High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes

Vigneault, Éric; Mbodji, Khaly; Magnan, Sindy; Després, Philippe; Lavallée, Marie-Claude; Aubin, Sylviane; Beaulieu, Luc; Foster, William; Martin, André-Guy

doi:10.1016/j.radonc.2017.06.012

Cited by 30 publications

(18 citation statements)

References 29 publications

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“…More so, patients receiving ADT exhibited a reduced BFFS and OS rates when compared to those not receiving ADT therapy. Vigneault reported on the effects of various EBRT (36–44 Gy in 12–25 fractions) with HDR‐BT (15–21 Gy in 1–3 fractions) regimes on 832 patients with localized prostate adenocarcinoma and showed BFFS rates for patients with intermediate and high risks cancers to be 94.6% and 93.5%, respectively ( P = NS). In addition, patients receiving ADT (41.3% of the entire cohort) also showed a lower 5‐year BFFS rate compared to those not receiving ADT therapy (90.5% vs. 96.5%, P = 0.001).…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2019

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Introduction To examine the long‐term outcomes of high dose rate brachytherapy boost (HDR‐BT) combined with external beam radiotherapy (EBRT) for intermediate and high‐risk prostate cancer patients. Methods Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR‐BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results A total of 24 patients received an initial HDR‐BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow‐up was 58 months. The 5‐year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion The combined HDR‐BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre‐emptive TURP and/or HS insertion.

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Section: Discussionmentioning

confidence: 99%

“…More so, patients receiving ADT exhibited a reduced BFFS and OS rates when compared to those not receiving ADT therapy. Vigneault11 reported on the effects of various EBRT (36-44 Gy in 12-25 fractions) Australian studies. In Yaxley et al,12 the authors reported on the effects of EBRT and HDR-BT with ADT in 507 men with prostate cancer.…”

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confidence: 99%

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

et al. 2019

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“…At 5 years, Helou et al reported bPFS was 97.4% and 92.7% in sequential phase II studies of a single 15 Gy HDR boost and two 10 Gy fraction boosts respectively [7]. Retrospective series reported bPFS at 5 years ranging from 82.5% to 97.7% [6,17,19]. It should be noted that those studies with bPFS at 5 years for HDR-EBRT in excess of 90% had more patients with intermediate risk disease and fewer with high risk disease [6,7,19].…”

Section: Discussionmentioning

confidence: 99%

A comparison of outcomes for patients with intermediate and high risk prostate cancer treated with low dose rate and high dose rate brachytherapy in combination with external beam radiotherapy

Slevin

Rodda

Bownes

et al. 2020

Clinical and Translational Radiation Oncology

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Low dose rate brachytherapy High dose rate brachytherapy External beam radiotherapy a b s t r a c t Introduction: There is evidence to support use of external beam radiotherapy (EBRT) in combination with both low dose rate brachytherapy (LDR-EBRT) and high dose rate brachytherapy (HDR-EBRT) to treat intermediate and high risk prostate cancer. Methods: Men with intermediate and high risk prostate cancer treated using LDR-EBRT (treated between 1996 and 2007) and HDR-EBRT (treated between 2007 and 2012) were identified from an institutional database. Multivariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS).Results: 116 men were treated with LDR-EBRT and 171 were treated with HDR-EBRT. At 5 years, bPFS was estimated to be 90.5% for the LDR-EBRT cohort and 77.6% for the HDR-EBRT cohort. On multivariable analysis, patients treated with HDR-EBRT were more than twice as likely to experience biochemical progression compared with LDR-EBRT (HR 2.33, 95% CI 1.12-4.07). Patients with Gleason 8 disease were more than five times more likely to experience biochemical progression compared with Gleason 6 disease (HR 5.47, 95% CI 1.26-23.64). Cumulative incidence of grade 3 genitourinary and gastrointestinal toxicities for the LDR-EBRT and HDR-EBRT cohorts were 8% versus 4% and 5% versus 1% respectively, although these differences did not reach statistical significance. Conclusion: LDR-EBRT may provide more effective PSA control at 5 years compared with HDR-EBRT. Direct comparison of these treatments through randomised trials are recommended to investigate this hypothesis further.

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“…Vigneault et al (27) reported on a cohort of 832 men with intermediate and high-risk disease treated with a range of doses of HDR brachytherapy boost in combination with EBRT and found biochemical control of 95% with median follow-up of 66 months (27). In this trial, they reported that late grade 3 GU toxicity ranged from ∼2-5% dependent on the dose level the patient was treated on (27). There were no grade 3 GI toxicities reported.…”

Section: Hdr Boostmentioning

confidence: 91%

“…While no other prospective, randomized comparisons of DE-EBRT and HDR boost exist, multiple single institution reports have demonstrated favorable biochemical control rates similar to those in ASCENDE-RT with better toxicity profiles. Vigneault et al (27) reported on a cohort of 832 men with intermediate and high-risk disease treated with a range of doses of HDR brachytherapy boost in combination with EBRT and found biochemical control of 95% with median follow-up of 66 months (27). In this trial, they reported that late grade 3 GU toxicity ranged from ∼2-5% dependent on the dose level the patient was treated on (27).…”

Section: Hdr Boostmentioning

confidence: 94%

A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

et al. 2019

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For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LDR) or high-dose rate (HDR) brachytherapy to EBRT, although only ASCENDE-RT compared brachytherapy to dose-escalated EBRT but did report an over 50% improvement in biochemical failure with a LDR boost. Multiple single institution and comparative research series also support the use of a brachytherapy boost in the DE-EBRT era and demonstrate excellent prostate cancer specific outcomes. Despite improved oncologic outcomes with a brachytherapy boost in the high-risk setting, the utilization of both LDR, and HDR brachytherapy use is declining. The acute genitourinary toxicities when brachytherapy boost is combined with EBRT, particularly a LDR boost, are of concern in comparison to EBRT alone. HDR brachytherapy boost has many physical properties inherent to its rapid delivery of a large dose which may reduce acute toxicities and also appeal to the radiobiology of prostate cancer. We herein review the evidence for use of either LDR or HDR brachytherapy boost for high-risk prostate cancer and summarize comparisons between the two treatment modalities.

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High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes

Cited by 30 publications

References 29 publications

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

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 comparison of outcomes for patients with intermediate and high risk prostate cancer treated with low dose rate and high dose rate brachytherapy in combination with external beam radiotherapy

A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

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