Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy

Morton, Gerard; McGuffin, Merrylee; Chung, Hans T.; Tseng, Chia‐Lin; Helou, Joelle; Ravi, Ananth; Cheung, Patrick; Szumacher, Ewa; Liu, Stanley K.; Chu, William; Zhang, Liying; Mamedov, Alexandre; Loblaw, Andrew

doi:10.1016/j.radonc.2020.02.009

Cited by 109 publications

(92 citation statements)

References 22 publications

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“…Various hypofractionated regimens have been compared to evaluate the balance between oncologic outcomes and treatment-related toxicity [4,5,6,7,8]. One of the most studied regimens include 27 Gy in two 13.5 Gy fractions, given in two implants, as outlined in the current NCCN guidelines [10].…”

Section: Discussionmentioning

confidence: 99%

“…High-dose-rate (HDR) brachytherapy as monotherapy has been shown to be a safe and effective method of treating men with low-and intermediate-risk prostate cancer [1,2,3,4,5,6,7,8,9]. This technique was originally proposed in the 1990s by Yoshioka et al [1,2].…”

mentioning

confidence: 99%

“…However, the specifics in how to deliver this regimen vary among providers. Different prospective trials have used varying lengths of time between the two fractions: some performing the second implant after one week, some performing the second implant after two weeks, and some allowing for either [7,8,11]. At our institution, patients receive 2 implants that are scheduled either one or two weeks apart, based on patient and brachytherapist availability.…”

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confidence: 99%

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

Harris¹,

Korpics²,

Sherwani³

et al. 2020

jcb

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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

Harris¹,

Korpics²,

Sherwani³

et al. 2020

jcb

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“…Although outside the scope of this patient-reported outcome study, a recent comparative trial has raised concerns about the oncological effectiveness of a single-dose HDR-BT regimen in the primary setting. This trial randomized 170 patients between whole-gland 1x19Gy and 2x13.5Gy and reported 5-year biochemical control rates of 73.5% (single-dose) versus 95% (two-fraction) [21] , with similar low morbidity [22] . Unfortunately, there is no comparative data available on single-dose versus two-fraction focal salvage HDR-BT.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life after ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: reporting the patient’s perspective

Son

Monninkhof

Peters

et al. 2020

Clinical and Translational Radiation Oncology

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Highlights We analyzed patient-reported quality of life in 100 patients who underwent ultrafocal salvage HDR-brachytherapy. Patient-reported bowel symptoms were neglible. Urinary complaints increased and sexual functioning declined over time. Lower impact is predicted for patients with favorable function at baseline and lower dose to the urethra.

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“…Treatment in a single fraction represents the ultimate in extreme hypofractionation and this has been shown to be feasible utilising HDR monotherapy schedules of 19 Gy . Single‐fraction SBRT is also now being explored, for example, in the 30 patients Portuguese PROSINT study which is comparing 45 Gy in 5 fractions versus 24 Gy single‐dose SBRT (NCT02570919).…”

Section: Future Directionsmentioning

confidence: 99%

Moderate hypofractionation for prostate cancer: A user's guide

et al. 2018

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Three large randomised controlled trials have been published in the last year demonstrating the non-inferiority of moderate hypofractionation compared to conventional fractionation for localised prostate cancer with respect to both disease control and late toxicity at 5 years. Furthermore, no clinically significant differences in patient-reported outcomes have emerged. More mature follow-up data are now also available from phase 2 studies confirming that moderate hypofractionation is associated with low rates of significant toxicity at 10 years. Moving forward it is likely that appropriate patient selection, integration of androgen deprivation and attention to optimising technique will play a more important role than modest differences in dose-fractionation schedules. Here we briefly review the evidence, discuss issues of patient selection and provide an approach to implementing moderately hypofractionated radiation therapy for prostate cancer in clinical practice.

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Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy

Cited by 109 publications

References 22 publications

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

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

Health-related quality of life after ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: reporting the patient’s perspective

Moderate hypofractionation for prostate cancer: A user's guide

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