Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a phase clinical trial

Stromberg, Jannifer S.; Martínez, Álvaro; González, José; Edmundson, Gregory K.; Ohanian, Neshan; Vicini, Frank A.; Hollander, Jay B.; Gustafson, Gary; Spencer, W. F.; Yan, Di; Brabbins, D.

doi:10.1016/0360-3016(95)00035-w

Cited by 81 publications

(40 citation statements)

References 52 publications

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“…These reports resulted in a renaissance for prostate BT. In 1977, Court and Chassangne (18) began treating prostate cancer with after-loading techniques, and since then several reports have been published (13,14,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Although the data presented were encouraging, no randomised study has been published, and there are criticisms concerning some of the BT treatment studies (29,30).…”

mentioning

confidence: 74%

“…A needle is inserted in the upper part of the gland and since it lies in a straight line with the second needle (arrow) and the transducer, it will disappear due to the strong reflection of the lower needle. study by Stromberg et al, flexible cystoscopy was performed during treatment to ensure that no needles were inserted into the urethra or bladder neck (22).…”

Section: Problems Associated With Anatomymentioning

confidence: 99%

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High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: Technical and methodological aspects

Edgren

Ekelund²,

Albertsson³

et al. 2006

Int J Oncol

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Abstract. The aim of this study was to focus on certain characteristic problems associated with Iridium-192 high dose-rate brachytherapy in combination with external beam radiation therapy (EBRT) in the treatment of patients with localised prostate cancer. Over a period of 16 years, >2,000 patients with prostate cancer have been treated in Sweden with a combination of two fractions of 10 Gy Ir-192 HDR-BT and 50 Gy of fractionated EBRT. Although this treatment is usually well tolerated, there are biological and technical factors to be considered before and during the treatment of the patient to avoid side effects or under-treatment of the target volume. Some of the problems facing the doctors are transducer stability, needle deviation, target definition, target motion, pubic arch interference, concomitant diseases and tolerance doses for different organs at risk. These problems are discussed and possible solutions are presented in this study. IntroductionProstate cancer is the most common malignancy afflicting Swedish men (1,2). Annually, more than 9,000 new cases are diagnosed (3). Although health controls have been ardently discussed during recent years, no screening programmes have as yet been initiated in Scandinavia (4,5). Radiotherapy and radical prostatectomy are generally regarded as the two chief modalities suitable for curative intent treatment (6-12). The results of treatment by these modalities are equivalent, but the acute and long-term side effects which develop after the definitive treatment of prostate cancer differ. The main side effects after surgery are impotence and incontinence, while proctitis, colitis and cystitis are seen after radiotherapy (13).The advantage of brachytherapy (BT) is the short irradiation range. This minimises the dose to organs at risk in the neighbourhood of the target, even though therapy requires that the irradiation source is placed inside or very near the target.Prostate BT was first reported by Pasteau in 1911 (14). The complication rate was high, probably due to the application of the source through the urethra. In the years that followed, the treatment of prostate cancer has focused on radical prostatectomy and external beam radiation therapy (EBRT). However, two different techniques for obtaining a more homogeneous dose distribution in the prostate, which reduce the frequency of side effects, were reported by Flocks in 1964 (15), by Carlton (16) and by Whitmore et al in 1972 (17). These techniques utilized permanent implants of low doserate (LDR) Gold-198 and Iodine-125 isotopes, respectively. These reports resulted in a renaissance for prostate BT. In 1977, Court and Chassangne (18) began treating prostate cancer with after-loading techniques, and since then several reports have been published (13,14,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Although the data presented were encouraging, no randomised study has been published, and there are criticisms concerning some of the BT treatment studies (29,30). Randomised clinical trials are planned by national groups...

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confidence: 74%

Section: Problems Associated With Anatomymentioning

confidence: 99%

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: Technical and methodological aspects

Edgren

Ekelund²,

Albertsson³

et al. 2006

Int J Oncol

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“…Combining 3D-CRT with a brachytherapy boost may represent an equally effective approach of delivering higher radiation doses to this select cohort of patients, which would appear to be critical for optimal tumor control. Stromberg et al [20,21] have shown that using a high-dose rate brachytherapy boost (HDR-BRT) in combination with external beam radiotherapy for patients with locally advanced disease, the 3-year biochemical outcome was improved compared to a comparable cohort treated with 66 Gy of conventional external beam radiotherapy (c-ERT). In that report the most significant differences in the 3-year PSA relapse-free survival rates were observed for patients with pretreatment PSA levels of 10-20 ng/ml (HDR-BRT 85% vs. c-ERT 47%; P ‫ס‬ 0.01) and pretreatment PSA levels >20 ng/ml (HDR-BRT 89% vs. c-ERT 29%; P ‫ס‬ 0.001).…”

