Interstitial high dose rate (HDR) brachytherapy alone for early stage prostate cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14633-14633
Author(s):  
R. J. Mark ◽  
P. J. Anderson ◽  
T. Neumann ◽  
M. Nair
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Gleason Score ◽  
Disease Free Survival ◽  
High Dose Rate ◽  
High Dose ◽  
Free Survival ◽  
Treatment Volume ◽  
Grade 3 ◽  
Disease Free

14633 Background: Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using Low Dose Rate (LDR) and High Dose Rate (HDR) technique has been reported with results comparing favorably to surgery and External Beam Radiation Therapy (EBRT). Often, HDR and LDR interstitial implant is combined with EBRT. There is little published data on HDR alone. We report our results with HDR alone. Methods: Between 1997 and 2006, 167 patients with T1 and T2 localized prostate underwent TRUS guided interstitial implant. There were no Gleason Score or PSA exclusions. No patient received EBRT or Hormonal Blockade. Median Gleason Score was 7 (range: 4 to 10). Median PSA was 9.3 (2.7 to 39.8). Treatment volumes ranged from 42 cm3 to 196 cm3. Treatment volume included the prostate and seminal vesicles in all cases. Our protocol for HDR alone, has called for two HDR Implants. The treatment volume received 2,250 cGy in 3 fractions prescribed to the 100% Isodose line, given over 24 hours. A 2nd implant was performed 4 weeks later, delivering a further 2,250 cGy in 3 fractions, bringing the final dose to the prostate to 4,500 cGy in 6 fractions. Urethral dose points (12–16) were followed, and limited to ≤ 105% of the prescription dose. Results: With a median follow-up of 64 months (range: 6 months to 112 months), PSA disease free survival was 89.8% (150/167). Urethral stricture requiring dilatation has developed in 4.2% (7/167) of patients. Urinary stress incontinence has occurred in 3.6% (6/167). RTOG late bladder toxicities were: 0% Grade 4, 0% Grade 3, and 3.6% (6/167) Grade 2. RTOG late rectal toxicities were: 0.6% (1/167) Grade 4, 0% Grade 3, 1.8% (3/167) Grade 2, and 2.4% (4/167) Grade 1. There have been no cases of rectal incontinence to date. Conclusions: Five year results with HDR implant alone compare favorably to EBRT, LDR ± EBRT, and HDR + EBRT, both with regard to PSA disease free survival, and complications. HDR offers other advantages over LDR, such as no radiation exposure to hospital personnel, no seed migration, greater dose flexibility and precision of radiation dose delivery. Larger volumes can be treated with HDR. By omitting EBRT, bladder and rectal complications appear to be significantly reduced. No significant financial relationships to disclose.

Interstitial high dose rate (HDR) brachtherapy + IMRT vs. HDR monotherapy for early stage prostate cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14606-14606 ◽  
Author(s):  
T. Neumann ◽  
R. Mark ◽  
P. J. Anderson ◽  
M. Nair
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Gleason Score ◽  
Disease Free Survival ◽  
High Dose Rate ◽  
External Beam Radiation ◽  
High Dose ◽  
Beam Radiation ◽  
Significant Difference ◽  
Grade 3

