High-Dose-Rate Monotherapy for Localized Prostate Cancer: 10-Year Results

Hauswald, Henrik; Kamrava, Mitchell; Fallon, Julia; Wang, Pin-Chieh; Park, Sang-June; Van, Thanh; Borja, Lalaine; Steinberg, Michael L.; Demanes, D. Jeffrey

doi:10.1016/j.ijrobp.2015.07.2290

Cited by 111 publications

(66 citation statements)

References 32 publications

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“…[1][2][3][4][5] In a study published earlier this year, our group showed a 10-year PSA progression-free survival of 97.8% and local control of 99.7% with no late grade 3 or 4 rectal toxicity, and a 4.9% grade 3 or 4 genitourinary toxicity. 3 We currently offer HDR monotherapy to patients with low and intermediate risk prostate cancer, as combination therapy for high-risk disease, and in the salvage setting. With the advancement in sterotactic body radiation therapy, robotic surgery, HDR brachytherapy will continue to be an excellent and cost-effective treatment option for patients.…”

Section: Discussionsupporting

confidence: 50%

“…We have transitioned from early application of radium to permanent I‐125 implant inserted with an open surgical technique, then onto ultrasound guidance, and have continued to improve with implementation of CT and MRI‐planned HDR and LDR brachytherapy. HDR Brachytherapy continues to prove to be an effective treatment for low and intermediate risk prostate cancer with excellent biochemical disease‐free survival and local control . In a study published earlier this year, our group showed a 10‐year PSA progression‐free survival of 97.8% and local control of 99.7% with no late grade 3 or 4 rectal toxicity, and a 4.9% grade 3 or 4 genitourinary toxicity .…”

Section: Discussionmentioning

confidence: 64%

“…HDR Brachytherapy continues to prove to be an effective treatment for low and intermediate risk prostate cancer with excellent biochemical disease‐free survival and local control . In a study published earlier this year, our group showed a 10‐year PSA progression‐free survival of 97.8% and local control of 99.7% with no late grade 3 or 4 rectal toxicity, and a 4.9% grade 3 or 4 genitourinary toxicity . We currently offer HDR monotherapy to patients with low and intermediate risk prostate cancer, as combination therapy for high‐risk disease, and in the salvage setting.…”

Section: Discussionmentioning

confidence: 92%

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Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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Introduction: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy 9 6-fractions and 35 men had 13.5 Gy 9 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse shortterm acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 92%

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Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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“…They also found that each successive 5-year cohort showed a decline in potency 38 . High dose rate brachytherapy was developed as an alternative for patients who could not undergo combined low dose rate and external beam RT and has been used by a few groups with excellent results 39, 40, 41, 42, 43, 44, 45. A recent review of the high dose rate patient outcomes reports that erectile preservation was observed in 57%-89% of patients 46 …”

Section: History Of Ed Treatmentmentioning

confidence: 99%

Radiation-induced erectile dysfunction: Recent advances and future directions

Mahmood

Shamah

Creed

et al. 2016

Advances in Radiation Oncology

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Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the United States. A large number of patients undergo radiation therapy (RT) as a standard care of treatment; however, RT causes erectile dysfunction (radiation-induced erectile dysfunction; RiED) because of late side effects after RT that significantly affects quality of life of prostate cancer patients. Within 5 years of RT, approximately 50% of patients could develop RiED. Based on the past and current research findings and number of publications from our group, the precise mechanism of RiED is under exploration in detail. Recent investigations have shown prostate RT induces significant morphologic arterial damage with aberrant alterations in internal pudendal arterial tone. Prostatic RT also reduces motor function in the cavernous nerve which may attribute to axonal degeneration may contributing to RiED. Furthermore, the advances in radiogenomics such as radiation induced somatic mutation identification, copy number variation and genome-wide association studies has significantly facilitated identification of biomarkers that could be used to monitoring radiation-induced late toxicity and damage to the nerves; thus, genomic- and proteomic-based biomarkers could greatly improve treatment and minimize arterial tissue and nerve damage. Further, advanced technologies such as proton beam therapy that precisely target tumor and significantly reduce off-target damage to vital organs and healthy tissues. In this review, we summarize recent advances in RiED research and novel treatment modalities for RiED. We also discuss the possible molecular mechanism involved in the development of RiED in prostate cancer patients. Further, we discuss various readily available methods as well as novel strategies such as stem cell therapies, shockwave therapy, nerve grafting with tissue engineering, and nutritional supplementations might be used to mitigate or cure sexual dysfunction following radiation treatment.

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“…Ни одного случая позд-них лучевых повреждений Grade 4 выявлено не было. Таким об-разом, показано, что брахитерапия с высокой мощностью дозы обладает приемлемым уровнем острой и поздней токсичности, однако необходимы дальнейшие исследования для более полной оценки эффективности данного метода лечения [23,24].…”

Section: брахитерапияunclassified