Section: Discussionmentioning

confidence: 99%

Combined 3‐dimensional conformal radiotherapy and transperineal Pd‐103 permanent implantation for patients with intermediate and unfavorable risk prostate cancer

et al. 2000

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, and the median pretreatment PSA level was 8.0 ng/ml (range, 1.7-42.0 ng/ml). The clinical stage of these patients was as follows: T1c, 36 (55%); T2a, 27 (42%); T2b/T3, 2 (3%). Fifteen patients (23%) had a Gleason ≤ 6, 41 patients (63%) were classified as Gleason 7, and 9 (14%) as Gleason ≥ 8. Fifty-two (80%) received neoadjuvant androgen deprivation (NAAD) for cytoreduction. The median follow-up was 36 months (range, 24-42 months). Results: The PSA relapse-free survival rate at 3 years was 87%, with a median PSA value at last follow-up of 0.25 ng/ml. The relapse-free survival was 90% for those who had an initial PSA ≤ 10 ng/ml and 80% for patients who had an initial PSA > 10 ng/ml (p = 0.5). No difference in outcome was observed between patients with intermediate and unfavorable risk disease. Eight patients (13%) developed late Grade 2 rectal bleeding. Twenty-three patients (42%) required medication for urinary symptoms during the first 6 months after therapy. Three patients (5%) noted rare stress incontinence at last follow-up. Of the 44 patients who were potent prior to therapy, 17 (26%) developed erectile dysfunction (ED). Conclusion: Although the follow-up is short, the early biochemical outcome of combined 3D-CRT and brachytherapy for intermediate/unfavorable risk prostate cancer is promising. While rectal toxicity is minimal, urinary side effects are more common. Further follow-up is necessary to fully evaluate the efficacy of this combined therapeutic approach.

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“…31 Briefly, patients received whole-pelvis 4-field RT to a total dose of 45.6 Gy (1 Gy = 100 cGy = 100 rad [radiation absorbed dose]). The outpatient, temporary HDR prostate implants delivered 5.5 to 6.5 Gy to the prostate and were performed on the fifth day of each of the first 3 weeks of whole-pelvis external irradiation.…”

Section: Clinicalmentioning

confidence: 99%

The Histology of Radiation Therapy Effect on Prostate Adenocarcinoma as Assessed by Needle Biopsy After Brachytherapy Boost: Correlation With Biochemical Failure

Goldstein¹,

Martinez²,

Vicini³

et al. 1998

Am J Clin Pathol

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A b s t r a c t Brachytherapy boost with external radiation therapy (RT) allows safer delivery to the prostate than conventional techniques. We measured the degree of radiation effect of adenocarcinoma cells in post-Radiation therapy (RT) is a standard treatment option for clinically localized prostate adenocarcinoma. Long-term local control depends on tumor stage, Gleason score, pretreatment serum prostate-specific antigen (PSA) level, and the dose and method of radiation delivery. W1 One potential reason that treatment for some patients fails locally after definitive RT is that the prostate received an insufficient radiation dose. To improve on results achieved with conventional external beam RT, there is an ongoing effort to develop methods that increase the amount of RT dose delivered to the prostate without increasing RT-related adverse effects to adjacent organs. Brachytherapy, which consists of temporary or permanent implantation of radioactive seeds into the prostate, is one method that has been used to increase the intraprostatic dose. In the present study, a temporary high-dose rate (HDR) brachytherapy boost was used in addition to external pelvic RT for patients with prostate adenocarcinoma.Post-RT biopsy specimens are useful in evaluating the ability of RT to eliminate adenocarcinoma. Patients rarely develop local recurrences if the post-RT biopsy is devoid of carcinoma. -212 Earlier studies found that a high percentage of patients with adenocarcinoma in the post-RT biopsy developed recurrences, metastases, or biochemical failure, especially if the biopsy was performed because of an abnormal digital rectal examination or a rising serum PSA level. 13-29Recent studies have shown that not all patients with adenocarcinoma on a prospectively planned, routine post-RT biopsy develop biochemical failure, suggesting that some of these adenocarcinomas have been made biologically inert. 1212 -30 Recently, Crook et al 1 devised an RT-effect score for post-RT prostate adenocarcinoma. They suggested that patients with adenocarcinoma in the post-RT biopsy specimen who were unlikely to develop biochemical failure had a marked RT effect in the adenocarcinoma cells.

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Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a phase clinical trial

Cited by 81 publications

References 52 publications

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: Technical and methodological aspects

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: Technical and methodological aspects

Combined 3‐dimensional conformal radiotherapy and transperineal Pd‐103 permanent implantation for patients with intermediate and unfavorable risk prostate cancer

The Histology of Radiation Therapy Effect on Prostate Adenocarcinoma as Assessed by Needle Biopsy After Brachytherapy Boost: Correlation With Biochemical Failure

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