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. 2025 Jan 1;16(2):533-542.
doi: 10.7150/jca.104279. eCollection 2025.

Single-fraction high-dose-rate brachytherapy as monotherapy for localized prostate cancer: long-term follow-up study based on meta-analysis

Li Xiao  1   2 , Li-Li Yu  3 , Li-Yuan Zhang  4 , Wei Guo  1   2 , Li-Xin Liu  5 , Yun-Chuan Sun  1   2 , Xuan Kan  6 , Kai Zhang  7
Affiliations

Single-fraction high-dose-rate brachytherapy as monotherapy for localized prostate cancer: long-term follow-up study based on meta-analysis

Li Xiao et al. J Cancer. .

Abstract

Objective: Although single-fraction high-dose-rate brachytherapy (SFHDR-BT) for localized prostate cancer has been attempted in clinical trials, there is currently a lack of relevant medical evidence. It is essential to conduct a systematic analysis of the long-term safety and efficacy of SFHDR-BT. Materials and methods: Comprehensive and systematic searches for eligible studies were performed in PubMed, Embase, and the Cochrane Library databases. The primary endpoints included safety and efficacy, represented by toxic effects, biochemical recurrence-free survival (bRFS) and overall survival (OS), respectively. The proportion rates were used as the effect measure for each study and were presented with corresponding 95% confidence intervals (CI). Results: Eight studies met the inclusion criteria for quantitative analysis, including 552 patients. The median follow-up was 71.3 months (60-72.8 months). The estimates of cumulative occurrence for severe gastrointestinal (GI) and genitourinary (GU) toxic effects were 0 and 3% (95% CI 1-5%), respectively. The pooled cumulative incidence of grade ≥ 3 sexual dysfunction occurrence was 4% (95% CI 1-7%). The estimate of long term bRFS was 72% (95% CI 68-76%) and 90% (95% CI 85-95%) for long term OS. Conclusion: In general, SFHDR-BT is well tolerated and associated with suboptimal clinical benefit in patients with localized prostate cancer. High-quality prospective studies of SFHDR-BT are necessary to verify its safety and efficacy.

Keywords: Brachytherapy; Clinical outcomes; High-dose-rate; Prostatic neoplasms; Toxic effects.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow chart of the included trials.
Figure 2
Figure 2
Forest plot for severe GU toxicity.
Figure 3
Figure 3
Forest plot for severe sexual dysfunction.
Figure 4
Figure 4
Forest plot for 5-6 years bRFS.
Figure 5
Figure 5
Forest plot for 5-6 years OS.
Figure 6
Figure 6
Funnel plots evaluating 5-6 years bRFS.
Figure 7
Figure 7
Sensitivity analysis of the 5-6 years bRFS.
See this image and copyright information in PMC

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