High-dose-rate interstitial brachytherapy as monotherapy in one fraction of 20.5 Gy for the treatment of localized prostate cancer: Toxicity and 6-year biochemical results

Prada, Pedro J.; Ferri, María; Cardenal, Juan; Blanco, Ana; Anchuelo, J.; Cerio, I. Diaz de; Vázquez, Andrés; Pacheco, Maite; Raba, Ignacio; Ruiz, Samuel

doi:10.1016/j.brachy.2018.06.002

Cited by 43 publications

(38 citation statements)

References 18 publications

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“…This high α/β explains why the single fraction schemes have not produced the clinical results expected from the LQ model, when the α/β determined for low doses per fraction is considered [13,14]. In this case, relatively high EQD 2 , calculated with low values of α/β, produce modest BC probabilities (see Figure 2).…”

Section: Discussionmentioning

confidence: 97%

“…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.…”

Section: Purposementioning

confidence: 97%

“…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.…”

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

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

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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Purpose: Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. Material and methods: Published HDR-BT clinical results for low-and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. Results: We obtained a value of α/β = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. Conclusions: The α/β obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/β explains reasonably well the data available in the region of high doses per fraction considered.

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Section: Discussionmentioning

confidence: 97%

Section: Purposementioning

confidence: 97%

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

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

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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“…Originally, low-dose-rate brachytherapy (using iodine-125 seeds) was mainly used for low- to intermediate-risk patients. Currently, there is an increase in the treatment of higher-risk disease with high-dose-rate brachytherapy, providing comparable cancer control rates to other primary treatments [11,12,13]. As compared to iodine-125 seeds, high-dose-rate brachytherapy offers the advantage of higher dose control via the approach of adjusting source dwell times and positions.…”

Section: Whole-gland Primary Radiotherapymentioning

confidence: 99%

“…As compared to iodine-125 seeds, high-dose-rate brachytherapy offers the advantage of higher dose control via the approach of adjusting source dwell times and positions. The steep dose decline of brachytherapy makes it possible to further escalate the dose to the tumor, without compromising the dose constraints for the organs at risk [13]. This feature can also be used to deliver a concurrent tumor boost next to whole-gland EBRT techniques, thereby further increasing the therapeutic efficacy for intermediate- to high-risk disease [14].…”

Section: Whole-gland Primary Radiotherapymentioning

confidence: 99%

Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives

Son

Peters

Moerland

et al. 2018

Cancers

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Over the last decades, primary prostate cancer radiotherapy saw improving developments, such as more conformal dose administration and hypofractionated treatment regimens. Still, prostate cancer recurrences after whole-gland radiotherapy remain common, especially in patients with intermediate- to high-risk disease. The vast majority of these patients are treated palliatively with androgen deprivation therapy (ADT), which exposes them to harmful side-effects and is only effective for a limited amount of time. For patients with a localized recurrent tumor and no signs of metastatic disease, local treatment with curative intent seems more rational. However, whole-gland salvage treatments such as salvage radiotherapy or salvage prostatectomy are associated with significant toxicity and are, therefore, uncommonly performed. Treatments that are solely aimed at the recurrent tumor itself, thereby better sparing the surrounding organs at risk, potentially provide a safer salvage treatment option in terms of toxicity. To achieve such tumor-targeted treatment, imaging developments have made it possible to better exclude metastatic disease and accurately discriminate the tumor. Currently, focal salvage treatment is being performed with different modalities, including brachytherapy, cryotherapy, high-intensity focused ultrasound (HIFU), and stereotactic body radiation therapy (SBRT). Oncologic outcomes seem comparable to whole-gland salvage series, but with much lower toxicity rates. In terms of oncologic control, these results will improve further with better understanding of patient selection. Other developments, such as high-field diagnostic MRI and live adaptive MRI-guided radiotherapy, will further improve precision of the treatment.

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Single-Dose Radiotherapy for Prostate Cancer—Lessons Learned From Single-Fraction High-Dose-Rate Brachytherapy

Squires

Krauss

2021

JAMA Oncol

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High-dose-rate interstitial brachytherapy as monotherapy in one fraction of 20.5 Gy for the treatment of localized prostate cancer: Toxicity and 6-year biochemical results

Cited by 43 publications

References 18 publications

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

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

Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives

Single-Dose Radiotherapy for Prostate Cancer—Lessons Learned From Single-Fraction High-Dose-Rate Brachytherapy

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