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Purpose:The combined external beam-and high-dose rate brachytherapy (HDR-BT) of localized prostate cancer was introduced at Kiel University in 1986. The aim of this intermediate analysis was to judge the Kiel method of localized prostate cancer radiation treatment after ten years experience. Patients and Methods: In the past ten years 174 patients with histological proven localized prostate cancer were subjected to combined tele-/HDR-brachytherapy. Local staging in all of the cases by transrectal ultrasound, nodal staging in the majority of the cases by CT or MRI. Average age of the patients was 68.2 years (44-84). According to AJCC/UICC staging T1B, T2, T3 was found in 2, 113 and 59 cases, respectively. Highly differentiated tumors (G1) were found in 27, moderately differentited (G2) in 87, poorly differentiated (G3) in 60 cases. The mean follow-up was 47.1 months with the median of 51.7 months. Total prescribed dose 50 Gy on the small pelvis and 70 Gy on the prostate capsule due to the integration of two, 15 Gy each, HDR-brachytherapy fractions in 6 weeks. Results: Ten patients died of prostate cancer and 18 of intercurrent diseases resulting in a 5 years overall survival rate of 83% and tumor specific survival rate of 94%. Twenty-one patients showed a clinical progression, of these 14 systemic, 5 local and 2 both systemic and local. Additional 16 patients had PSA elevation only. The 5-years biochemical and/or clinical progression-free survival in the cohort was 79% and 73% for the T3 tumors. Side effects were 27 cases of proctitis/colitis and 20 cases of dysuria/cystitis. Conclusion:The integrated HDR-BT combined with external beam radiation treatment is a method with excellent tumor control rates at five years superior to those of external beam treatment alone or external beam combined with iodine-125 implants. This form of radiotherapy would appear to be particularly well-suited to treatment of advanced localized (T3) tumors.Key Words: Prostate cancer 9 Radiation therapy. HDR-brachytherapy 9 PSA 9 Dose escalation. Transrectal ultrasound R adiotherapy has an established role in the curative management of the patients with prostate cancer, however, the management of organ-confined carcinoma of the prostate remains one of the most controversial issues in contemporary oncology. External beam radiation (EBRT) alone can produce acceptable results in patients with clinically organ-confined tumors and a pretreatment PSA level < 15 ng/ml. To produce good results in patients with higher pretreatment PSA level than 15 ng/ml, aggressive local treatment and/or effective adjuvant treatments are necessary. Combined external beam and interstitial brachytherapy treatment schedules were found succesful also in bulky prostate carcinoma causing moderate toxicity and improved survival.

Brachytherapy is a very successful treatment option for many different tumors. Consequently the quality assurance (QA) of afterloaders is of special interest. For many quality checks verification films are essential. Because currently in many clinics the film development units are replaced by computed radiography systems, the question arises of how to perform QA for afterloaders without conventional radiography films. In this note the use of a new designed multi-slit phantom demonstrates the possibility of performing QA checks with high sensitivity computed radiography systems. Because the presented phantom allows a method for imaging the radiation source it might be useful in the development of further QA techniques.

Perioperative interstitial HDR/PDR-IMBT of localized breast or thoracic wall recurrences following previous full-dose EBRT appears to be a meaningful salvage treatment with acceptable toxicity.

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