PURPOSE: To analyze results with high-dose-rate (HDR) brachytherapy and intensity modulated radiation therapy (IMRT) vs. IMRT alone for prostate cancer. METHODS AND MATERIALS: Between October 2003 and August 2008, 284 patients with early stage prostate cancer underwent HDR brachytherapy to 2200cGy and IMRT to 5040cGy (n=240) or IMRT alone to 7920-8100cGy (n=44). RESULTS: The median followup was 2.2 years. There was no significant difference in terms of the proportions of patients who had diabetes mellitus (p=0.07) or who received hormonal therapy (p=0.75) by radiotherapy technique. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with HDR brachytherapy and IMRT are 100%, 98%, and 93%, respectively. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with IMRT alone are 100%, 100%, and 67%, respectively. There was no significant difference in biochemical disease-free survival or toxicity between treatment groups. The similarity in outcomes between treatment groups remained unchanged when we examined only hormone-naive patients. CONCLUSIONS: The HDR brachytherapy and IMRT yielded similar biochemical disease-free survival and toxicity to IMRT alone. As a result, we continue to base treatment on physician and patient preference. Longer followup will help to determine the role of HDR brachytherapy and IMRT in the treatment of early stage prostate cancer, particularly because a number of patients received androgen deprivation therapy and we delivered a higher biologically effective dose with combined modality therapy.
PURPOSE: To analyze results with high-dose-rate (HDR) brachytherapy and intensity modulated radiation therapy (IMRT) vs. IMRT alone for prostate cancer. METHODS AND MATERIALS: Between October 2003 and August 2008, 284 patients with early stage prostate cancer underwent HDR brachytherapy to 2200cGy and IMRT to 5040cGy (n=240) or IMRT alone to 7920-8100cGy (n=44). RESULTS: The median followup was 2.2 years. There was no significant difference in terms of the proportions of patients who had diabetes mellitus (p=0.07) or who received hormonal therapy (p=0.75) by radiotherapy technique. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with HDR brachytherapy and IMRT are 100%, 98%, and 93%, respectively. The 3-year biochemical disease-free survival rates in low-risk, intermediate-risk, and high-risk patients treated with IMRT alone are 100%, 100%, and 67%, respectively. There was no significant difference in biochemical disease-free survival or toxicity between treatment groups. The similarity in outcomes between treatment groups remained unchanged when we examined only hormone-naive patients. CONCLUSIONS: The HDR brachytherapy and IMRT yielded similar biochemical disease-free survival and toxicity to IMRT alone. As a result, we continue to base treatment on physician and patient preference. Longer followup will help to determine the role of HDR brachytherapy and IMRT in the treatment of early stage prostate cancer, particularly because a number of patients received androgen deprivation therapy and we delivered a higher biologically effective dose with combined modality therapy.