14606 Background: Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using High Dose Rate (HDR) + External Beam Radiation Therapy (EBRT) or IMRT has been reported with favorable results. The role of supplemental EBRT or IMRT in brachytherapy is undefined. We compare our results of HDR + IMRT vs. HDR monotherapy. Methods: Between 1997 and 2006, 276 patients with T1 and T2 localized prostate underwent TRUS interstitial implant. After discussion of treatment options, 109 patients elected HDR Implant + IMRT and 167 patients underwent HDR alone. No patient received Hormonal Blockade. Median Gleason Score was 7 (range: 4 to 10). Median PSA was 9.8 (0.60 to 39.8). In patients who received IMRT + HDR, 4500 cGy in 25 fractions was given via IMRT and 1650 cGy in 3 fractions via HDR. Our protocol for HDR alone, has called for two HDR Implants. The treatment volume received 2,250 cGy in 3 fractions prescribed to the 100% Isodose line, given over 24 hours. A 2nd implant was performed 4 weeks later, delivering a further 2,250 cGy in 3 fractions, bringing the final dose to the prostate to 4,500 cGy in 6 fractions. Results: There was no significant difference between the treatment groups with respect to T-Stage, Gleason Score, and PSA. With a median follow-up of 66 months (range: 6 months to 120 months), the overall PSA disease free survival (DFS) was 89.5% (247/276). In patients undergoing IMRT + HDR, PSA DFS was 89.0% (97/109) vs. 89.8% (150/167) for patients undergoing HDR alone (p = 0.6). The 5 year actuarial survival was 86% for the group receiving IMRT + HDR vs. 89% with HDR (log rank = 0.5). Urinary stress incontinence has occurred in 2.5% (7/276). RTOG late bladder toxicities were: 0% Grade 4, 0% Grade 3, and 3.3% (9/276) Grade 2. RTOG late rectal toxicities were: 0.4% (1/276) Grade 4, 0% Grade 3, 3.6% (10/276) Grade 2, and 4.7% (13/276) Grade 1. RTOG late rectal toxicity was higher in patients undergoing HDR + IMRT with 14.7% (16/109) of patients experiencing Grade 2 and 1 symptoms, vs. 3.0% (5/167) receiving HDR alone (p ≤ 0.01). Conclusions: We have observed no difference in PSA DFS in patients undergoing HDR vs. HDR + IMRT. Complications were similar, though RTOG Grade 1 and 2 late toxicity was higher in patients receiving HDR + IMRT. By omitting IMRT, rectal complications may be reduced. No significant financial relationships to disclose.

scholarly journals High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up

2021 ◽  
Vol 11 ◽  
Author(s):  
Manuel Behmueller ◽  
Nikolaos Tselis ◽  
Nikolaos Zamboglou ◽  
Eleni Zoga ◽  
Dimos Baltas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
High Dose Rate ◽  
High Dose ◽  
Intermediate Risk ◽  
Biochemical Relapse ◽  
Free Survival ◽  
Grade 3

IntroductionTo evaluate the oncological outcome of high dose rate (HDR) brachytherapy (BRT) as monotherapy for clinically localised prostate cancer (PCA).Material and MethodsBetween January 2002 and February 2004, 141 consecutive patients with clinically localised PCA were treated with HDR-BRT monotherapy. The cohort comprised 103 (73%) low-, 32 (22.7%) intermediate- and 6 (4.3%) high risk patients according to D’Amico classification or 104 (73.8%) low-, 24 (17.0%) intermediate favourable-, 12 (8.5%) intermediate unfavourable- and one (0.7%) very high risk patient according to National Comprehensive Cancer Network (NCCN) one. Patients received four fractions of 9.5 Gy delivered within a single implant up to a total physical dose of 38 Gy. Catheter-implantation was transrectal ultrasound-based whereas treatment planning CT-based. Thirty-three patients (23.4%) received ADT neoadjuvantly and continued concurrently with BRT. Biochemical relapse-free survival (BRFS) was defined according to the Phoenix Consensus Criteria and genitourinary (GU)/gastrointestinal (GI) toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 5.0.ResultsMedian age at treatment and median follow-up time was 67.2 and 15.2 years, respectively. Twenty-three (16.3%) patients experienced a biochemical relapse and 5 (3.5%) developed distant metastases, with only one patient dying of PCA. The BRFS was 85.1% at 15 years and 78.7% at 18 years. The corresponding overall survival, metastases-free survival, and prostate cancer specific mortality at 15- and 18-years was 73.9%/59.1%, 98.3%/90.6%, and 100%/98.5% respectively. Late grade 3 GI and GU toxicity was 4.2% and 5.6% respectively. Erectile dysfunction grade 3 was reported by 27 (19%) patients. From the prognostic factors evaluated, tumor stage (≤T2b compared to ≥T2c) along with the risk group (low-intermediate vs. high) when using the D’Amico classification but not when the NCCN one was taken into account, correlated significantly with BRFS.ConclusionOur long-term results confirm HDR-BRT to be a safe and effective monotherapeutic treatment modality for low- and intermediate risk PCA.

scholarly journals Conventional dose versus dose escalated radiotherapy including high-dose-rate brachytherapy boost for patients with Gleason score 9–10 clinical localized prostate cancer

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Hideya Yamazaki ◽  
Gen Suzuki ◽  
Norihiro Aibe ◽  
Daisuke Shimizu ◽  
Takuya Kimoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Gleason Score ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
Free Survival ◽  
Conventional Dose ◽  
Brachytherapy Boost

