A single institution analysis of low-dose-rate brachytherapy: 5-year reported survival and late toxicity outcomes

Abstract

PurposeTo report the 5-year biochemical relapse-free survival (BRFS), overall survival (OS), and long-term toxicity outcomes of patients treated with low-dose-rate (LDR) brachytherapy as monotherapy for low- to intermediate-risk prostate cancer.Material and methodsBetween 2004 and 2011, 371 patients were treated with LDR brachytherapy as monotherapy. Of these, 102 patients (27%) underwent transurethral resection of the prostate (TURP) prior to implantation. Follow-up was performed every 3 months for 12 months, then every 6 months over 4 years and included prostate specific antigen evaluation. The biochemical relapse-free survival (BRFS) was defined according to the Phoenix criteria. Acute and late toxicities were documented using the Common Terminology Criteria for Adverse Events version 4.0. The BRFS and OS estimates were calculated using Kaplan-Meier plots. Univariate and multivariate analyses were performed to evaluate outcomes by pre-treatment clinical prognostic factors and radiation dosimetry.ResultsThe median follow-up of all patients was 5.45 years. The 5-year BRFS and OS rates were 95% and 96%, respectively. The BRFS rates for patients with Gleason score (GS) > 7 and GS ≤ 6 were 96% and 91% respectively (p = 0.06). On univariate analysis, T1 and T2 staging, risk-group classification, and prostate volumes had no impact on survival at 5 years (p > 0.1). Late grade 2 and 3 genitourinary (GU) toxicities were observed in 10% and 5% of patients respectively. Additionally, patients with prior TURP had a greater incidence of late grade 2 or 3 urinary retention (p = 0.001). There were 14 deaths in total; however, none were attributed to prostate cancer.ConclusionsLDR brachytherapy is an effective treatment option in low- to intermediate-risk prostate cancer patients. We observed low biochemical relapse rates and minimal GU toxicities several years after treatment in patients with or without TURP. However, a small risk of urinary retention was observed in some patients.

High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

“…A prior mini TURP did not result in a urinary incontinence rate of 18% as previously reported by Kollmeier et al . The use of a prior mini TURP in LDR brachytherapy has also shown similar low GU toxicity with no urethral necrosis or urinary incontinence reported …”

“…19,20 A prior mini TURP did not result in a urinary incontinence rate of 18% as previously reported by Kollmeier et al 21 The use of a prior mini TURP in LDR brachytherapy has also shown similar low GU toxicity with no urethral necrosis or urinary incontinence reported. 22,23 The use of HS was also safe with all patients successfully implanted with no postoperative complications reported. In addition, we reported less GI rectal toxicities in patients who underwent HS insertion.…”

Combined Low Dose Rate Brachytherapy and External Beam Radiation Therapy for Intermediate-Risk Prostate Cancer

“…In this study, the cumulative incidence of late grade 3 GU toxicity was 6.5%, consistent with most reports except the ASCENDE-RT study [10]. This is no different to the incidence of late grade 3 GU toxicity in LDR alone and this is widely considered to be acceptable [8,[13][14][15].…”

“…The NRG Oncology/RTOG0232 study [7] [8]. This cohort consisted of Gleason score 3þ4¼7 or ISUP group 2 prostate cancers with PSA <10 and clinical stage T1c-2a disease only.…”

Brachytherapy for localized prostate cancer in the modern era: a comparison of patient-reported quality of life outcomes among different techniques

“…Given the rapid dose fall off associated with brachytherapy, one can achieve an increased BED while limiting normal tissue toxicity. Both high-dose-rate (HDR) and low-dose-rate (LDR) techniques exist, each with a unique set of advantages and disadvantages [16,17,18]. In the definitive management of prostate cancer, brachytherapy can be used as a monotherapy or as a boost with EBRT depending on the aggressiveness of the disease, with favorable outcomes compared to EBRT alone [19,20].…”