High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients

Abstract

BackgroundTo report the clinical outcome of high dose rate brachytherapy as sole treatment for clinically localised prostate cancer.MethodsBetween March 2004 and January 2008, a total of 351 consecutive patients with clinically localised prostate cancer were treated with transrectal ultrasound guided high dose rate brachytherapy. The prescribed dose was 38.0 Gy in four fractions (two implants of two fractions each of 9.5 Gy with an interval of 14 days between the implants) delivered to an intraoperative transrectal ultrasound real-time defined planning treatment volume. Biochemical failure was defined according to the Phoenix Consensus and toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 3.ResultsThe median follow-up time was 59.3 months. The 36 and 60 month biochemical control and metastasis-free survival rates were respectively 98%, 94% and 99%, 98%. Toxicity was scored per event with 4.8% acute Grade 3 genitourinary and no acute Grade 3 gastrointestinal toxicity. Late Grade 3 genitourinary and gastrointestinal toxicity were respectively 3.4% and 1.4%. No instances of Grade 4 or greater acute or late adverse events were reported.ConclusionsOur results confirm high dose rate brachytherapy as safe and effective monotherapy for clinically organ-confined prostate cancer.

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

“…In general, most HDR studies (87,97,110–114), found no benefit to addition of ADT. The preliminary results of the Spanish HDR RCT reported no benefit to ADT (119).…”

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

“…Mavroidis et al [9] estimated the dose of that single fraction and found that a dose between 19.2 and 19.7 Gy is required to produce a tumor control equal to or greater than that of a scheme with 4 fractions, 9.5 Gy each, specifically 95.9% to 97.8% vs. 93.5% to 97.8%. However, for the latter scheme, a biochemical control probability (BC) at 5 years between 91% and 97% was obtained for low-and intermediate-risk patients [10,11,12], while for the same groups of patients, 66 ±6% and 82 ±3%, both at 95% confidence interval (CI) for single doses of 19.0 Gy [13] and 20.5 Gy [14], respectively, were found.…”

“…Studies involving high-risk patients were considered only if BC was applied for low-or intermediate-risk patients, separately. Table 1 summarizes characteristics of the 13 clinical studies [10,11,12,13,14,19,20,21,22,23,24,25,26] verifying the conditions mentioned above. They include 16 different fractionation schedules, with a number of fractions varying between 1 and 9, for a total of 22 empirical data sets.…”

A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer

“…Globally there has been an observed decline in brachytherapy, specifically in population‐based studies in the USA , including an estimate from a peak of 31.7% to 11.1% in one study , and from 17% in 2002 to a low of 8% in 2010 . From an efficacy perspective, several clinical studies have shown excellent long‐term biochemical disease control rates for both LDR brachytherapy and HDR brachytherapy, with brachytherapy shown to be as effective as surgery . The reduced brachytherapy use observed in the present study probably reflects variation in funding and expertise for brachytherapy uptake and decentralization of radiation services as well as wider use of EBRT with intensity‐modulated RT .…”