AbstractAs several recent researches focus on the importance of Gleason 9–10, we examine the role of radiotherapy dose escalation in those patients. We analyzed 476 patients with Gleason score 9–10 prostate cancer treated with radiotherapy. Of them, 127 patients were treated with conventional-dose external beam radiotherapy (Conv RT) and 349 patients were treated with high-dose radiotherapy (HDRT; 249 patients received high-dose-rate brachytherapy boost + external beam radiotherapy [HDR boost] and 100 patients received intensity-modulated radiotherapy [IMRT]). We compared these treatment groups using multi-institutional retrospective data. The patients had a median follow-up period of 66.3 months. HDRT showed superior biochemical disease-free survival (bDFS) rate (85.2%; HDR boost 84.7% and IMRT 86.6%) to Conv RT (71.1%, p < 0.0001) at 5 years, with a hazard ratio of 0.448. There were borderline difference in prostate cancer-specific mortality (PCSM; 4.3% and 2.75%, p = 0.0581), and distant metastasis-free survival (DMFS; 94.4% and 89.6%, p = 0.0916) rates at 5-years between Conv RT and HDRT group. Dose escalated radiotherapy showed better bDFS, borderline improvement in PCSM, and equivocal outcome in DMFS in with clinically localized Gleason 9–10 prostate cancer.

High-Dose Rate Brachytherapy Increases Disease-Free Survival for Retroperitoneal Sarcomas

2018 ◽  
Vol 227 (4) ◽  
pp. S239-S240
Author(s):  
Jasvinder Singh ◽  
Faiz Gani ◽  
Nakul Shankar ◽  
Joseph K. Canner ◽  
Heidi N. Overton ◽  
...  
Keyword(s):  
Dose Rate ◽  
Disease Free Survival ◽  
High Dose Rate ◽  
High Dose ◽  
High Dose Rate Brachytherapy ◽  
Free Survival ◽  
Retroperitoneal Sarcomas ◽  
Disease Free

scholarly journals Outcomes of patients with cervical cancer treated with low- or high-dose rate brachytherapy after concurrent chemoradiation

2021 ◽  
pp. ijgc-2020-002120
Author(s):  
Aba Anoa Scott ◽  
Joel Yarney ◽  
Verna Vanderpuye ◽  
Charles Akoto Aidoo ◽  
Mervin Agyeman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Dose Rate ◽  
Local Control ◽  
Disease Free Survival ◽  
High Dose Rate ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Free Survival ◽  
Disease Free

ObjectiveThe majority of patients with cervical cancer in Ghana present with locally advanced disease. In October 2014, high-dose rate (HDR) brachytherapy was introduced at the National Center for Radiotherapy, Accra after years of using low-dose rate (LDR) brachytherapy. The aim of this study was to compare the treatment outcomes of patients treated with LDR versus HDR brachytherapy.MethodsPatients with cervical cancer treated from January 2008 to December 2017 were reviewed. Those with stage IB–IIIB who received chemoradiation plus brachytherapy were included in the study. Post-operative patients and those with stage IV were excluded. The study end points were local control, disease-free survival, and overall survival at 2 years. Endpoints were estimated using the Kaplan–Meier method. Comparisons between treatment groups were performed using the log-rank test and Cox proportional hazards model.ResultsWe included 284 LDR and 136 HDR brachytherapy patients. For stages IB, IIA, IIB, IIIA and IIIB disease, the 2-year local control for LDR versus HDR brachytherapy was 63% and 61% (p=0.35), 86% and 90% (p=0.68), 86% and 88% (p=0.83), 66% and 60% (p=0.56), and 77% and 40% (p=0.005), respectively. The 2-year disease-free survival for LDR versus HDR brachytherapy was 64% and 61% (p=0.50), 81% and 69% (p=0.18), 81% and 80% (p=0.54), 62% and 33% (p=0.82), and 71% and 30% (p=0.001) for stages IB, IIA, IIB, IIIA, and IIIB, respectively. The 2-year overall survival for LDR versus HDR brachytherapy was 94% and 93% (p=0.92), 98% and 68% (p=0.21), 89% and 88% (p=0.60), and 88% and 82% (p=0.34) for stages IB, IIA, IIB, and IIIB disease, respectively.ConclusionThere was no difference between LDR and HDR brachytherapy in local control and disease-free survival for all stages of disease, except in stage IIIB. These findings highlight the need to refine this brachytherapy technique for this group of patients.

