Nationwide multi-institutional retrospective analysis of high-dose-rate brachytherapy combined with external beam radiotherapy for localized prostate cancer: An Asian Prostate HDR-BT Consortium

Ishiyama, Hiromichi; Kamitani, Nobuhiko; Kawamura, Hidemasa; Kato, Shingo; Aoki, Manabu; Kariya, Shuji; Matsumura, Taisei; Kaidu, Motoki; Yoshida, Ken; Hashimoto, Y.; Noda, Yasutaka; Lim, Keith H.C.; Kawase, Takatsugu; Takahashi, Tetsuya; Inaba, Koji; Kumano, Motoyasu; Yoshikawa, Norishige; Yoshioka, Yasuo; Nakamura, Katsumasa; Hoshino, Junichi; Itami, Jun; Hayakawa, Kazushige

doi:10.1016/j.brachy.2017.01.006

Cited by 31 publications

(26 citation statements)

References 18 publications

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“…The detailed method of applicator implantation in HDR was described elsewhere [ 10 ]. A total of 1172 patients were treated with a combination of HDR and EBRT at various fractionations ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Yamazaki

Masui

Suzuki

et al. 2020

JCM

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Androgen deprivation therapy (ADT) is used to improve overall survival (OS) in prostate cancer treatment; however, we encountered that long-term ADT in elderly patients may be related to high other-cause mortality (OCM). This study aimed to confirm the potential risk associated with long-term ADT in elderly patients using a different large cohort. A comparison analysis was conducted between the ≥2- and <2-year ADT groups using open, large data from 1840 patients with clinically localized prostate cancer treated with radiotherapy (1172 treated with high-dose-rate brachytherapy (HDR) + external beam radiotherapy (EBRT) and 668 treated with external beam radiotherapy). The OCM-free survival (OCMFS), overall survival, and prostate cancer-specific survival rates were measured. The 10-year OCMFS rates in patients aged ≥75 years were 94.6% and 86% in the <2- and ≥2-year ADT groups, respectively, but were 96.3% and 93.5% (p = 0.0006) in their younger counterparts. If dividing into HDR and EBRT groups. This inclination was found in brachytherapy group but not in EBRT group. The overall survival rate was also lower in the elderly patients in the ≥2-year ADT group than in the <2-year ADT group; however, the 10-year prostate cancer-specific survival rate was the same in both groups. Long-term ADT in elderly patients resulted in not only higher OCM rates but also poorer OS rates; therefore, longer-term ADT in elderly patients should be performed with meticulous care.

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Section: Methodsmentioning

confidence: 99%

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Yamazaki

Masui

Suzuki

et al. 2020

JCM

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“…Data of HDR + EBRT were obtained from freely accessible database [9]. The detailed method of HDR was described elsewhere [10].…”

Section: Brachytherapy (Bt)mentioning

confidence: 99%

“…EBRT included 421 three-dimensional conformal radiotherapy (3D-CRT) and 481 intensity-modulated radiotherapy (IMRT) (Supplemental Table 2). Part of EBRT data were obtained from freely accessible dataset (n = 643) [9], and image-guided IMRT using helical tomotherapy was performed at the Department of Radiology, Ujitakeda Hospital (n = 259). The technique of imageguided IMRT using helical tomotherapy has been described elsewhere [11].…”

Section: External Beam Radiotherapy (Ebrt)mentioning

confidence: 99%

Radiotherapy for elder patients aged ≥80 with clinically localized prostate cancer – Brachytherapy enhanced late GU toxicity especially in elderly

