High-dose-rate brachytherapy as monotherapy 
for low- and intermediate-risk prostate cancer: 
long-term experience of Swedish single-center

Johansson, Bengt; Olsén, Johan Staby; Karlsson, Leif; Lundin, Erik; Lennernäs, Bo

doi:10.5114/jcb.2021.105846

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…( 25 ), whereas iPSA with a cut off of 10 ng/ml and age were of statistical significance in the study by Johansson et al. ( 26 ), both treating low-, intermediate-risk PCA-patients with HDR-BRT as monotherapy. In the univariate analysis of 1100 low- and intermediate-risk PCA-patients treated with LDR-BRT, Crook et al.…”

Section: Discussionmentioning

confidence: 90%

High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up

et al. 2021

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IntroductionTo evaluate the oncological outcome of high dose rate (HDR) brachytherapy (BRT) as monotherapy for clinically localised prostate cancer (PCA).Material and MethodsBetween January 2002 and February 2004, 141 consecutive patients with clinically localised PCA were treated with HDR-BRT monotherapy. The cohort comprised 103 (73%) low-, 32 (22.7%) intermediate- and 6 (4.3%) high risk patients according to D’Amico classification or 104 (73.8%) low-, 24 (17.0%) intermediate favourable-, 12 (8.5%) intermediate unfavourable- and one (0.7%) very high risk patient according to National Comprehensive Cancer Network (NCCN) one. Patients received four fractions of 9.5 Gy delivered within a single implant up to a total physical dose of 38 Gy. Catheter-implantation was transrectal ultrasound-based whereas treatment planning CT-based. Thirty-three patients (23.4%) received ADT neoadjuvantly and continued concurrently with BRT. Biochemical relapse-free survival (BRFS) was defined according to the Phoenix Consensus Criteria and genitourinary (GU)/gastrointestinal (GI) toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 5.0.ResultsMedian age at treatment and median follow-up time was 67.2 and 15.2 years, respectively. Twenty-three (16.3%) patients experienced a biochemical relapse and 5 (3.5%) developed distant metastases, with only one patient dying of PCA. The BRFS was 85.1% at 15 years and 78.7% at 18 years. The corresponding overall survival, metastases-free survival, and prostate cancer specific mortality at 15- and 18-years was 73.9%/59.1%, 98.3%/90.6%, and 100%/98.5% respectively. Late grade 3 GI and GU toxicity was 4.2% and 5.6% respectively. Erectile dysfunction grade 3 was reported by 27 (19%) patients. From the prognostic factors evaluated, tumor stage (≤T2b compared to ≥T2c) along with the risk group (low-intermediate vs. high) when using the D’Amico classification but not when the NCCN one was taken into account, correlated significantly with BRFS.ConclusionOur long-term results confirm HDR-BRT to be a safe and effective monotherapeutic treatment modality for low- and intermediate risk PCA.

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Section: Discussionmentioning

confidence: 90%

High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up

et al. 2021

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“…A retrospective study on a long term treatment outcome is recently reported by a Swedish single-center study [ 25 ]. The treatment was a high-dose rate brachytherapy applied as monotherapy for treating low- and intermediate-risk prostate cancer patients.…”

Section: Methodsmentioning

confidence: 99%

“… Individual TCP distributions obtained for the parameter values shown in Equations (6) and (7). ( a )—individual TCP distribution for the three-fraction regimen (5 failures out of 107 patients (4.7%) [ 25 ]); ( b )—individual TCP distribution for the two-fraction regimen (15 failures out of 103 patients (14.6%) as reported in [ 25 ]). …”

Section: Figurementioning

confidence: 99%

“…For instance, Alite et al [24] reported a better outcome of SBRT on non-small cell lung cancer (NSCLC) in five fractions when delivered in 14 days (a Monday-Wednesday schedule) vs five fractions delivered in five consecutive days. Quite recently, a retrospective study on a long-term HDR brachytherapy of prostate cancer treatment outcome was reported by a Swedish single-center study [25], where a better cure rate is observed in the group of patients treated with three fractions in 28 days compared to a group treated with two fractions in 14 days. A similar cure rate (biochemical control) as in the group treated with three fractions is reported in [26] for prostate cancer patients treated with HDR brachytherapy of three fractions in 28 days.…”

