Combined treatment with temporary short-term high dose rate Iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma

Borghede, Goran; Hedelin, Hans; Holmäng, Sten; Johansson, K.-A.; Aldenborg, Frank; Pettersson, S.; Sernbo, Göran; Wallgren, Arne; Mercke, Claes

doi:10.1016/s0167-8140(97)00121-7

Cited by 87 publications

(30 citation statements)

References 36 publications

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“…It is reassuring the overall frequency and severity of the reported AE was low, and it are comparable to other prospective brachytherapy studies. (6,(21)(22)(23) This is also comparable to other prospective HDR brachytherapy studies. Borghede et al reported on the results of 50 patients treated with 50 Gy of external beam radiotherapy combined with 2 HDR brachytherapy implants delivering a total dose of 20 Gy (2 fractions).…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

Hsu¹,

Bae²,

Shinohara³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To estimate the rate of late grade 3 or greater genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) following treatment with external beam radiation therapy and prostate high dose rate (HDR) brachytherapy.Methods and Materials-Each participating institution submitted CT based HDR brachytherapy dosimetry data electronically for credentialing and for each study patient. Patients with locally confined T1c-T3b prostate cancer were eligible for this study. All patients were treated with 45 Gy in 25 fractions from external beam radiotherapy and one HDR implant delivering 19 Gy in 2 fractions. All AEs were graded according to CTCAEv3.0. Late GU/ GI AEs were defined as those occurring more than nine months from the start of the protocol treatment, in patients with at least 18 months of potential follow-up.Results-A total of 129 patients from 14 institutions were enrolled in this study. 125 patients were eligible and AE data was available for 112 patients. The pretreatment characteristics of the patients were as follows: T1c-T2c 91%, T3a-T3b 9%, PSA ≤ 10 70%, PSA >10-≤20 30%, GS 2-6 10%, GS 7 72%, and GS 8-10 18%. At a median follow-up time of 29.6 months, 3 acute and 4 late grade 3 GU/GI AEs were reported. The estimated rate of late grade 3-5 GU and GI AE at 18 months was 2.56%.Conclusion-This is the first prospective, multi-institutional trial of CT based HDR brachytherapy and external beam radiotherapy. The technique and doses used in this study resulted in acceptable levels of adverse events.

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Section: Discussionsupporting

confidence: 85%

“…The median number of patients accrued per institution was 8 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and the average was 9 patients. The average monthly accrual for the study was 5.9 patients.…”

Section: Resultsmentioning

confidence: 99%

Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

Hsu¹,

Bae²,

Shinohara³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…Publications on prostate cancer patients treated with conventional fractionated EBRT combined with hypofractionated IMRT boosts 96 of 2 fractions of 5-8 Gy (median follow-up of 63 months) or with concomitant boosts 97,98 in 28 fractions of 2.5 Gy and 25 fractions of 2.7 Gy (median follow-up of 46 and 39 months, respectively) concluded that these treatments were feasible and well tolerated. The results on EBRT treatments in combination with HDRBT boosts 65,66,[99][100][101][102][103][104][105] with median follow-up ranging from 40 to 105 months (2 fractions Â 5-15 Gy, 3 fractions Â 3-6.5 Gy, or 4 fractions Â 3-6 Gy) and extreme hypofractionated treatments of HDRBT delivered as monotherapy [106][107][108][109][110][111][112] at median follow-up of 22-65 months (3 fractions Â 10.5 Gy, 4 fractions Â 8.5-9.5 Gy, 6 fractions Â 6.75-7 Gy, 8 fractions Â 6 Gy, or 9 fractions Â 6 Gy) or stereotactic body radiosurgery [113][114][115] 119,120 median follow-up: 32 months for the hypofractionation regimens and 35 months for the conventional). Despite differences in dose prescription, delivery methods, patient selection according to prognostic factors, short follow-up in many studies, and the use of androgen deprivation therapy in some patients, the clinical experience with hypofractionation seems to be consistent with a low a/b ratio for prostate cancer.…”

Section: Feasibility Of the Hypofractionation Regimensmentioning

confidence: 99%

What do we know about the α/β for prostate cancer?

2012

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Since last decade, the debate on the parameter which reflects prostate cancer sensitivity to fractionation in a radiotherapy treatment, the α/β, has become extensive. Unlike most tumors, the low labeling indices (LI) and large potential doubling time that characterize the prostate tumor led some authors to consider that it may behave as a late responding tissue. So far, the existing studies with regard to this subject point to a low value of α/β, around 2.7 Gy, which may be considered as a therapeutic gain in relation to surrounding normal tissues by using fewer and larger fractions. The aim of this paper is to review several estimates that have been made in the last few years regarding the prostate cancer α/β both from clinical and experimental data, as well as the set of factors that have potentially influenced these evaluations.

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“…Other HDR BT (/100 Gy) papers report 2 Á/11% grade 2Á/4 late GI toxicity [9,12,13,19], while papers reporting toxicity after conformal EBRT dose escalation (74 Á/79 Gy) [16,32 Á/34] indicate 6 Á/14% grade 2 Á/4 toxicity and papers concerning conventional/conformal EBRT (64Á/70 Gy) [17,30,35,37] report 5 Á/15%. The definition of the assessment point for late effects varies from 4 months to 24 months or more in these studies as well.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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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.

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Combined treatment with temporary short-term high dose rate Iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma

Cited by 87 publications

References 36 publications

Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

What do we know about the α/β for prostate cancer?

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

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