External Beam Radiation Therapy Plus High-Dose-Rate Brachytherapy in the Treatment of Locally Advanced Prostate

PurposeTo evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer.Materials and MethodsFrom 2002 to July 2012, 377 pts with a diagnosis of intermediate-high risk prostate cancer were treated with EBRT followed by supplemental HDRB. The patient characteristics were as follows: mean age 65.78 (41-86 years), Gleason was 7 in 191 pts (50.7%) and 8 or higher in 131 (35%), 226 pts. (60%) had a PSA >10 ng/ml, T3 stage 263 pts (70%), T2 64 (17%) and T1 49 (13%). The EBRT dose was 60.0 Gy (45-70 Gy) to the prostate and seminal vesicles for all patients. A total of 120 pts (31%) also received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Complete androgen deprivation was given to 353 pts (93.63%).ResultsWith a median follow-up of 48.72 months (12-126), 5 and 7-year actuarial overall survival rates were 88% (95% confidence interval [CI] = 84-92) and 75% (95% CI = 68-83). Cause-specific survival at 5 and 7 years were 98% (95% CI = 97-99) and 97% (95% CI = 96-98), respectively. The 5 and 7-year biochemical relapse free survival were 91% (95% CI = 87-95) and 89% (95% CI = 83-95). Gastrointestinal (GI) grade 2 and grade 3 late-toxicity was observed in 17 pts (4.6%) and 6 pts (1.6%), respectively. Genitourinary (GU) grade 2 and grade 3 toxicity was observed in 46 pts (12.2 %) and 3 pts (0.8%).ConclusionsThese findings after long-term follow-up confirm that EBRT plus a single-fraction HDRB boost provides good results in terms of both treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, and the risks of anaesthesia while minimizing patient discomfort. We believe these findings support the use of single-fractionation boost techniques. Note: The results presented will be updated with one year of follow-up more than the published in: Boladeras A, Santorsa L, Gutierrez C, et al: External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol. 2014 Aug;112(2):227-32. PurposeTo evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. Materials and MethodsFrom 2002 to July 2012, 377 pts with a diagnosis of intermediate-high risk prostate cancer were treated with EBRT followed by supplemental HDRB. The patient characteristics were as follows: mean age 65.78 (41-86 years), Gleason was 7 in 191 pts (50.7%) and 8 or higher in 131 (35%), 226 pts. (60%) had a PSA >10 ng/ml, T3 stage 263 pts (70%), T2 64 (17%) and T1 49 (13%). The EBRT dose was 60.0 Gy (45-70 Gy) to the prostate and seminal vesicles for all patients. A total of 120 pts (31%) also received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Complete androgen deprivation was given to 353 pts (93.63%). From 2002 to July 2012, 377 pts with a diagnosis of intermediate-high risk prostate cancer were treated with EBRT followed by supplemental HDRB. The patient characteristics were as follows: mean age 65.78 (41-86 years), Gleason was 7 in 191 pts (50.7%) and 8 or higher in 131 (35%), 226 pts. (60%) had a PSA >10 ng/ml, T3 stage 263 pts (70%), T2 64 (17%) and T1 49 (13%). The EBRT dose was 60.0 Gy (45-70 Gy) to the prostate and seminal vesicles for all patients. A total of 120 pts (31%) also received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Complete androgen deprivation was given to 353 pts (93.63%). ResultsWith a median follow-up of 48.72 months (12-126), 5 and 7-year actuarial overall survival rates were 88% (95% confidence interval [CI] = 84-92) and 75% (95% CI = 68-83). Cause-specific survival at 5 and 7 years were 98% (95% CI = 97-99) and 97% (95% CI = 96-98), respectively. The 5 and 7-year biochemical relapse free survival were 91% (95% CI = 87-95) and 89% (95% CI = 83-95). Gastrointestinal (GI) grade 2 and grade 3 late-toxicity was observed in 17 pts (4.6%) and 6 pts (1.6%), respectively. Genitourinary (GU) grade 2 and grade 3 toxicity was observed in 46 pts (12.2 %) and 3 pts (0.8%). With a median follow-up of 48.72 months (12-126), 5 and 7-year actuarial overall survival rates were 88% (95% confidence interval [CI] = 84-92) and 75% (95% CI = 68-83). Cause-specific survival at 5 and 7 years were 98% (95% CI = 97-99) and 97% (95% CI = 96-98), respectively. The 5 and 7-year biochemical relapse free survival were 91% (95% CI = 87-95) and 89% (95% CI = 83-95). Gastrointestinal (GI) grade 2 and grade 3 late-toxicity was observed in 17 pts (4.6%) and 6 pts (1.6%), respectively. Genitourinary (GU) grade 2 and grade 3 toxicity was observed in 46 pts (12.2 %) and 3 pts (0.8%). ConclusionsThese findings after long-term follow-up confirm that EBRT plus a single-fraction HDRB boost provides good results in terms of both treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, and the risks of anaesthesia while minimizing patient discomfort. We believe these findings support the use of single-fractionation boost techniques. Note: The results presented will be updated with one year of follow-up more than the published in: Boladeras A, Santorsa L, Gutierrez C, et al: External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol. 2014 Aug;112(2):227-32. These findings after long-term follow-up confirm that EBRT plus a single-fraction HDRB boost provides good results in terms of both treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, and the risks of anaesthesia while minimizing patient discomfort. We believe these findings support the use of single-fractionation boost techniques. Note: The results presented will be updated with one year of follow-up more than the published in: Boladeras A, Santorsa L, Gutierrez C, et al: External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol. 2014 Aug;112(2):227-32.