Genitourinary Toxicity After High-Dose-Rate (HDR) Brachytherapy Combined With Hypofractionated External Beam Radiotherapy for Localized Prostate Cancer: An Analysis to Determine the Correlation Between Dose–Volume Histogram Parameters in HDR Brachytherapy and Severity of Toxicity

Ishiyama, Hiromichi; Kitano, Masashi; Satoh, Takefumi; Kotani, Shouko; Uemae, Mineko; Matsumoto, Kazumasa; Okusa, Hiroshi; Tabata, Ken‐ichi; Baba, Shirō; Hayakawa, Kazushige

doi:10.1016/j.ijrobp.2008.11.006

Cited by 38 publications

(20 citation statements)

References 28 publications

(30 reference statements)

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“…In addition, hypofractionated radiotherapy may prove advantageous for treating prostate cancer when compared with other types of cancer, because of the low α:β ratio [5]. We have been treating prostate cancer patients with HDR brachytherapy combined with hypofractionated EBRT using a fractional dose of 3 Gy administered five times per week [6]. …”

Section: Introductionmentioning

confidence: 99%

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

Ishiyama

Satoh

Kitano

et al. 2013

Journal of Radiation Research

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The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25–94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach.

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Section: Introductionmentioning

confidence: 99%

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

Ishiyama

Satoh

Kitano

et al. 2013

Journal of Radiation Research

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“…Increasing urethral dose is assumed to be associated with increasing complications (15,16), but the steepness of the dose response, the volume effects, and the relative sensitivity of particular sections of the urinary tract are not clearly understood. Several authors have suggested dose limits, but these are inconsistent, whereas others have not found a clear dose response (17,18).…”

Section: Discussionmentioning

confidence: 99%

Clinical Trials of a Urethral Dose Measurement System in Brachytherapy Using Scintillation Detectors

Suchowerska

Jackson

Lambert

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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“…As a result, we have been treating prostate cancer patients with high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiotherapy since 1999 [1, 2]. The dosimetric accuracy of HDR brachytherapy relies on catheter positions being accurately reproduced to match the original positions in the planning CT dataset for all fractions of treatment.…”

Section: Purposementioning

confidence: 99%

“…This may lead to not only a significant risk of under-dosage at the target, but also over-dosage to the organs at risk. Several studies have demonstrated urethral stricture as the predominant late urinary toxicity of prostate HDR brachytherapy [2, 11]. With significant caudal displacement, a high dose is likely to be erroneously delivered to the bulbo-membranous urethra.…”

Section: Purposementioning

confidence: 99%

Catheter displacement prior to the delivery of high-dose-rate brachytherapy in the treatment of prostate cancer patients

Kawakami

Ishiyama

Terazaki

et al. 2014

jcb

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PurposeThe purpose of this work was to report measured catheter displacement prior to the delivery of high-dose-rate brachytherapy (HDR) in the treatment of prostate cancer.Material and methodsData from 30 prostate cancer patients treated with HDR brachytherapy were analyzed retrospectively. Eighteen transperineal hollow catheters were inserted under transrectal ultrasound guidance. Gold marker seeds were also placed transperineally into the base and apex of the prostate gland. Five treatment fractions of 7.5 Gy each were administered over 3 days. The patient underwent CT scanning prior to each treatment fraction. Catheter displacement was measured from the pre-treatment CT dataset reconstructed at 1.25 mm slice thickness.ResultsMost of catheters were displaced in the caudal direction. Variations of 18 catheters for each patient were small (standard deviations < 1 mm for all but one patient). Mean displacements relative to the apex marker were 6 ± 4 mm, 12 ± 6 mm, 12 ± 6 mm, 12 ± 6 mm, and 12 ± 6 mm from plan to 1st, 2nd, 3rd, 4th, and 5th fractions, respectively.ConclusionsOur results indicate that catheter positions must be confirmed and if required, adjusted, prior to every treatment fraction for the precise treatment delivery of HDR brachytherapy, and to potentially reduce over-dosage to the bulbo-membranous urethra.

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Genitourinary Toxicity After High-Dose-Rate (HDR) Brachytherapy Combined With Hypofractionated External Beam Radiotherapy for Localized Prostate Cancer: An Analysis to Determine the Correlation Between Dose–Volume Histogram Parameters in HDR Brachytherapy and Severity of Toxicity

Cited by 38 publications

References 28 publications

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

Clinical Trials of a Urethral Dose Measurement System in Brachytherapy Using Scintillation Detectors

Catheter displacement prior to the delivery of high-dose-rate brachytherapy in the treatment of prostate cancer patients

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