NRG Oncology RTOG 0415: A randomized phase III non-inferiority study comparing two fractionation schedules in patients with low-risk prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 1-1 ◽  
Author(s):  
W. Robert Lee ◽  
James J. Dignam ◽  
Mahul Amin ◽  
Deborah Bruner ◽  
Daniel Low ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Biochemical Recurrence ◽  
Disease Free Survival ◽  
Low Risk ◽  
Free Survival ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Grade 3 ◽  
Disease Free

1 Background: To determine whether the efficacy of a hypofractionated (H) schedule is no worse than a conventional (C) schedule in men with low-risk prostate cancer. Methods: From April 2006 to December 2009, one thousand one hundred fifteen men with low-risk prostate cancer (clinical stage T1-2a, Gleason ≤ 6, PSA < 10) were randomly assigned 1:1 to a conventional (C) schedule (73.8 Gy in 41 fractions over 8.2 weeks) or to a hypofractionated (H) schedule (70 Gy in 28 fractions over 5.6 weeks). The trial was designed to establish with 90% power and alpha = 0.05 that (H) results in 5-year disease-free survival (DFS) that is not lower than (C) by more than 7% (hazard ratio (HR) < 1.52). Secondary endpoints include freedom from biochemical recurrence (FFBR) and overall survival. At the third planned interim analysis (July 2015), the NRG Oncology Data Monitoring Committee recommended that the results of the trial be reported. Results: One thousand one hundred and one protocol eligible men were randomized: 547 to C and 554 to H. Median follow-up is 5.9 years. Baseline characteristics are not different according to treatment arm. At the time of analysis 185 DFS events have been observed; 99 in the C arm and 86 in the H arm. The estimated 7-year disease-free survival is 75.6% (95% CI 70.3, 80.1) in the C arm and 81.8% (77.5, 85.3) in the H arm. The DFS HR (C/H) is 0.85 (0.64, 1.14). Comparison of biochemical recurrence (HR = 0.77, (0.51, 1.17)) and overall survival (HR = 0.95, (0.65, 1.41)) also met protocol non-inferiority criteria. Grade ≥ 3 GI toxicity is 3.0% (C) vs. 4.6% (H), Relative risk (RR) for H vs. C 1.53, (95% CI 0.86, 2.83); grade ≥ 3 GU toxicity is 4.5% (C) vs. 6.4% (H), RR = 1.43 (0.86,2.37). Conclusions: In men with low-risk prostate cancer, 70 Gy in 28 fractions over 5.6 weeks is non-inferior to 73.8 Gy in 41 fractions over 8.2 weeks. Clinical trial information: NCT00331773.

scholarly journals Conformal radiotherapy plus high dose rate brachytherapy prostate boost in patients with intermediate and high risk prostate cancer: our experience in Asian males

2012 ◽  
Vol 11 (4) ◽  
pp. 257-270
Author(s):  
Mutahir A. Tunio ◽  
Altaf Hashmi ◽  
Amjad Sattar ◽  
Rehan Mohsin ◽  
Shoukat Ali ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
High Dose Rate ◽  
High Dose ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Post Radiation ◽  
Grade 3 ◽  
3D Crt

AbstractPurpose: Recent studies have shown increased prostate cancer control rates with radiation dose escalation. Herein the experience of dose escalation by high dose rate brachytherapy (HDR-BT) adjunct to the three-dimensional conformal radiation therapy (3D-CRT) for prostate cancer is presented.Patients and methods: During the period between August 2005 and July 2007, patients with intermediate and high risk prostate cancer were treated with 3D-CRT of dose 46Gy ÷ 23 fractions to whole pelvis followed by: Arm A (102 patients): prostate boost with HDR-BT 14 Gy × 2 sessions and Arm B (103 patients): prostate boost via 3D-CRT of dose 26 Gy ÷ 13 fractions. Primary objectives were overall survival (OS), distant metastases free survival (DMFS) and PSA progression free survival (PPFS) rates. Secondary objectives were the toxicity profile and post-radiation histopathological response.Results: At median follow up of 3.5 years, PPFS, DMFS and OS rates were; 97.8% versus 89.0% (p = 0.009), 98.1% versus 93.6% (p = 0.13) and 98.8% versus 91.6% (p = 0.24) in Arm A and Arm B. respectively. Grade 3 or 4 delayed genitourinary toxicities occurred in 2% and 4.8% of patients in Arm A and Arm B, respectively. Delayed grade 3 and 4 gastrointestinal toxicities were seen in 2% and 3.9% of patients in Arm A and Arm B, respectively. The post-radiation prostate biopsies were negative in 14/17(82.3%) and 9/15 (60%) in Arm A and Arm B, respectively.Conclusion: 3D-CRT combined with HDR-BT resulted in better PPFS and lower morbidity than 3DCRT alone for intermediate and high risk prostate cancer.

