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

Abstract

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.

Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis

“…It has been reported that the combination of ADT with RT improves results of high-risk PCa treatment [29]. In our multivariate meta-regression analysis, we found that the reported percent of patients on ADT was not associated with urethral strictures.…”

High‐dose‐rate brachytherapy and hypofractionated external beam radiotherapy combined with long‐term androgen deprivation therapy for very high‐risk prostate cancer

“…The 5-year biochemical control and overall survival rates were 90.6% (HR 97.8%, VHR 81.9%) and 96.9% (HR 100%, VHR 93.3%), respectively. 18 In a multivariate analysis that examined the independent contribution of each component of the VHR criteria with oncological outcomes, primary Gleason pattern 5 was associated with increased risks of BF and DM. Increasing evidence has suggested that, among HR groups, Gleason score 9-10 disease defines a particularly aggressive natural history with worse outcomes.…”

“…Additional needles were placed into the base of the seminal vesicles in all clinical stages. The average number of needles implanted was 17 (range [12][13][14][15][16][17][18]. In the longitudinal section, the tip of the needle was advanced within the bladder lumen with the aim of preventing the interfractional displacement of implant needles in the caudal direction, which was caused by edema and/or hematoma of the prostate, periprostatic and perineal tissues (Fig.…”

Perioperative search for circulating tumor cells in patients undergoing prostate brachytherapy for clinically nonmetastatic prostate cancer

“…Low-dose-rate (LDR) brachytherapy provides superior outcomes in patients with low-and intermediate-risk diseases [1,2]. The combination of high-dose-rate (HDR) brachytherapy and external irradiation is an effective treatment for delivering radiation doses more precisely in prostate cancer, even if patients have extracapsular invasion and seminal vesicle invasion [3][4][5]. Technical modifications for prostate brachytherapy are being developed to obtain the better treatment outcome [2,[7][8][9][10].…”

“…Technical modifications for prostate brachytherapy are being developed to obtain the better treatment outcome [2,[7][8][9][10]. However, approximately 5%-20% of those patients, as it now stands, show recurrence within 5 years after brachytherapy [1,2,5,11,12].…”