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. 2020 Dec;12(6):533-539.
doi: 10.5114/jcb.2020.101685. Epub 2020 Dec 16.

High-dose-rate brachytherapy as monotherapy for localized prostate cancer using three different doses - 14 years of single-centre experience

Carlo Pietro Soatti  1 , Durim Delishaj  1 , Romerai D'Amico  1 , Cristina Frigerio  2 , Ilaria Costanza Fumagalli  3 , Francesco Bonsignore  2 , Giulia Sangalli  2 , Fausto Declich  2 , Stefano Arcangeli  3 , Antonio Ardizzoia  4 , Alessandro Colombo  1
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High-dose-rate brachytherapy as monotherapy for localized prostate cancer using three different doses - 14 years of single-centre experience

Carlo Pietro Soatti et al. J Contemp Brachytherapy. 2020 Dec.

Abstract

Purpose: To evaluate clinical outcomes in patients with localized prostate cancer (LPC) treated with 3D conformal high-dose-rate (HDR) brachytherapy (BT) as monotherapy.

Material and methods: From March 2004 to November 2017, 277 men with LPC underwent 3D conformal HDR-BT as monotherapy, with a temporary implant. The dose prescription was: 38 Gy in 4 fractions (149 patients), 27 Gy in 2 fractions (41 patients), and 19-20 Gy in a single fraction (87 patients). Biochemical progression-free survival (bPFS), progression-free survival (PFS), and cancer-specific survival (CSS) were calculated. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity assessment were performed using Common Terminology Criteria for Adverse Events v5.0.

Results: The mean age was 67 (range, 47-81) years. Overall, 145 patients were low-risk, 116 intermediate-risk, and 16 high-risk prostate cancer. After a median follow-up of six years (range, 6-160 months), bPFS, PFS, and CSS were 81%, 96%, and 97%, respectively. Dose prescription, initial prostate specific antigen (iPSA) ≥ 9,5 ng/ml, and high-risk disease resulted in prognostic factors regarding bPFS. Only G2-G3 acute or late GI and GU toxicities were observed.

Conclusions: HDR-BT as monotherapy is a valid and safe treatment modality for localized prostate cancer. After a long follow-up, patients receiving 19-20 Gy in a single fraction had a lower biochemical control rate compared to patients receiving 38 Gy in 4 fractions or 27 Gy in 2 fractions. Randomized prospective trials with a longer follow-up are necessary to confirm our results, and define total doses and dose per fraction for HDR-BT in patients with LPC.

Keywords: PSA; brachytherapy; high-dose-rate; prostate cancer; prostate-specific antigen.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves of biochemical progression-free survival A) in all patients and B) in patients treated with 19-20 Gy in single fraction, 27 in two fractions, and 38 Gy in four fractions
Fig. 2
Fig. 2
Kaplan-Meier curves of progression-free survival (A) and cancer-specific survival of all patients analyzed (B)
See this image and copyright information in PMC

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References

    1. Siegel RL, Miller KD, Jemal A. CA Cancer statistics, 2019. Cancer J Clin 2019; 69: 7-34. - PubMed
    1. Pinsky PF, Prorok PC, Yu K et al. . Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer 2017; 123: 592-599. - PMC - PubMed
    1. Herget KA, Patel DP, Hanson HA et al. . Recent decline in prostate cancer incidence in the United States, by age, stage, and Gleason score. Cancer Med 2016; 5: 136-141. - PMC - PubMed
    1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Prostate cancer version 2. 2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (accessed April 20, 2019).
    1. Martinez A, Gonzalez J, Stromberg J et al. . Conformal prostate brachytherapy: initial experience of a phase I/II dose-escalating trial. Int J Radiat Oncol Biol Phys 1995; 33: 1019-1027. - PubMed