotactic radiosurgery.

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Five-Year Outcomes of a Single-Institution Prospective Trial of 19-Gy Single-Fraction High-Dose-Rate Brachytherapy for Low- and Intermediate-Risk Prostate Cancer

Cited by 52 publications

References 21 publications

Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer

High‐dose‐rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome

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