Hemi-gland focal low dose rate prostate brachytherapy: An analysis of dosimetric outcomes

Laing, Robert; Franklin, A.; Uribe, Jennifer; Horton, Alex; Uribe-Lewis, Santiago; Langley, Stephen

doi:10.1016/j.radonc.2016.09.014

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…Four studies (4.8%) related to preclinical research (IDEAL phase 0). The 43 remaining original research studies that applied IDEAL were mapped to the corresponding IDEAL stage: IDEAL with nine (20.9%), 27 (62.8%), four (9.3%), 0 (0%), and three (7.0%) publications, respectively .…”

Section: Resultsmentioning

confidence: 99%

Use of the IDEAL framework in the urological literature: where are we in 2018?

2019

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ObjectivesTo assess uptake and application of the IDEAL principles in original surgical procedure-or device-related clinical research studies, as well as its reported relevance as characterized by secondary publications, editorials and reviews. ConclusionsThe IDEAL framework has found widespread adoption in the urology literature as witnessed by a large number of original manuscripts and secondary publications citing IDEAL; however, its application is largely limited to the early stages of surgical innovation, frequently with inappropriate and incomplete implementation. Further efforts are needed to guide investigators in the optimal use of the IDEAL framework as it relates to surgical innovation in urology.Abbreviation: IQR, interquartile range.

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Section: Resultsmentioning

confidence: 99%

Use of the IDEAL framework in the urological literature: where are we in 2018?

2019

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“…The divergent behaviour in PSA kinetics between temperature‐based ablative therapies and PB may be explained by their mechanism of action. 125 I seed implants deliver 87.5% of radiation energy from isotope decay in the first 6 months and the ‘untreated’ HG also receives a (reduced) radiation dose . Theoretically, temperature‐based therapies are not expected to affect the untreated HG.…”

Section: Discussionmentioning

confidence: 99%

“…A median (interquartile range [IQR]) of 54 (48–60) 125 I seeds were implanted per patient with a median (IQR) source activity of 0.533 (0.533–0.538) U. The dosimetric approach aimed to treat the entire affected HG even if some seeds were implanted in the contralateral side to ensure optimal dosimetry . The procedure took ~40 min and post‐implant dosimetry was obtained within the next 18 h by a CT scan.…”

Section: Methodsmentioning

confidence: 99%

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Langley¹,

Uribe²,

Uribe-Lewis³

et al. 2019

BJU International

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Objectives To report clinical outcomes of the Hemi‐Ablative Prostate Brachytherapy (HAPpy) trial evaluating treatment‐related toxicity and effectiveness of hemi‐gland (HG) low‐dose‐rate (LDR) prostate brachytherapy as a focal approach to control unilateral localised prostate cancer. Patients and Methods Single institution phase IIS pilot study of patients treated with focal 4D Brachytherapy™ (BXTAccelyon, Burnham, Buckinghamshire, UK). The primary outcome was patient‐reported toxicity 24 months after implant. The secondary outcome was assessment of disease control. Outcomes in HG patients were compared to whole‐gland (WG) controls obtained from our prospective cohort registry by negative binomial and linear regression models. Results Pre‐treatment demography was similar between the 30 HG patients and 362 WG controls. Post‐implant dosimetry was similar for the prostate gland target volumes and significantly reduced for the urethra and bowel in HG patients relative to WG controls, but this did not translate into a difference in post‐implant mean symptom scores between the two groups. Nevertheless, the change in score from baseline indicated that the impact on pre‐treatment symptom status was less after HG implants. Only HG patients showed a return to baseline urinary scores as early as 12 months. Sexual potency was conserved in 73% and 67% of HG and WG patients, respectively (P = 0.84). Post‐implant prostate‐specific antigen (PSA) kinetics revealed that baseline PSA was reduced at 24 months by 78% and 88% in HG and WG patients, respectively (P < 0.05). Treatment relapse occurred in one (3%) HG patient 55 months after implant and in nine (3%) WG patients at 32–67 months after implant. Conclusion This pilot study suggests that treatment‐related toxicity and biochemical outcomes after HG implants are broadly similar to those observed with WG treatment despite the lower dose delivered by HG implants.

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“…There is also some early interest in mpMRI imaging to guide focal brachytherapy, with implants delivering dose to only the visible tumor lesion or involved hemi-gland, as a means to minimize treatment-related toxicity ( 14 ). While early reports of these treatments suggest they are technically feasible and can reduce doses to nearby organs at risk, their long-term oncologic efficacy remains unproven ( 120 - 122 ).…”

Section: New Developments In Ldr Prostate Brachytherapymentioning

confidence: 99%

Low dose rate prostate brachytherapy

Stish¹,

Davis²,

Mynderse³

et al. 2018

Transl. Androl. Urol.

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Low dose rate (LDR) prostate brachytherapy is an evidence based radiation technique with excellent oncologic outcomes. By utilizing direct image guidance for radioactive source placement, LDR brachytherapy provides superior radiation dose escalation and conformality compared to external beam radiation therapy (EBRT). With this level of precision, late grade 3 or 4 genitourinary or gastrointestinal toxicity rates are typically between 1% and 4%. Furthermore, when performed as a same day surgical procedure, this technique provides a cost effective and convenient strategy. A large body of literature with robust follow-up has led multiple expert consensus groups to endorse the use of LDR brachytherapy as an appropriate management option for all risk groups of non-metastatic prostate cancer. LDR brachytherapy is often effective when delivered as a monotherapy, although for some patients with intermediate or high-risk disease, optimal outcome are achieved in combination with supplemental EBRT and/or androgen deprivation therapy (ADT). In addition to reviewing technical aspects and reported clinical outcomes of LDR prostate brachytherapy, this article will focus on the considerations related to appropriate patient selection and other aspects of its use in the treatment of prostate cancer.

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Hemi-gland focal low dose rate prostate brachytherapy: An analysis of dosimetric outcomes

Cited by 17 publications

References 22 publications

Use of the IDEAL framework in the urological literature: where are we in 2018?

Use of the IDEAL framework in the urological literature: where are we in 2018?

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Low dose rate prostate brachytherapy

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