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Journal of Contemporary Brachytherapy
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2/2021
vol. 13
 
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abstract:
Original paper

Low-/high-dose-rate brachytherapy boost in patients with intermediate-risk prostate cancer treated with radiotherapy: long-term results from a single institution team experience

Silvia Rodríguez Villalba
1
,
Paula Monasor Denia
1
,
Maria Jose Pérez-Calatayud
2
,
Jose Richart Sancho
1, 3
,
José Pérez-Calatayud
1, 4
,
Antonio Fuster Escrivá
5
,
Pedro Torrus Tendero
5
,
Manuel Santos Ortega
1

  1. Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain
  2. Radiotherapy Department, Fundación IVO Valencia, València, Spain
  3. Radiotherapy Department, Hospital Iniversitario San Juan, San Juan de Alicante, Alicante, Spain
  4. Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
  5. Urology Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
J Contemp Brachytherapy 2021; 13, 2: 135–144
DOI: https://doi.org/10.5114/jcb.2021.105280
Online publish date: 2021/04/14
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Introduction
To compare brachytherapy (BT) boost of low-dose-rate (LDR) and high-dose-rate (HDR) techniques in patients diagnosed with intermediate-risk prostate cancer.

Material and methods
Between January 2005 and February 2018, 142 patients (50 LDR and 92 HDR) with intermediate-risk prostate cancer were treated with a BT boost, and retrospectively analyzed. Prescribed dose was 45 Gy with external beam radiotherapy (EBRT) plus 100-108 Gy with LDR-BT, and 60 Gy with EBRT plus one fraction of 10 Gy with HDR-BT. 99% of patients received androgen deprivation therapy (ADT) for 6 months. Primary endpoint was to compare LDR and HDR boosts in terms of biochemical progression-free survival (bPFS). Secondary endpoint, after re-classifying patients into “favorable” and “unfavorable” sub-groups, was to analyze differences with a similar treatment intensity.

Results
Median overall follow-up for the total cohort was 66.5 months (range, 16-185 months). There were no significant differences in bPFS, overall survival, cause specific survival, local failure, lymph node failure, or distant failure when LDR or HDR was employed. bPFS at 90 months was 100% for favorable, and 89% and 85% for unfavorable patients at 60 months and 90 months, respectively (log-rank test, p = 0.017). The crude incidence of genitourinary acute and chronic toxicity grade 3 was 0.7% and 4%, respectively. Twelve patients (8%) had chronic rectal hemorrhage grade 2, in whom argon was applied (4 LDR and 8 HDR).

Conclusions
Combined treatment is an excellent therapeutic option in patients with intermediate-risk prostate carcinoma, with similar results in both LDR and HDR approaches and very low toxicities. Importantly, the current literature has indicated that unfavorable-risk patients belong to a different category, and should be treated as patients with high-risk factors. Therefore, the stratification and identification of both risk groups is extremely relevant.

keywords:

prostate carcinoma, intermediate-risk, LDR-BT, HDR-BT

  
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