Clinical outcomes of high-dose-rate brachytherapy and external beam radiotherapy in the management of clinically localized prostate cancer Journal Article


Authors: Kotecha, R.; Yamada, Y.; Pei, X.; Kollmeier, M. A.; Cox, B.; Cohen, G. N.; Zaider, M.; Zelefsky, M. J.
Article Title: Clinical outcomes of high-dose-rate brachytherapy and external beam radiotherapy in the management of clinically localized prostate cancer
Abstract: Purpose: To report prostate-specific antigen (PSA) relapse-free survival and treatment-related toxicity outcomes after combining high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) for patients with clinically localized prostate cancer. Methods and Materials: Between 1998 and 2009, 229 patients were treated with HDR brachytherapy followed 3 weeks later by supplemental EBRT. The HDR brachytherapy boost consisted of three fractions of 192Ir (5.5-7.5Gy per fraction), and EBRT consisted of intensity-modulated radiotherapy delivering an additional 45.0-50.4Gy directed to the prostate gland and seminal vesicles. Median follow-up was 61 months. Results: Seven-year PSA relapse-free survival for low-, intermediate-, and high-risk patients were 95%, 90%, and 57%, respectively (p< 0.001). Among high-risk patients treated with biological equivalent doses in excess of 190. Gy, 7-year PSA relapse-free survival was 81%. In multivariate analysis, Gleason scores of ≥8 predicted for increased risk of biochemical failure, whereas the use of short-term neoadjuvant androgen deprivation therapy did not influence tumor-control outcomes even among intermediate- or high-risk patients. Seven-year incidence of distant metastases for low-, intermediate-, and high-risk patients were 5%, 3%, and 17%, respectively. Seven-year incidence of late Grade 2 and 3 genitourinary toxicities were 22.1% and 4.9%, respectively and the 7-year incidence of Grade 2 and 3 gastrointestinal toxicities were 1% and 0.4%, respectively. Conclusion: HDR prostate brachytherapy in conjunction with supplemental EBRT results in excellent biochemical relapse-free survival rates with a low incidence of severe late genitourinary or gastrointestinal toxicities. The use of short-term neoadjuvant androgen deprivation did not influence long-term biochemical tumor control in this cohort. © 2013.
Keywords: prostate cancer; imrt; brachytherapy; radiation therapy; toxicity; high-dose rate
Journal Title: Brachytherapy
Volume: 12
Issue: 1
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2013-01-01
Start Page: 44
End Page: 49
Language: English
DOI: 10.1016/j.brachy.2012.05.003
PROVIDER: scopus
PUBMED: 22831750
DOI/URL:
Notes: --- - "Export Date: 1 February 2013" - "CODEN: BRACC" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brett Wayne Cox
    62 Cox
  2. Michael J Zelefsky
    599 Zelefsky
  3. Yoshiya Yamada
    352 Yamada
  4. Gilad N Cohen
    132 Cohen
  5. Marisa A Kollmeier
    143 Kollmeier
  6. Marco Zaider
    169 Zaider
  7. Xin Pei
    97 Pei