125I Brachytherapy for Localized Prostate Cancer: A Single Institution Experience

2013 ◽  
Vol 99 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Alessia Guarneri ◽  
Angela Botticella ◽  
Andrea Riccardo Filippi ◽  
Fernando Munoz ◽  
Giancarlo Beltramo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Early Stage ◽  
Disease Free Survival ◽  
Localized Prostate Cancer ◽  
Free Survival ◽  
Genitourinary Toxicity ◽  
Grade 3 ◽  
Disease Free

Aims and background To evaluate the clinical outcome of a cohort of localized prostate cancer patients treated with 125I permanent brachytherapy at the University of Turin. Methods and study design A retrospective analysis was carried out on 167 consecutive patients with early stage prostate adenocarcinoma who underwent 125I brachytherapy between January 2003 and December 2010. A minimum follow-up of ≥12 months was mandatory for inclusion. Biochemical disease-free survival (defined on the basis of the ASTRO definition and the ASTRO-Phoenix definition) was chosen as the primary end point. Secondary end points were gastrointestinal and genitourinary toxicity (acute and late, defined according to the RTOG scale). Results With a median follow-up of 42 months (range, 13.5–90.7), biochemical disease-free survival at 3 and 5 years was respectively 91.1% and 85.7%, according to the ASTRO definition and 94.5% and 85.1% according to ASTRO-Phoenix definition (for statistical purposes, only the ASTRO definition was used). Hormone treatment and nadir PSA (cutoff of 0.35 ng/ml) were the only factors affecting biochemical disease-free survival both on univariate ( P = 0.02 and P = 0.001, respectively) and multivariate analysis (HR 0.024; P = 0.021 and HR 21.6; P = 0.006, respectively). Only 3.6% of patients experienced ≥grade 3 acute urinary toxicity and 5% ≥grade 3 late urinary toxicity. Prior transurethral prostate resection was the only independent predictor of grade 3 late urinary toxicity on multivariate analysis (HR 0.13; P = 0.009). Conclusions This mono-institutional series confirmed that brachytherapy is an effective and safe treatment modality for localized prostate cancer, with acceptable short- and long-term morbidity rates.

scholarly journals Brachytherapy is a Promising Treatment for Prostate Cancer

2017 ◽  
Vol 10 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Dmitry Yurievich Kamenev ◽  
Ivan Petrovich Moshurov ◽  
Bronislava Borisovna Kravets ◽  
Nataliya Viktorovna Korotkikh
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
High Dose Rate ◽  
High Dose ◽  
Free Survival ◽  
Pulmonary System ◽  
Choice Of Treatment ◽  
Promising Treatment ◽  
Contact Radiation ◽  
Methods Of Treatment

Abstract – prostate Cancer is one of the most common cancers among men. Incidence is second only to tumors of the broncho-  pulmonary system. In recent years significantly increased the interest in contact radiation methods of treatment of this disease (brachytherapy). In the treatment of prostate cancer there is experience of application of different source of dose-rate  used sources of low dose (isotopes of iodine (125I), palladium (103Pd) and cesium (131Cs) and sources used for high dose rate (iridium Ir192 or cobalt 60 Co). In Russia the greatest popularity is the use of isotope Ir192 andI125 for brachytherapy. Given indentichnost the indications for treatment, equivalent figures cancerspecifically and relapse-free survival, the question of the choice of treatment is very important. A brief review of the literature on the use of brachytherapy for prostate cancer sources of different dose. Presents comparative characteristics of treatment results, complications, early and late toxic reactions when used brachytherapy isotopes different dose.

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