Low-dose-rate brachytherapy combined with ultrahypofractionated radiation therapy for clinically localized, intermediate-risk prostate cancer: Results from a prospective trial Journal Article
| Authors: | Kollmeier, M. A.; McBride, S.; Varghese, M.; Debonis, D.; Zhang, Z.; Cohen, G.; Damato, A. L.; Mychalczak, B.; Gewanter, R.; Zelefsky, M. J. |
| Article Title: | Low-dose-rate brachytherapy combined with ultrahypofractionated radiation therapy for clinically localized, intermediate-risk prostate cancer: Results from a prospective trial |
| Abstract: | Purpose: To report early toxicity and tumor control outcomes of Pd-103 brachytherapy with ultrahypofractionated stereotactic radiation therapy (RT) for intermediate-risk prostate cancer. Methods and Materials: This prospective trial included 40 patients with intermediate-risk prostate cancer who underwent low-dose-rate (Pd-103) brachytherapy (prescription dose, 100 Gy), followed 1 month later with ultrahypofractionated stereotactic RT (25 Gy in 5 fractions) to the prostate and seminal vesicles. The primary endpoint was the rate of grade 2+ genitourinary toxicity at 12 months using Common Terminology Criteria for Adverse Events v 4.0. Secondary endpoints included patient-reported quality-of-life metrics (International Prostate Scoring System [IPSS], International Index of Erectile Function, and Expanded Prostate Cancer Index Composite-bowel). Biochemical failure was defined as prostate-specific antigen nadir +2 ng/mL. Posttreatment biopsies were performed at between 24 and 36 months; median follow-up was 36 months. Results: The rate of grade 2 urinary toxicity at 12 months was 25% with no grade 3 urinary toxicity noted. Mean IPSS at baseline and 12 and 24 months was 5, 10, and 6.2, respectively. Mean change in IPSS from baseline at 12 months was +5.5 (interquartile range, 1-9.75) and +1.05 (interquartile range, –3 to 3.25) at 24 months. Grade 2 bowel toxicity was 5% at 12 months with no grade 3 bowel toxicity noted. Mean Expanded Prostate Cancer Index Composite-bowel domain scores at baseline and 12 months were 92.8 and 90.3, respectively. Of patients who were potent (International Index of Erectile Function ≥21) at baseline, 75% remained potent at 12 months. Of 40 patients, 28 underwent posttreatment prostate biopsy (PPB), which was negative (n = 20) or demonstrated severe treatment effect (n = 8). No patient had a positive PPB or developed biochemical failure during the follow-up period. One patient without a PPB developed osseous metastases at 18 months posttreatment in the absence of biochemical failure. Conclusion: Low-dose-rate brachytherapy in combination with ultrahypofractionated stereotactic RT was safe and effective for intermediate-risk prostate cancer in early results of this trial. © 2020 Elsevier Inc. |
| Keywords: | prostate specific antigen; radiotherapy; oncology; biopsy; antigens; dosimetry; biochemical failure; urology; toxicity; low dose rate brachytherapy; diseases; common terminology criteria; inter quartile ranges; methods and materials; genitourinary toxicities; expanded prostate cancer index composites |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 108 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-11-15 |
| Start Page: | 905 |
| End Page: | 913 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2020.05.032 |
| PUBMED: | 32505609 |
| PROVIDER: | scopus |
| PMCID: | PMC8436887 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2020 -- Source: Scopus |
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