eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2019
vol. 11
 
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abstract:
Original paper

Single fraction high-dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: toxicities and early outcomes from a single institutional experience

Justin M. Barnes
1
,
Prashant Gabani
2
,
Max Sanders
3
,
Anupama Chundury
4
,
Michael Altman
2
,
Jose Garcia-Ramirez
2
,
Harold Li
2
,
Jacqueline E. Zoberi
2
,
Brian C. Baumann
2
,
Hiram A. Gay
2

  1. Saint Louis University School of Medicine, Saint Louis, United States
  2. Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
  3. University of Missouri-St. Louis, Saint Louis, United States
  4. Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
J Contemp Brachytherapy 2019; 11, 5: 399–408
DOI: https://doi.org/10.5114/jcb.2019.89367
Online publish date: 2019/10/30
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Purpose
High-dose-rate brachytherapy (HDR-BT) delivered in a single fraction as monotherapy is a potential treatment modality for low- and intermediate-risk prostate cancer (LIR-PC); however, outcome data with this technique remain limited. Here we describe our institutional HDR monotherapy experience and report the efficacy and toxicity of this treatment.

Material and methods
LIR-PC patients who received a definitive single fraction HDR-BT during 2013-2017 were retrospectively identified. The intended HDR monotherapy dose was 19 Gy in one fraction. Acute (< 90 days) and late (≥ 90 days) toxicity was assessed using CTCAE version 4.03. Trends in prostate-specific antigen (PSA) and American Urological Association (AUA) symptom scores after treatment were assessed using Bayesian linear mixed models. The Kaplan-Meier method was used to evaluate biochemical failure-free survival (BFFS).

Results
28 patients with median follow-up of 23.6 months were identified. The median age at treatment was 65 years (48-83). The NCCN risk groups were low in 14, favorable intermediate in 10, and unfavorable intermediate in 4 patients. There were 5 (18%) and 0 (0%) acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities, respectively, and one (4%) acute grade 3 GU toxicity. There were no late grade 3 toxicities, and 5 (18%) and 0 (0%) late grade 2 GU and GI toxicities respectively. PSA values and AUA symptom scores decreased significantly after treatment. There were 3 biochemical failures with the two- and three-year BFFS of 90.7% and 80.6%, respectively.

Conclusions
Early results from a single institution suggest that single fraction HDR-BT with 19 Gy has limited toxicity, although with suboptimal biochemical control.

keywords:

prostate cancer, brachytherapy, high-dose-rate, single fraction

  
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