Yamazaki

Masui

Suzuki

et al. 2020

Clinical and Translational Radiation Oncology

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Background and purpose: Elongation of life expectancy had led to marked increase in number of elderly patients with localized prostate cancer. However, the standard treatment for such patients is not well determined because of a high prevalence of comorbidities and slow growth of prostate cancer. The aim of this study is to examine the feasibility of radiotherapy for elderly patients aged !80 years. Materials and methods: We compared 96 patients aged !80 years and 2333 younger patients (aged 60-79 years) using multi-institutional data included cT1-T4N0M0 prostate cancer treated with 902 external beam radiotherapy (EBRT) and 1527 brachytherapy (BT). Results: The 5-year biochemical failure-free survival rate was similar between elderly !80 years and younger control (91.3% vs. 85.9%, p = 0.6171) (100%, 92.9%, 82.4% and 96.3%, 93.7%, 89% for low, intermediate and high risk group), and for the prostate cancer-specific survival rate (100% and 99.3%, p = 0.6171). The accumulated incidence of late gastrointestinal (GI) at 5 years was also similar between elderly and younger patients (3.5% vs. 2.5%, p = 0.6857). Brachytherapy improved biochemical control rate and reduced GI toxicity compared with EBRT, however, enhanced late genitourinary (GU) toxicity, especially in elderly patients. Elderly received brachytherapy showed highest rate of late GU toxicity grade !2 of 22.1% than the younger counterparts of 12.7% at 5 years, whereas younger patients treated with EBRT had 2.4% and elderly EBRT had 2.7% (p < 0.0001). Conclusion: Elderly patients aged !80 years showed equivalent biochemical control, prostate cancerrelated survival, and gastrointestinal toxicity profiles to younger patients. Meticulous care should be required for brachytherapy enhanced late GU toxicity, especially in elderly patients aged !80 years.

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“…Population data has been reported to support the use of HDR boost in intermediate and high-risk disease. Ishiyama and colleagues conducted a retrospective review of 3,242 patients treated with HDR boost from 16 Asian hospitals ( 41 ). Five and 10-year biochemical control rates were 90.6% and 81.4%, respectively, in a population where 67% were in a high or very high-risk grouping.…”

Section: Rationalementioning

confidence: 99%

High dose-rate brachytherapy in the treatment of prostate cancer

Mendez

Morton

2018

Transl. Androl. Urol.

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High dose-rate (HDR) brachytherapy involves delivery of a high dose of radiation to the cancer with great sparing of surrounding organs at risk. Prostate cancer is thought to be particularly sensitive to radiation delivered at high dose-rate or at high dose per fraction. The rapid delivery and high conformality of dose results in lower toxicity than that seen with low dose-rate (LDR) implants. HDR combined with external beam radiotherapy results in higher cancer control rate than external beam only, and should be offered to eligible high and intermediate risk patients. While a variety of dose and fractionations have been used, a single 15 Gy HDR combined with 40–50 Gy external beam radiotherapy results in a disease-free survival of over 90% for intermediate risk and 80% for high risk. HDR monotherapy in two or more fractions (e.g., 27 Gy in 2 fractions or 34.5 Gy in 3) is emerging as a viable alternative to LDR brachytherapy for low and low-intermediate risk patients, and has less toxicity. The role of single fraction monotherapy to a dose of 19–20 Gy is evolving, with some conflicting data to date. HDR should also be considered as a salvage approach for recurrent disease following previous external beam radiotherapy. A particular advantage of HDR in this setting is the ease of delivering focal treatments, which combined with modern imaging allows focal dose escalation with minimal toxicity. Trans-rectal ultrasound (TRUS) based planning is replacing CT-based planning as the technique of choice as it minimizes or eliminates the need to move the patient between insertion, planning and treatment delivery, thus ensuring high accuracy and reproducibility of treatment.

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Nationwide multi-institutional retrospective analysis of high-dose-rate brachytherapy combined with external beam radiotherapy for localized prostate cancer: An Asian Prostate HDR-BT Consortium

Cited by 31 publications

References 18 publications

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Radiotherapy for elder patients aged ≥80 with clinically localized prostate cancer – Brachytherapy enhanced late GU toxicity especially in elderly

High dose-rate brachytherapy in the treatment of prostate cancer

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