Patient and physician reported toxicity with two-fraction definitive high-dose-rate prostate brachytherapy: the impact of implant interval

Abstract

Purpose: High-dose-rate (HDR) brachytherapy is an effective method of treating localized prostate cancer. There are limited data on the relationship between implant interval and outcomes. This study aims to assess if the implant interval between HDR treatments has an impact on patient-reported health-related quality of life (QOL) and physician-graded toxicity in men treated for localized prostate cancer. Material and methods: Patients were treated with HDR brachytherapy as monotherapy with 27 Gy in 2 fractions, given over two implants, performed 1-2 weeks apart. Patients were dichotomized into one-week and two-week cohorts. Patient-reported EPIC-26 genitourinary (GU), gastrointestinal (GI), and sexual QOL were assessed. Linear regression, chi-squared testing, and generalized linear mixed effect models were used to assess the differences in patient characteristics, patient-reported QOL, and physician-graded toxicity. Results: Outcomes of 122 patients were analyzed. Median follow-up was 18 months. Patient-reported GU and GI QOL worsened after treatment with a return towards baseline over time, while patient-reported sexual QOL worsened after treatment, but did not return towards baseline. There were no differences in patient-reported health related QOL as a function of implant interval. Maximum physician-graded GU, GI, and sexual toxicity rates of grade 2 or 3 were 68%, 3%, and 53%, respectively. There was no difference in rates of grade 2 or 3 toxicity as a function of implants interval. Conclusions: HDR brachytherapy for prostate cancer is a well-tolerated treatment. The interval between treatments is not associated with differences in patient-reported QOL or physician-graded toxicities.

Population‐based patient‐reported quality of life outcomes following low‐dose‐rate versus high‐dose‐rate brachytherapy monotherapy for low‐intermediate risk prostate cancer

“…Despite the lack of baseline urinary function score, given the strict patient selection for BT, 17 one would expect all men who are eligible for either LDR‐BT or HDR‐BT to have reasonably good, and likely comparable, baseline urinary function scores. Reassuringly, regardless of baseline urinary function scores, all men who had either LDR‐BT or HDR‐BT monotherapy in Victoria had excellent urinary function domain score 12‐month post‐treatment, comparable to multiple earlier series on LDR‐BT 18,19 or HDR‐BT 20–22 . The urinary function scores at 12 months after LDR‐BT or HDR‐BT monotherapy in this study were also comparable to men who had external beam radiation therapy with BT boost in previous PCOR‐Vic study 23 (Table 4).…”

“…Reassuringly, regardless of baseline urinary function scores, all men who had either LDR-BT or HDR-BT monotherapy in Victoria had excellent urinary function domain score 12month post-treatment, comparable to multiple earlier series on LDR-BT 18,19 or HDR-BT. [20][21][22] The urinary function scores at 12 months after LDR-BT or HDR-BT monotherapy in this study were also comparable to men who had external beam radiation therapy with BT boost in previous PCOR-Vic study 23 (Table 4). On the other hand, it is unknown whether men who had LDR-BT and HDR-BT had comparable baseline sexual function score, 24 given that pre-treatment sexual (dys)function is generally not a selection or exclusion criteria for LDR-BT or HDR-BT.…”

Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control

“…They found no differences in patient-reported health-related QoL scores or in physician-graded toxicity rates between the one-week and two-week cohorts. They concluded that HDR-BT consisting of two implants is a well-tolerated treatment for men with localized prostate cancer, and that there are no significant differences in the rates of patient-reported health-related QoL or physician-graded toxicity in patients as a function of time between each treatment [ 25 ].…”