Favorable clinical outcomes of three-dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer.

PURPOSE To report PSA relapse-free survival and toxicity outcomes of prostate cancer patients who have undergone three-dimensional computer-optimized high-dose-rate (HDR) brachytherapy with external beam radiotherapy as definitive treatment. METHODS AND MATERIALS One hundred five patients consecutively treated between 1998 and 2004 are reported. All patients were treated with HDR boost with lr 192 (5.5-7.0 Gy), based upon postimplant CT three-dimensional treatment planning using an in-house treatment plan optimization algorithm. Three-dimensional conformal external beam radiotherapy (45-50.4 Gy) was also administered 3 weeks after the HDR procedure. Toxicity was measured using National Cancer Institutes Common Toxicity Criteria and International Prostate Symptom Score indices. RESULTS With a median followup of 44 months (8-79 months), the 5-year PSA relapse-free survival outcomes for low, intermediate and high-risk patients were 100%, 98%, and 92%, respectively, Median urinary toxicity, and 93% of patients denied rectal problems at the time of last followup. Erectile dysfunction was noted in 47% patients at the time of last followup, but overall 80% were able to achieve vaginal penetration when those who responded to sildenafil were included. CONCLUSION Computer-optimized three-dimensional HDR prostate brachytherapy provides excellent disease control for even high risk localized prostate cancer. Significant toxicity has been minimal.

[1]  D. Baltas,et al.  3D conformal HDR brachytherapy and external beam irradiation combined with temporary androgen deprivation in the treatment of localized prostate cancer. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[2]  G. Morton,et al.  The emerging role of high-dose-rate brachytherapy for prostate cancer. , 2005, Clinical oncology (Royal College of Radiologists (Great Britain)).

[3]  J. Fowler,et al.  How low is the α/β ratio for prostate cancer? in regard to Wang et al., IJROBP 2003;55:194–203 , 2003 .

[4]  I. Hsu,et al.  Normal tissue dosimetric comparison between HDR prostate implant boost and conformal external beam radiotherapy boost: potential for dose escalation. , 2000, International journal of radiation oncology, biology, physics.

[5]  T. Mate,et al.  Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. , 2004, International journal of radiation oncology, biology, physics.

[6]  A. Renshaw,et al.  Biochemical Outcome after radical prostatectomy, external beam Radiation Therapy, or interstitial Radiation therapy for clinically localized prostate cancer , 1998 .

[7]  G. Gustafson,et al.  High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. , 2004, The Journal of urology.

[8]  S. Loening,et al.  High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. , 2005, European urology.

[9]  Y. Yoshioka,et al.  High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. , 2000, International journal of radiation oncology, biology, physics.

[10]  G. Gustafson,et al.  Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. , 2001, International journal of radiation oncology, biology, physics.

[11]  James D. Cox,et al.  Consensus statement: Guidelines for PSA following radiation therapy , 1997 .

[12]  J. Chavaudra,et al.  Prescribing, Recording, And Reporting Photon Beam Therapy Presentation Of The ICRU Report # 50 , 1992 .

[13]  L. Schour,et al.  High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy's 10-year results. , 2005, International journal of radiation oncology, biology, physics.

[14]  G. Gustafson,et al.  Conformal high dose rate brachytherapy improves biochemical control and cause specific survival in patients with prostate cancer and poor prognostic factors. , 2003, The Journal of urology.

[15]  D. Brenner,et al.  Direct evidence that prostate tumors show high sensitivity to fractionation (low α/β ratio), similar to late-responding normal tissue , 2002 .

[16]  P. Novaes,et al.  Late urinary morbidity with high dose prostate brachytherapy as a boost to conventional external beam radiation therapy for local and locally advanced prostate cancer. , 2004, The Journal of urology.

[17]  J. Fowler,et al.  New data on the value of α/β—evidence mounts that it is low , 2004 .

[18]  Scott Tyldesley,et al.  Evaluation of the Houston biochemical relapse definition in men treated with prolonged neoadjuvant and adjuvant androgen ablation and assessment of follow-up lead-time bias. , 2003, International journal of radiation oncology, biology, physics.

[19]  A. Renshaw,et al.  Optimizing patient selection for dose escalation techniques using the prostate-specific antigen level, biopsy gleason score, and clinical T-stage. , 1999, International journal of radiation oncology, biology, physics.

[20]  Jian Z. Wang,et al.  The low α/β ratio for prostate cancer: What does the clinical outcome of HDR brachytherapy tell us? , 2003 .

[21]  D J Brenner,et al.  Fractionation and protraction for radiotherapy of prostate carcinoma. , 1999, International journal of radiation oncology, biology, physics.