High-dose rate interstitial with external beam irradiation for localized prostate cancer – results of a prospective trial

Dinges, Stefan; Deger, S.; Koswig, Stephan; Boehmer, Dirk; Schnorr, Dietmar; Wiegel, Thomas; Loening, Stefan A.; Dietel, Manfred; Hinkelbein, W.; Budach, Volker

doi:10.1016/s0167-8140(98)00054-1

Cited by 107 publications

(52 citation statements)

References 20 publications

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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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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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“…Dinges et al reported the results from 82 evaluable patients, treated with external beam radiotherapy (45 Gy in 25 fractions) combined with two sessions of brachytherapy (9 Gy a week). Of these patients, 73% had negative biopsies at 2 years follow-up and 43 patients had a PSA B/1.0 mg/l after 24 months [30]. In our present study, patients with PSA relapse were examined with digital rectal examination and suspected pathological findings were investigated using fine-needle aspiration cytology.…”

Section: Clinical Outcomementioning

confidence: 94%

“…The urethra is considered to be rather resistant to irradiation. However, urethral strictures, urethral necrosis, urinary incontinence have been reported [30,35,36]. Galalae et al have identified trans-urethral resection of the prostate (TUR-P) less then 6 months before irradiation as a risk factor, and they reduced the urinary tract toxicity by excluding patients with previous history of TUR-P [36].…”

Section: Side Effectsmentioning

confidence: 99%

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: A 6-year follow-up

et al. 2007

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“…Dinges and collaborators reported on doses producing late 3-4 grade side effects. Five percent risk for severe side effects was noted at 91 Gy, and 50% risk at 160 Gy converted into 2 Gy fractions (23). Thus it is important to outline the urethra and at the same time, there is a problem in visualising the position of the urethra in the planning position.…”

Section: Problems Associated With Anatomymentioning

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).…”

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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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High-dose rate interstitial with external beam irradiation for localized prostate cancer – results of a prospective trial

Cited by 107 publications

References 20 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

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: A 6-year follow-up

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

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