High-Dose Rate Brachytherapy of Prostatic Adenocarcinoma in Combination with External Beam Radiotherapy

Lennernäs, Bo; Holmäng, Sten; Hedelin, Hans

doi:10.1007/s00066-002-0920-0

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…Other HDR BT ( /100 Gy) papers report 2Á/8% grade 3 Á/4 late GU toxicity [10,15,21,36], while papers reporting toxicity after conformal EBRT dose escalation (74 Á/79 Gy) [16,18,32] indicate 1Á/9% grade 3Á/4 toxicity. The definition of the assessment point for late effects varies from 4 months to 24 months or more in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…In Sweden, a technique using temporary transperineally implanted iridium 192 sources was introduced at University Hospital Sahlgrenska, Gothenburg, in 1988, and this treatment has encouraging long term results [15]. At the department of Oncology, Radiumhemmet, Karolinska University Hospital, we have been treating patients since 1998 with EBRT'/HDR BT boost for localized prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…The rest period (8,26). The patients also receive 3-6 months of pre-treatment Flutamid (250 mg x 3/day) and Leuprorelin (3.75 mg x 1/month).…”

Section: Methodsmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Edgren

Ekelund²,

Albertsson³

et al. 2006

Int J Oncol

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Abstract. The aim of this study was to focus on certain characteristic problems associated with Iridium-192 high dose-rate brachytherapy in combination with external beam radiation therapy (EBRT) in the treatment of patients with localised prostate cancer. Over a period of 16 years, >2,000 patients with prostate cancer have been treated in Sweden with a combination of two fractions of 10 Gy Ir-192 HDR-BT and 50 Gy of fractionated EBRT. Although this treatment is usually well tolerated, there are biological and technical factors to be considered before and during the treatment of the patient to avoid side effects or under-treatment of the target volume. Some of the problems facing the doctors are transducer stability, needle deviation, target definition, target motion, pubic arch interference, concomitant diseases and tolerance doses for different organs at risk. These problems are discussed and possible solutions are presented in this study. IntroductionProstate cancer is the most common malignancy afflicting Swedish men (1,2). Annually, more than 9,000 new cases are diagnosed (3). Although health controls have been ardently discussed during recent years, no screening programmes have as yet been initiated in Scandinavia (4,5). Radiotherapy and radical prostatectomy are generally regarded as the two chief modalities suitable for curative intent treatment (6-12). 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).The advantage of brachytherapy (BT) is the short irradiation range. This minimises the dose to organs at risk in the neighbourhood of the target, even though therapy requires that the irradiation source is placed inside or very near the target.Prostate BT was first reported by Pasteau in 1911 (14). The complication rate was high, probably due to the application of the source through the urethra. In the years that followed, the treatment of prostate cancer has focused on radical prostatectomy and external beam radiation therapy (EBRT). However, two different techniques for obtaining a more homogeneous dose distribution in the prostate, which reduce the frequency of side effects, were reported by Flocks in 1964 (15), by Carlton (16) and by Whitmore et al in 1972 (17). These techniques utilized permanent implants of low doserate (LDR) Gold-198 and Iodine-125 isotopes, respectively. 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). Randomised clinical trials are planned by national groups...

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“…Allocation to one treatment arm was performed when the center did not randomize patients or when the patient did not want to be randomized. As in other tumor entities, one of the major concerns of using adjuvant radiotherapy is increased toxicity [13,19,22]. We report on acute radiation-associated toxicity during radiotherapy and toxicity at the first control following radiotherapy in these patients.…”

Section: Introductionmentioning

confidence: 97%

Acute Toxicity of Adjuvant Radiotherapy in Locally Advanced Differentiated Thyroid Carcinoma

et al. 2003

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High-Dose Rate Brachytherapy of Prostatic Adenocarcinoma in Combination with External Beam Radiotherapy

Abstract: The combined treatment gave an exceptionally good local control (86%). The method represents a promising curative treatment, but the effect can be double edged. The small number of patients in this study restricts a more conclusive statement concerning this treatment modality.

Cited by 13 publications

References 21 publications

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

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

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

Acute Toxicity of Adjuvant Radiotherapy in Locally Advanced Differentiated Thyroid Carcinoma

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