Long‐term outcomes of high‐dose‐rate brachytherapy for intermediate‐ and high‐risk prostate cancer with a median follow‐up of 10 years

Yaxley, John; Lah, Kevin; Yaxley, Julian; Gardiner, Robert A.; Samaratunga, Hemamali; MacKean, James

doi:10.1111/bju.13659

Cited by 27 publications

(15 citation statements)

References 21 publications

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“…Similarly our urethral stricture rate of 4.2% was in keeping with a recent review that reported crude rates from 0–14% . However, our rates were significantly lower than other Australian studies, which we attribute to three strategies. First, the precise placement of a gold fiducial marker at the very apex of the prostate under transrectal ultrasound control significantly improved the accurate delineation of the prostatic apex on CT imaging.…”

Section: Discussionsupporting

confidence: 91%

“…This preventative strategy widened the prostatic urethral channel and reduced the risk of subsequent urethral strictures. 12 A prior mini TURP did not increase the risk of acute or late GU toxicity in the 14 patients who underwent the procedure. The rate of late Grade 1 or greater GU toxicity was higher in the TURP cohort compared to the non-TURP cohort but this was not significant (61.5% vs. 41.5%, P = 0.18).…”

Section: Discussionmentioning

confidence: 83%

“…Finally, 14 men (15%) underwent a mini TURP before receiving HDR‐BT because of bladder outlet obstruction. This preventative strategy widened the prostatic urethral channel and reduced the risk of subsequent urethral strictures …”

Section: Discussionmentioning

confidence: 99%

“…Vigneault11 reported on the effects of various EBRT (36-44 Gy in 12-25 fractions) Australian studies. In Yaxley et al,12 the authors reported on the effects of EBRT and HDR-BT with ADT in 507 men with prostate cancer. With a followup rate of 10.3 years, the incidence of no biochemical evidence of disease (bNED) for men with intermediate and high risk disease were 93.3% and 74.2% respectively, at 5 years and 86.9% and 56.1% respectively, at 10 years.…”

mentioning

confidence: 99%

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High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

et al. 2019

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Introduction To examine the long‐term outcomes of high dose rate brachytherapy boost (HDR‐BT) combined with external beam radiotherapy (EBRT) for intermediate and high‐risk prostate cancer patients. Methods Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR‐BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results A total of 24 patients received an initial HDR‐BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow‐up was 58 months. The 5‐year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion The combined HDR‐BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre‐emptive TURP and/or HS insertion.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

et al. 2019

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“…В исследованиях из Японии [40,41], Испании [42,43], Австралии [44] была отмечена высокая эффектив-ОНКОУРОЛОГИЯ 1'2017 ТОМ 13 CANCER UROLOGY 1'2017 VOL. 13 Диагностика и лечение опухолей мочеполовой системы.…”

Section: оценка риска прогрессированияunclassified

Combined chemohormonalradiation treatment of highand very-high-risk non-metastatic prostate cancer

