Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high-dose-rate brachytherapy

Mendez, Lucas C.; Ravi, Ananth; Chung, Hans T.; Tseng, Chia‐Lin; Wronski, Matt; Paudel, Moti; McGuffin, Merrylee; Cheung, Patrick; Loblaw, Andrew; Morton, Gerard

doi:10.1016/j.brachy.2017.10.001

Cited by 36 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the second study, Mendez et al [34] indicated that the biochemical failure rate found at 30 months was around 10%, which is larger than expected for a single fraction of 19 Gy.…”

Section: Discussionmentioning

confidence: 83%

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

View full text Add to dashboard Cite

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.

show abstract

“…In the second study, Mendez et al [34] indicated that the biochemical failure rate found at 30 months was around 10%, which is larger than expected for a single fraction of 19 Gy.…”

Section: Discussionmentioning

confidence: 83%

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

View full text Add to dashboard Cite

show abstract

“…As for the optimal single-fraction dose, 19 Gy seems to be well tolerated, and doses ≥20 Gy have been shown to significantly increase toxicity 55 . The biological effective dose using an α/β ratio of 1.5 of 19-Gy single-fraction HDRB is 260 Gy, 56 which was shown to produce at least the same benefit as that given by the 4 × 9.5 Gy and 2 × 13.5 Gy schemes57, 58 and to correspond biologically to approximately 90 Gy administered at 2 Gy/fraction 15 …”

Section: Discussionmentioning

confidence: 99%

“…This study served as the pilot study for the CCTG phase 2 trial evaluating prostate cancer control defined as absolute PSA nadir at 48 months of LDRB and HDRB (NCT02960087). To overcome the poor clinical outcomes so far reported with 19-Gy single-fraction HDR, the CCTG trial required a mandatory dose escalation to 120% to 150% of the prescription dose to the dominant intraprostatic lesion defined on magnetic resonance imaging 58 . The trial is currently enrolling patients across numerous Canadian institutions and will provide robust evidence on the clinical outcomes of 19-Gy single-fraction HDRB.…”

Section: Discussionmentioning

confidence: 99%

A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

Hathout

Mahmoud

Wang

et al. 2019

Advances in Radiation Oncology

Self Cite

View full text Add to dashboard Cite

PurposeTo compare health-related quality of life (HRQOL) of high-dose-rate brachytherapy (HDRB) versus low dose-rate brachytherapy (LDRB) for localized prostate cancer in a multi-institutional phase 2 randomized trial.Methods and MaterialsMen with favorable-risk prostate cancer were randomized between monotherapy brachytherapy with either Iodine-125 LDRB to 144 Gy or single-fraction Iridium-192 HDRB to 19 Gy. HRQOL and urinary toxicity were recorded at baseline and at 1, 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite (EPIC)-26 scoring and the International Prostate Symptom Score (IPSS). Independent samples t test and mixed effects modeling were performed for continuous variables. Time to IPSS resolution, defined as return to its baseline score ±5 points, was calculated using Kaplan-Meier estimator curves with the log-rank test. A multiple-comparison adjusted P value of ≤.05 was considered significant.ResultsLDRB and HDRB were performed in 15 and 16 patients, respectively, for a total of 31 patients. At 3 months, patients treated with LDRB had a higher IPSS score (mean, 15.5 vs 6.0, respectively; P = .003) and lower EPIC urinary irritative score (mean, 69.2 vs 85.3, respectively; P = .037) compared with those who received HDRB. On repeated measures at 1, 3, 6, and 12 months, the IPSS (P = .003) and EPIC urinary irritative scores (P = .019) were significantly better in the HDR arm, translating into a lower urinary toxicity profile. There were no significant differences in the EPIC urinary incontinence, sexual, or bowel habit scores between the 2 groups at any measured time point. Time to IPSS resolution was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P = .028).ConclusionsHDRB monotherapy is a promising modality associated with a lower urinary toxicity profile and higher HRQOL in the first 12 months compared with LDRB.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high-dose-rate brachytherapy

Cited by 36 publications

References 15 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

A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

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

Contact Info

Product

Resources

About