Abstract
Background
Single-dose high-dose-rate brachytherapy (HDR-BT), in a Phase-II study, was compared
to two or three fractions in intermediate and high-risk localized prostate cancer.
Patients and methods
293 patients received 1 × 19 Gy or 1 × 20 Gy (A = 49), 2 × 13 Gy (B = 138), or 3 × 10.5 Gy (C = 106) and assessed with prospective measures of serum PSA, late genitourinary (GU)
and gastrointestinal (GI) morbidity using RTOG scales and the International Prostate
Symptom Score (IPSS).
Results
Median follow-up is 49, 63 and 108 months (A, B and C, respectively). At 4 years biochemical relapse free survival was 94% (A), 93% (B) and 91% (C) (p = 0.54). Risk-category was the only significant independent predictor of relapse (p < 0.0001). Kaplan–Meier 4-year-estimates of GU-3 were 2% (A and B) and 11% (C). GI-3
was 0% (A and B) and 1% (C). No GU or GI grade-4 events were observed. IPSS ≥ 20 was 11% (A), 9% (B) and 16% (C) (p = 0.9). Prevalence of GU-3 was ≤4% in the 3 groups at all times; GI-3 was low or non-existent.
Prevalence of catheter use was ≤6% in all groups.
Conclusions
A single dose of 19–20 Gy achieves similar rates of late morbidity and biochemical control compared to 2
and 3 fractions.
Keywords
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References
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial.Int J Radiat Oncol Biol Phys. 2000; 48: 675-681
- Is high dose rate brachytherapy reliable and effective treatment for prostate cancer patients? A review of the literature.Crit Rev Oncol Hematol. 2015; 94: 360-370
- High-dose-rate brachytherapy as monotherapy for prostate cancer.Brachytherapy. 2014; 13: 529-541
- ACR Appropriateness Criteria high-dose-rate brachytherapy for prostate cancer.Brachytherapy. 2014; 13: 27-31
- High-dose-rate brachytherapy as monotherapy for prostate cancer: technique, rationale and perspective.J Contemp Brachytherapy. 2014; 6: 91-98
- The emerging role of high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer.J Radiat Res. 2013; 54: 781-788
- Feasibility and early outcome of high-dose-rate Ir-192 brachytherapy as monotherapy in two fractions within 1 day for high-/very high-risk prostate cancer.Mol Clin Oncol. 2016; 4: 789-793
- High-dose-rate brachytherapy as a monotherapy for favorable-risk prostate cancer: a Phase II trial.Int J Radiat Oncol Biol Phys. 2012; 82: 1889-1896
- High-dose-rate brachytherapy with two or three fractions as monotherapy in the treatment of locally advanced prostate cancer.Radiother Oncol. 2014; 112: 63-67
- High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results.Int J Radiat Oncol Biol Phys. 2013; 85: 672-678
- Favorable preliminary outcomes for men with low- and intermediate-risk prostate cancer treated With 19-Gy single-fraction high-dose-rate brachytherapy.Int J Radiat Oncol Biol Phys. 2017; 97: 98-106
- High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results.Brachytherapy. 2012; 11: 105-110
- Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Early toxicity and quality-of life results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy.Radiother Oncol. 2016;
- High-dose-rate brachytherapy alone given as two or one fraction to patients for locally advanced prostate cancer: acute toxicity.Radiother Oncol. 2014; 110: 268-271
- Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.Int J Radiat Oncol Biol Phys. 2006; 65: 965-974
- American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy.Brachytherapy. 2012; 11: 20-32
- Fractionation and protraction for radiotherapy of prostate carcinoma.Int J Radiat Oncol Biol Phys. 1999; 43: 1095-1101
- Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue.Int J Radiat Oncol Biol Phys. 2002; 52: 6-13
- Is alpha/beta for prostate tumors really low?.Int J Radiat Oncol Biol Phys. 2001; 50: 1021-1031
- What hypofractionated protocols should be tested for prostate cancer?.Int J Radiat Oncol Biol Phys. 2003; 56: 1093-1104
- Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 Patients in Seven International Institutional Datasets: alpha/beta = 1.4 (0.9-2.2) Gy.Int J Radiat Oncol Biol Phys. 2012; 82: e17-e24
- A modelled comparison of prostate cancer control rates after high-dose-rate brachytherapy (3145 multicentre patients) combined with, or in contrast to, external-beam radiotherapy.Radiother Oncol. 2014; 111: 114-119
- The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction.Semin Radiat Oncol. 2008; 18: 234-239
- High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results.Radiother Oncol. 2016; 119: 411-416
- Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial.Lancet Oncol. 2016; 17: 1061-1069
- Randomized Phase III noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer.J Clin Oncol. 2016; 34: 2325-2332
Article info
Publication history
Published online: June 27, 2017
Accepted:
June 7,
2017
Received in revised form:
May 28,
2017
Received:
April 3,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