Section: Introductionmentioning

confidence: 99%

“…A similar cure rate (biochemical control) as in the group treated with three fractions is reported in [26] for prostate cancer patients treated with HDR brachytherapy of three fractions in 28 days. In the current study, we analyze the data reported in [25] using one of the TCP models, incorporating a possible increase in tumor radio-sensitivity developed in [7,9].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Different Timing Schedules on Prostate HDR-Mono-Brachytherapy. A TCP Modeling Investigation

Stavrev

Stavreva

Genova

et al. 2021

Cancers

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Background: Mechanistic TCP (tumor control probability) models exist that account for possible re-sensitization of an initially hypoxic tumor during treatment. This phenomenon potentially explains the better outcome of a 28-day vs 14-day treatment schedule of HDR (high dose rate) brachytherapy of low- to intermediate-risk prostate cancer as recently reported. Methods: A TCP model accounting for tumor re-sensitization developed earlier is used to analyze the reported clinical data. In order to analyze clinical data using individual TCP model, TCP distributions are constructed assuming inter-individual spread in radio-sensitivity. Results: Population radio-sensitivity parameter values are found that result in TCP population values which are close to the reported ones. Using the estimated population parameters, two hypothetical regimens are investigated that are shorter than the ones used clinically. The impact of the re-sensitization rate on the calculated treatment outcome is also investigated as is the anti-hypothesis that there is no re-sensitization during treatment. Conclusions: The carried out investigation shows that the observed clinical data cannot be described without assuming an initially hypoxic state of the tumor followed by re-oxygenation and, hence, re-sensitization. This phenomenon explains the better outcome of the prolonged treatment schedule compared to shorter regimens based on the fact that prostate cancer is a slowly repopulating tumor.

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Detailed functional results after bladder-preserving surgery and high-dose-rate brachytherapy in pediatric bladder/prostate rhabdomyosarcoma

Ellerkamp

Schmidt

Warmann

et al. 2022

J Cancer Res Clin Oncol

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Purpose In pediatric bladder/prostate-rhabdomyosarcoma, the rate of bladder preservation after neoadjuvant chemotherapy is high, with an excellent oncological outcome. Information about functional urological long-term outcomes is rare. Methods Data of all patients who had undergone bladder-preserving surgery with or without brachytherapy at our institution between 2009 and 2020 were analyzed retrospectively. Detailed urological function was assessed focusing on age-related continence, bladder capacity and urodynamic findings. Results We identified 40 patients, median age at surgery of 27 months (range 9–191), and 32 patients additionally received postoperative high-dose-rate brachytherapy. The median follow-up was 32.5 months (range 6–125). The bladder capacity increased from median 66.7% (21.1–180) of expected bladder capacity related to age 3 months after surgery to 87.4% (58.1–181.8) 9 months after surgery. In the group of aged > 6-year-old, continence was 94% (83% with brachytherapy, 100% without brachytherapy). Erectile function was normal in 92% (90% with brachytherapy, 100% without brachytherapy). Bladder capacity was more than 65% expected bladder capacity related to age in 70% (60% with brachytherapy, 86% without brachytherapy). 65% of all patients need neither anticholinergic drugs nor low-dose antibiotics (63% with brachytherapy, 71% without brachytherapy). Conclusions Bladder preservation with good functional outcome can be achieved in localized bladder/prostate-rhabdomyosarcoma. In selected cases, supportive brachytherapy additionally contributes to an improvement in the oncological outcome with calculable risks for bladder and erectile function. Careful urological aftercare should be a fixed priority after oncological follow-ups.

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High-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer: long-term experience of Swedish single-center

Cited by 13 publications

References 35 publications

High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up

High-Dose-Rate Brachytherapy as Monotherapy for Low- and Intermediate-Risk Prostate Cancer. Oncological Outcomes After a Median 15-Year Follow-Up

The Impact of Different Timing Schedules on Prostate HDR-Mono-Brachytherapy. A TCP Modeling Investigation

Detailed functional results after bladder-preserving surgery and high-dose-rate brachytherapy in pediatric bladder/prostate rhabdomyosarcoma

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