High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results

Prada, Pedro J.; Cardenal, Juan; Blanco, Ana; Anchuelo, J.; Ferri, María; Fernández, Gerónimo; Arrojo, Elisabeth E.; Vázquez, Andrés; Pacheco, Maite; Fernández, José M.

doi:10.1016/j.radonc.2016.04.006

Cited by 97 publications

(71 citation statements)

References 16 publications

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“…It remains to be seen whether a single dose of 19 Gy will provide adequate long‐term PSA control with mixed results being reported to date by Prada et al . and Krauss et al …”

Section: Discussionmentioning

confidence: 94%

“…In summary, the existing data do not demonstrate significant differences in acute toxicities when delivering more than 1 fraction of HDR but perhaps an improved urinary toxicity profile when delivering just a single fraction of 19 Gy. It remains to be seen whether a single dose of 19 Gy will provide adequate long-term PSA control with mixed results being reported to date by Prada et al and Krauss et al 15,16 There are more limited data in terms of correlations between genitourinary toxicities and dosimetry following HDR brachytherapy. The American College of Radiology Appropriateness Criteria for HDR brachytherapy does not list any recommended dosimetric constraints.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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Introduction: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy 9 6-fractions and 35 men had 13.5 Gy 9 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse shortterm acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

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“…It remains to be seen whether a single dose of 19 Gy will provide adequate long‐term PSA control with mixed results being reported to date by Prada et al . and Krauss et al …”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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“…Such type of effort has already been attempted with HDR-BT. Recently, Prada et al [13] reported a relatively disappointing 66% 6-year bRFS survival though a very good tolerance after a single interstitial application of 19 Gy to the prostate. Reasons for this suboptimal result may be related, for instance, to a suboptimal dose-distribution with HDR-BT compared to SBRT.…”

Section: Introductionmentioning

confidence: 99%

ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial

et al. 2018

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BackgroundStereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, question of how far can the number of fractions with SBRT be reduced is a challenging research matter. As already explored by some authors in the context of brachytherapy, monotherapy appears to be feasible with an acceptable toxicity profile and a promising outcome. The aim of this multicenter phase I/II prospective trialis to demonstrate early evidence of safety and efficacy of a single-fraction SBRT approach for the treatment of localized disease.MethodsPatients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone will be treated with a single SBRT fraction of 19 Gy to the whole prostate gland with urethra-sparing (17 Gy). Intrafractional motion will be monitored with intraprostatic electromagnetic transponders. The primary endpoint of the phase I part of the study will be safety as assessed by CTCAE 4.03 grading scale, while biochemical relapse-free survival will be the endpoint for the phase II. The secondary endpoints include acute and late toxicity, quality of life, progression-free survival, and prostate-cancer specific survival.DiscussionThis is the first multicenter phase I/II trial assessing the efficacy and safety of a single-dose SBRT treatment for patients with localized prostate cancer. If positive, results of ONE SHOT may help to design subsequent phase III trials exploring the role of SBRT monotherapy in the exclusive radiotherapy treatment of localized disease.Trial registrationClinicaltrials.gov identifier: NCT03294889; Registered 27 September 2017.

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“…It is uncertain what the optimum dose/fractionation schedule is for focal salvage HDR brachytherapy. In the primary disease setting, there is concern that HDR monotherapy using 19 Gy in a single fraction provides insufficient disease control in comparison to fractionated regimens such as 27 Gy in 2 fractions [8,[52][53][54]. Despite its convenience, there has to be concern that single fraction treatments could also be inadequate in the setting of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer

Slevin

Hodgson

Rodda

et al. 2020

Clinical and Translational Radiation Oncology

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Introduction: Isolated local recurrence of prostate cancer following primary radiotherapy or brachytherapy may be treated with focal salvage high dose rate brachytherapy, although there remains an absence of high quality evidence to support this approach. Methods: Men with prostate cancer treated consecutively between 2015 and 2018 using 19 Gy in a single fraction high dose rate brachytherapy (HDR) for locally recurrent prostate cancer were identified from an institutional database. Univariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS). Results: 43 patients were eligible for evaluation. Median follow up duration was 26 months (range 1-60). Median bPFS was 35 months (95% confidence interval 25.6-44.4). Kaplan-Meier estimates for bPFS at 1, 2 and 3 years post salvage were 95.2%, 70.6% and 41.8% respectively. On univariable Cox regression analysis, only nadir PSA was significantly associated with bPFS although the majority of patients were also treated with androgen deprivation therapy. Only one late grade 3 genitourinary toxicity was observed. Conclusion: Focal salvage HDR brachytherapy may provide good biochemical control with a low risk of severe toxicity. Further evaluation within clinical trials are needed to establish its role in the management of locally recurrent prostate cancer.

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High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results

Cited by 97 publications

References 16 publications

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial

Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer

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