Каприн¹,

Троянов²,

Иванов³

et al. 2017

Cancer Urology

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Диагностика и лечение опухолей мочеполовой системы. Рак предстательной железы Комплексное гормонохимиолучевое лечение больных неметастатическим раком предстательной железы группы высокого и очень высокого риска прогрессирования А.Д. Каприн, А.В. Троянов, С.А. Иванов, О.Б. Карякин Медицинский радиологический научный центр им А.Ф. Цыба -филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава России; Россия, 249031 Обнинск, ул. Королева, 4 Контакты: Алексей Владимирович Троянов alex_troy@mail.ru Введение. Лечение больных раком предстательной железы (РПЖ) группы высокого и очень высокого риска прогрессирования представляет большую сложность. Лучевая терапия в сочетании с длительной гормональной терапией (ГТ) играет ключевую роль, однако низкая эффективность лечения по сравнению с таковой в группе пациентов промежуточного и низкого риска прогрессирования вынуждает искать новые лечебные алгоритмы и подходы. Цель работы -анализ существующих публикаций и обзоров касательно комплексного лечения как с включением химиотерапии, так и без него, а также различных видов лучевой терапии. Оценка риска прогрессирования. Системы классификации и оценки риска прогрессирования предложены различными организациями (NCCN, NICE, ESMO, AUA, EAU и др.). Система классификации NCCN включает группу очень высокого риска (Т3b-4). В настоящее время принадлежность к группе высокого риска (EAU) определяется при стадии ≥ T2c, или при уровне простатического специфического антигена > 20 нг/мл, или при сумме баллов по шкале Глисона 8-10. Лучевая терапия. Рекомендованная доза облучения составляет ≥ 74 Гр вне зависимости от группы риска. Низкий уровень 10-летней общей выживаемости при РПЖ высокого риска прогрессирования вынуждает искать более эффективные подходы терапии. ГТ. Применение режимов длительной (2-3 года) ГТ при РПЖ высокого риска прогрессирования не вызывает сомнений и является обязательным. Увеличение выживаемости без биохимического рецидива возможно при использовании антагонистов лютеинизирующего гормона рилизинг-гормона в долгосрочных режимах. Внутритканевая лучевая терапия. Брахитерапия, как и сочетание ее с дистанционной лучевой терапией, показывает высокие результаты в отношении безрецидивной выживаемости. В группе высокого риска отмечается значительно более низкая выживаемость, поэтому возможно улучшение эффективности лечения при использовании длительной адъювантной ГТ и иной системной терапии. В настоящее время результаты подобных исследований не опубликованы. Химиотерапия. Химиотерапия как часть комплексного лечения неметастатического гормоночувствительного РПЖ высокого и очень высокого риска прогрессирования является доказанно эффективным (увеличивая безрецидивную и общую выживаемость пациентов), но еще мало распространенным видом лечения. Заключение. Обзоры, метаанализы и результаты рандомизированных исследований III фазы сообщают о преимуществах в отношении безрецидивной выживаемости при использовании мультимодального подхода с включением химиотерапии. Комбинация химиотерапии на основе таксанов, ГТ ...

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HDR prostate brachytherapy plan robustness and its effect on in‐vivo source tracking error thresholds: A multi‐institutional study

et al. 2022

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The purpose of this study was to examine the effect of departmental planning techniques on appropriate in-vivo source tracking error thresholds for high dose rate (HDR) prostate brachytherapy (BT) treatments, and to determine if a single in-vivo source tracking error threshold would be appropriate for the same patient anatomy. Methods: The prostate, rectum, and urethra were contoured on a single patient transrectal ultrasound (TRUS) dataset. Anonymized DICOM files were disseminated to 16 departments who created an HDR prostate BT treatment plan on the dataset with a prescription dose of 15 Gy in a single fraction. Departments were asked to follow their own local treatment planning guidelines. Source positioning errors were then simulated in the 16 treatment plans and the effect on dose-volume histogram (DVH) indices calculated. Change in DVH indices were used to determine appropriate in-vivo source tracking error thresholds. Plans were considered to require intervention if the following DVH conditions occurred: prostate V100% < 90%, urethra D0.1cc > 118%, and rectum tt Dmax > 80%. Results: There was wide variation in appropriate in-vivo source tracking error thresholds among the 16 participating departments, ranging from 1 to 6 mm. Appropriate in-vivo source tracking error thresholds were also found to depend on the direction of the source positioning error and the endpoint. A robustness parameter was derived, and found to correlate with the sensitivity of plans to source positioning errors. Conclusions: A single HDR prostate BT in-vivo source tracking error threshold cannot be applied across multiple departments, even for the same patient anatomy. The burden on in-vivo source tracking devices may be eased through improving HDR prostate BT plan robustness during the plan optimisation phase.

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Long‐term outcomes of high‐dose‐rate brachytherapy for intermediate‐ and high‐risk prostate cancer with a median follow‐up of 10 years

Cited by 27 publications

References 21 publications

High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

Combined chemohormonalradiation treatment of highand very-high-risk non-metastatic prostate cancer

HDR prostate brachytherapy plan robustness and its effect on in‐vivo source tracking error thresholds: A multi‐institutional study

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