Highlights
- •HDR single fraction 19 Gy brachytherapy provides insufficient rates of biochemical and local control, in patients with localized prostate cancer.
- •The pattern of relapse is predominantly local.
- •HDR single fraction 19 Gy should not be used to treat favorable localized prostate cancer.
Abstract
Purpose
To report the pattern of relapse within the prostate with reference to the initial
site of disease in patients treated with single fraction 19-Gy.
Methods and materials
Forty-four patients were treated according to a prospective study of single-fraction
HDR-brachytherapy. Treatment was delivered using 192Ir to a dose of 19 Gy prescribed
to the prostate.
Patients who experienced a biochemical failure underwent a re-staging multiparametric
MRI (mpMRI) and MRI-TRUS fusion biopsy to rule-out local recurrence.
In patients with visible Dominant intraprostatic lesions (DIL) on pretreatment mpMRI,
the site of local relapse was compared with the initial site of disease. The dose
received by the site of recurrence was investigated.
Results
The median follow-up period was 48 months (range 29–63). The PSA nadir was reached
at 24 months follow-up, with a median value of 1.07 ng/mL. To date, 14 patients (32%)
have experienced biochemical failure (4 patients low-risk and 10 intermediate-risk;
p = 0.013). Re-staging mpMRI was performed in 11/14 patients. Eleven patients underwent
MRI-TRUS fusion biopsy confirming local relapse in all patients.
The analysis of DVH of all 44 patients revealed that patients with biochemical failure
had received significantly lower doses in terms of V100, V125 and D90 (p = 0.032, p = 0.018 and p = 0.018 respectively).
In patients with DILs on diagnostic mpMRI, the mean D90 and D98 on DIL were lower
for patients with biochemical failure.
Conclusions
This dosimetric analysis demonstrates a dose-response relationship in patients treated
with single fraction 19 Gy. Patients with intermediate risk disease, with visible
DIL on mpMRI and patients treated with cooler implants have higher incidence of biochemical
and local failure.
Keywords
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Article info
Publication history
Published online: February 18, 2020
Accepted:
January 25,
2020
Received in revised form:
January 24,
2020
Received:
September 25,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
