Combined curative radiotherapy including HDR brachytherapy and androgen deprivation in localized prostate cancer: A prospective assessment of acute and late treatment toxicity

Abstract

Self-reported symptoms including urinary, bowel and sexual side effects were investigated prospectively at multiple assessment points before and after combined radiotherapy of prostate cancer including HDR brachytherapy and neoadjuvant androgen deprivation therapy. Between April 2000 and June 2003, patients with predominantly advanced localized prostate tumours subjected to this treatment were asked before treatment and on follow-up visits to complete a questionnaire covering urinary, bowel and sexual problems. The mainly descriptive analyses included 525 patients, responding to at least one questionnaire before or during the period 2 Á/34 months after radiotherapy. Adding androgen deprivation before radiotherapy significantly worsened sexual function. During radiotherapy, urinary, bowel and sexual problems increased and were reported at higher levels up to 34 months, although there seemed to be a general tendency to less pronounced irritative bowel and urinary tract symptoms over time. No side effects requiring surgery were reported. Classic late irradiation effects such as mucosal bleeding were demonstrated mainly during the second year after therapy, but appear less pronounced in comparison with dose escalated EBRT series. In conclusion, despite the high radiation dose given, the toxicity seemed comparable with that of other series but long term (5 Á/10 years) symptom outcome has to be determined.

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: Technical and methodological aspects

“…These reports resulted in a renaissance for prostate BT. In 1977, Court and Chassangne (18) began treating prostate cancer with after-loading techniques, and since then several reports have been published (13,14,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Although the data presented were encouraging, no randomised study has been published, and there are criticisms concerning some of the BT treatment studies (29,30).…”

“…No operative death occurred, nor does the frequency of late side effects differ from those of external beam irradiation (13,19,33).…”

“…The urethra is a radiation sensitive organ, and severe side effects were reported in early BT treatments. Stricture development is a well-known problem (13,19). Dinges and collaborators reported on doses producing late 3-4 grade side effects.…”

“…The results of treatment by these modalities are equivalent, but the acute and long-term side effects which develop after the definitive treatment of prostate cancer differ. The main side effects after surgery are impotence and incontinence, while proctitis, colitis and cystitis are seen after radiotherapy (13).…”

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: A 6-year follow-up

“…This combination delivers a normalized dose equivalent of 2 Gy per fraction (NTD) of more than 104 Gy (assuming a conservative tumour alpha/beta ratio 0/3 Gy). Presently, the patient-reported toxicity and quality of life up to 3 years after treatment seem acceptable [3,4].…”