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. 2018 Sep 10;10(9):322.
doi: 10.3390/cancers10090322.

High-Dose-Rate Brachytherapy Monotherapy versus Image-Guided Intensity-Modulated Radiotherapy with Helical Tomotherapy for Patients with Localized Prostate Cancer

Hideya Yamazaki  1 , Koji Masui  2 , Gen Suzuki  3 , Satoaki Nakamura  4 , Daisuke Shimizu  5 , Tatsuyuki Nishikawa  6 , Haruumi Okabe  7 , Ken Yoshida  8 , Tadayuki Kotsuma  9 , Eiichi Tanaka  10 , Keisuke Otani  11 , Yasuo Yoshioka  12 , Kazuhiko Ogawa  13
Affiliations

High-Dose-Rate Brachytherapy Monotherapy versus Image-Guided Intensity-Modulated Radiotherapy with Helical Tomotherapy for Patients with Localized Prostate Cancer

Hideya Yamazaki et al. Cancers (Basel). .

Abstract

The aim of this paper is to compare outcomes between high-dose-rate interstitial brachytherapy (HDR-BT) monotherapy and image-guided intensity-modulated radiotherapy (IG-IMRT) for localized prostate cancer. We examined 353 HDR-BT and 270 IG-IMRT patients. To reduce background selection bias, we used the method of inverse probability treatment weighting (IPTW) with propensity scores. The actuarial five-year biochemical failure-free survival rates were 92.9% and 96.7% (p = 0.1847; p = 0.077 in IPTW) for HDR-BT and IG-IMRT, respectively; they were 100% and 95.8% (p = 0.286) for the low-risk group, 95.6% and 92% (p = 0.42) for the intermediate-risk group, 90.4% and 84.9% (p = 0.1059; p = 0.04 in IPTW) for the high-risk group, and 87.1% and 89.2% (p = 0.3816) for the very-high-risk group. In the assessment of accumulated incidences of grade ≥ 2 toxicity (Common Terminology Criteria for Adverse Events version 4.0) at five years, HDR-BT monotherapy showed higher genitourinary toxicity (11.9%) than IG-IMRT (3.3%) (p < 0.0001). The gastrointestinal toxicity was equivalent for HDR-BT (2.3%) and IG-IMRT (5.5%) (p = 0.063). No Grade 4 or 5 toxicity was detected in either modality. HDR-BT showed higher genitourinary toxicity than IG-IMRT. HDR-BT and IG-IMRT showed equivalent outcomes in low-, intermediate-, and very-high-risk groups. For high-risk patients, HDR-BT showed potential to improve prostate-specific antigen (PSA) control rate compared to IG-IMRT.

Keywords: high-dose-rate brachytherapy; image guided intensity modulated radiotherapy; prostate cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Biochemical control rates between HDR-BT monotherapy and IG-IMRT with helical tomotherapy: (a) total population; (b) low-risk group; (c) intermediate-risk group; (d) high-risk group; (e) very-high-risk group.
Figure 2
Figure 2
The accumulated incidence of grade ≥ 2 toxicity: (a) Genitourinary toxicity; (b) Gastrointestinal toxicity.
See this image and copyright information in PMC

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