High-dose-rate brachytherapy as a monotherapy for prostate cancer—Single-institution results of the extreme fractionation regimen

Kukielka, A.; Dąbrowski, Tomasz; Walasek, Tomasz; Olchawa, Agnieszka; Kudzia, R.; Dybek, D.

doi:10.1016/j.brachy.2015.01.004

Cited by 30 publications

(12 citation statements)

References 29 publications

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“…For 3 and 4 fraction schemes, doses per fraction similar to those already utilized in some of the studies shown in Table 1 were found. The only exception was that of Kukiełka et al, who used 3 fractions of 15 Gy [22]; however, according to our calculations, it is not necessary to reach such high values to achieve adequate BC. For 2 fraction schemes and BC = 90%, we found that fraction doses of approx.…”

Section: Discussioncontrasting

confidence: 61%

“…For the study of [21], the total dose and dose per fraction averages were considered. The study [22] in prostate cancer. BC at 5 years of the various clinical studies are shown in Figure 2, as a function of EQD 2 and grouped according to their fraction number.…”

Section: Resultsmentioning

confidence: 99%

“…Studies involving high-risk patients were considered only if BC was applied for low-or intermediate-risk patients, separately. Table 1 summarizes characteristics of the 13 clinical studies [10,11,12,13,14,19,20,21,22,23,24,25,26] verifying the conditions mentioned above. They include 16 different fractionation schedules, with a number of fractions varying between 1 and 9, for a total of 22 empirical data sets.…”

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

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A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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Purpose: Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. Material and methods: Published HDR-BT clinical results for low-and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. Results: We obtained a value of α/β = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. Conclusions: The α/β obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/β explains reasonably well the data available in the region of high doses per fraction considered.

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Section: Discussioncontrasting

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

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A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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“…There are now many studies with more than 5 years of follow-up supporting the efficacy and safety of HDR prostate brachytherapy either as a boost or monotherapy. 8 With acceptable biologic effective dose, 17 biochemical failure-free survival for low-risk prostate cancer was >95% while treated with HDR as monotherapy [18][19][20][21][22] ; biochemical failure-free survival for intermediate-and high-risk prostate cancer was 81% to 98% and 66% to 94% while treated with HDR as a boost, respectively. [23][24][25][26][27][28][29][30][31][32][33][34] The incidence of late grade 3 or higher GU and GI toxicity was 0% to 14% and 0% to 4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Building a High-Dose-Rate Prostate Brachytherapy Program With Real-Time Ultrasound-Based Planning: Initial Safety, Quality, and Outcome Results

Zhang

Kang

Ali

et al. 2020

Advances in Radiation Oncology

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Purpose: Growing evidence supports the efficacy and safety of high-dose-rate (HDR) brachytherapy as a boost or monotherapy in prostate cancer treatment. We initiated a new HDR prostate brachytherapy practice in April 2014. Here, we report the learning experiences, short-term safety, quality, and outcome. Methods and Materials: From April 2014 to December 2017, 164 men were treated with HDR brachytherapy with curative intent. Twenty-eight men (17.1%) underwent HDR brachytherapy as monotherapy, receiving 25 to 27 Gy in 2 fractions. Men treated with HDR brachytherapy as a boost received 19 to 21 Gy in 2 fractions. Fifty-two men (31.7%) had high-risk disease. HDR procedure times, dosimetry, and response were recorded and analyzed. Genitourinary (GU) and gastrointestinal (GI) toxicities were recorded according to the toxicity criteria of the Radiation Therapy Oncology Group. Results: Mean HDR procedure times decreased yearly from 179 minutes in 2014 to 115 minutes in 2017. Median follow-up was 18.6 months (range, 3-55 months). At last review, 79% of patients reported returning to baseline GU status, and 100% of patients noted no change in GI status from their baseline. Four patients experienced acute urinary retention. Treatment planning target volume (PTV) was defined as prostate with margins. Dosimetrically, 97.5% of all HDR implants had PTV D90 100%, 81.5% had PTV V100 95%, 73.6% had maximal urethral doses 120%, and 77.5% had rectal 1 mL dose 70% (all but one 10.8 Gy). The estimated 3-year overall survival was 98.7% (95% confidence interval, 91.4%-99.8%), and disease-free survival was 96.2% (95% confidence interval, 89.5%-98.7%). Conclusions: The low incidence of GU and GI complications in our cohort demonstrates that a HDR brachytherapy program can be successfully developed as a treatment option for patients with localized prostate cancer.

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“…In 2015, Kukiełka et al . published local control outcomes as high as 96.9% [ 7 ]. Similar urinary toxicity has been observed in patients treated with HDR monotherapy [ 8 ].…”

Section: Purposementioning

confidence: 99%

An evaluation of the robustness of organ-at-risk recommendations made by GEC/ESTRO according to interobserver variability: a single-center experience

Chicas-Sett¹,

Celada-Alvarez²,

Roldán³

et al. 2016

jcb

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PurposeGroupe Européen de Curiethérapie (GEC) and European Society for Radiotherapy & Oncology (ESTRO) has proposed a rectal dose constraint of the most exposed 2-cc volume (D2cc of ≤ 75 Gy EQD2α/β = 3) during external-beam plus high-dose-rate brachytherapy (HDR-BT) in localized prostate cancer patients. This study aimed to evaluate D2cc for rectal contouring via interobserver variability.Material and methodsFour blinded observers contoured rectums of 5 patients. Rectal contouring anatomical limits were determined through previous consensus. Dose-volume histogram (DVH) dosimetric parameters (D0.1cc, D1cc, and D2cc) were analyzed according to GEC/ESTRO recommendations and subjected to intra- and interobserver comparisons. Latter comparisons involved coefficients of variation. For each parameter, the mean, standard deviation (SD), and range were evaluated. The effect of interobserver variation on total dose was analyzed by estimating the biologically equivalent rectal dose (EQD2α/β = 3).ResultsInterobserver coefficients of variation for D0.1cc, D1cc, and D2cc were 5.7%, 4.5%, and 4%, respectively. The highest interobserver rectal delineation variation yielded a rectal dose difference up to 5.8 Gy EQD2. Estimated intraobserver variation for the reported D2cc was 5.5% in the worst-case scenario (non-significant).ConclusionsWe observed acceptable interobserver variability in EQD2 for D2cc, with strong impacts on clinical threshold levels (D2cc ≤ 75 Gy EQD2) in some cases. This small, single-center analysis will be extended in a multicenter study.

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High-dose-rate brachytherapy as a monotherapy for prostate cancer—Single-institution results of the extreme fractionation regimen

Cited by 30 publications

References 29 publications

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Building a High-Dose-Rate Prostate Brachytherapy Program With Real-Time Ultrasound-Based Planning: Initial Safety, Quality, and Outcome Results

An evaluation of the robustness of organ-at-risk recommendations made by GEC/ESTRO according to interobserver variability: a single-center experience

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