Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer

Claudia Schweizer; Vratislav Strnad; Ricarda Merten; Philipp Schubert; Michael Lotter; Stephan Kreppner; Rainer Fietkau; Andre Karius

doi:10.5114/jcb.2024.146671

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer

Claudia Schweizer

^{1, 2}

,

Vratislav Strnad

^{1, 2}

,

Ricarda Merten

^{1, 2}

,

Philipp Schubert

^{1, 2}

,

Michael Lotter

^{1, 2}

,

Stephan Kreppner

^{1, 2}

,

Rainer Fietkau

^{1, 2}

,

Andre Karius

^{1, 2}

Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
Comprehensive Cancer Center Erlangen EMN (CCC Erlangen-EMN), Erlangen, Germany

J Contemp Brachytherapy 2024

DOI: https://doi.org/10.5114/jcb.2024.146671

Online publish date: 2025/01/14

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Purpose:
To evaluate the efficacy and toxicity of interstitial temporary brachytherapy boost for prostate cancer patients using real-world data.

Material and methods:
Between 2008 and 2016, 115 patients treated with external beam radiotherapy (EBRT) followed by a brachytherapy boost (BT boost) were eligible for this retrospective analysis. Patients received either interstitial high-dose-rate brachytherapy (HDR-BT) with 2 x 9-9.5 Gray (Gy) schedule or pulsed-dose-rate brachytherapy (PDR-BT) with 35 Gy as boost after EBRT (50.4 Gy), up to a total dose of 86-98 Gy (EQD_2α/β = 3). Primary endpoints of the present analysis were cumulative local recurrence rate (LRR), biochemical recurrence-free survival (bRFS), tumor-specific survival, and overall survival (OS). As secondary objective, treatment-related toxicity was evaluated.

Results:
The median follow-up time was 87 (range, 9-159) months, and the median age was 72 (range, 48-83) years. The median prostate specific antigen value (PSA) was 12.2 (range, 2.4-288) ng/ml. 78/ 115 (68%) patients had high-risk prostate cancer according to the D’Amico classification. At 7 years, the cumulative LRR for the whole cohort was 1.8%. The 7-year bRFS, cancer-specific survival, and OS were 85.2%, 97.3%, and 88.9%. The 5-year prevalence of late toxicity grade 3 or higher according to the LENT-SOMA scale was 4%. There were no significant differences for treatment outcome or toxicity for HDR vs. PDR treatment. A prostate gland of 50 cm³ or more was not associated with worse treatment efficacy or increased side effects, apart from the prevalence of urethritis after 5 years (p = 0.035).

Conclusions:
BT boost in patients with prostate cancer is efficient and well-tolerated, with low rates of side effects also in elderly patients. HDR- and PDR-BT were equally efficient and well-tolerated. A large prostate gland is no contraindication for BT. Therefore, BT boost should be offered to all eligible patients.

keywords:

Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer

Claudia Schweizer 1, 2 , Vratislav Strnad 1, 2 , Ricarda Merten 1, 2 , Philipp Schubert 1, 2 , Michael Lotter 1, 2 , Stephan Kreppner 1, 2 , Rainer Fietkau 1, 2 , Andre Karius 1, 2

pulsed-dose-rate, high-dose-rate, prostate brachytherapy boost, toxicity of prostate brachytherapy

Claudia Schweizer

^{1, 2}

,

Vratislav Strnad

^{1, 2}

,

Ricarda Merten

^{1, 2}

,

Philipp Schubert

^{1, 2}

,

Michael Lotter

^{1, 2}

,

Stephan Kreppner

^{1, 2}

,

Rainer Fietkau

^{1, 2}

,

Andre Karius

^{1, 2}