International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationHigh-Dose-Rate Brachytherapy and External-Beam Radiotherapy for Hormone-Naïve Low- and Intermediate-Risk Prostate Cancer: A 7-Year Experience
Introduction
External-beam radiotherapy (EBRT) is one of the most used options for the treatment of localized prostate cancer (PC). High doses >70 Gy have to be used to achieve good local control, but may increase complications (1). High-dose conformal radiotherapy can also be achieved with brachytherapy. The use of high-dose-rate brachytherapy (HDR-BT) as a boost combined with EBRT is advocated. Martinez et al. (2) reported good results using two to three implants with fractions of 5.5–11.5 Gy. With a median follow-up of 8.2 years, the overall survival (OS) at 8 years in the series of Galalae et al. (3) was 70% after 40 Gy EBRT and 2 × 15 Gy HDR-BT, with a local recurrence rate of 6% for intermediate- and high-risk PC patients. This combined radiotherapy approach may enhance local control and decrease complications because HDR-BT creates a highly conformal dose of radiation within the prostate, with a rapid dose fall-off outside. The HDR boost also has a radiobiologic advantage gained by hypofractionation (4). Starting in 2000 we treated hormone-naïve patients with low- and intermediate-risk PC with HDR-BT as a boost in combination with EBRT to shorten the overall treatment time and to reduce toxicity. We report here our long-term results and toxicity.
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Patients
Between February 2000 and July 2007, 264 patients with low- and intermediate-risk PC were treated with EBRT in combination with an HDR-BT boost. These patients had Stage T1a–T2c histologically proven PC, an initial prostate-specific antigen (PSA) level <15 ng/mL, and a Gleason score (GS) ≤7. Pretreatment evaluations included a clinical history, physical examination, and blood laboratory findings. A bone scan and pelvic computed tomography (CT) were recommended on demand. Tumor-node-metastases
Results
The median age of patients was 66 years (range, 45–79 years). Median follow-up was 74.5 months (range, 2.0–133.0 months). All but 13 patients (95.1%) contributed a minimum of one toxicity assessment to these results, and all but 2 patients (99.3%) contributed with a minimum of one PSA analysis. The T stages of the patients were as follows: T1a (1.5%), T1b (0.4%), T1c (60.2%), T2a (32.2%), T2c (1.1%), T2b (3.4%), T2c (1.1%), and unknown T (1.1%). The GS was 7 in 6% of the patients, and 94% had
Discussion
High-dose-rate brachytherapy in combination with EBRT was given for localized low- and intermediate-risk PC. This group of patients can be treated with radical prostatectomy, with a freedom from biochemical failure (FFBF) ranging from 70% to 80% (6); the same long-term results are reported with laparoscopic prostatectomy (7). External-beam RT in this risk group has a good oncologic outcome, but toxicity is a major concern 1, 8. The majority of our patients were low-risk patients with a
Conclusions
We reported our long-term follow-up results of EBRT plus HDR-BT for low- and intermediate-risk PC patients, in terms of oncologic outcome and toxicity, and we compared our results with the available literature. We confirm the excellent results for low- and intermediate-risk PC patients using EBRT plus HDR-BT. We suggest the use of less intensive treatment for this group, using monotherapy HDR-BT. We also suggest the treatment of higher (intermediate)-risk patients with this regimen (EBRT plus
Acknowledgment
The authors thank Renee Rijnsdorp, Connie de Pan, and Dick Sipkema for their skilled technical assistance.
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Conflict of interest: none.