PURPOSE: To update outcome and toxicity results of a prospective trial of 19-Gy single-fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. METHODS AND MATERIALS: Patients were treated on a prospective study of single-fraction HDR brachytherapy. All patients had low- or intermediate-risk prostate cancer. Patients with prostate volumes >50 cm3, taking alpha-blockers for urinary symptoms, or with baseline American Urologic Association symptom scores >12 were ineligible. Patients underwent transrectal ultrasound-guided interstitial implant of the prostate followed by single-fraction HDR brachytherapy to a prescription dose of 19 Gy. RESULTS: Sixty-eight patients were enrolled with a median follow-up of 3.9 years. Median age was 62 years. Median gland volume at the time of treatment was 35 cm3, 92.6% of patients had T1 disease, 63.2% had a Gleason score of 6, and median pretreatment prostate-specific antigen was 5.0 ng/mL. Chronic grade 2 genitourinary toxicity was 14.7%. No grade 3 urinary toxicity occurred. A single patient experienced grade 2+ rectal toxicity (grade 3 diarrhea) that was transient and resolved with medical management. The 5-year estimated disease-free survival was 77.2% with no significant difference between low- and intermediate-risk patients. A single patient developed distant metastases during the follow-up period. Biopsy-proven local failure at 5 years was 18.8%, occurring at a median interval of 4.0 years posttreatment. No deaths occurred during follow-up. CONCLUSIONS: With extended follow-up, toxicity rates after single-fraction 19-Gy HDR brachytherapy remain low. Higher-than-expected rates of biochemical and local failure, however, raise concerns regarding the adequacy of this dose. Additional investigation to define the optimal single-fraction HDR brachytherapy dose is warranted, and single-fraction treatment currently should not be offered outside the context of a clinical trial.
PURPOSE: To update outcome and toxicity results of a prospective trial of 19-Gy single-fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. METHODS AND MATERIALS: Patients were treated on a prospective study of single-fraction HDR brachytherapy. All patients had low- or intermediate-risk prostate cancer. Patients with prostate volumes >50 cm3, taking alpha-blockers for urinary symptoms, or with baseline American Urologic Association symptom scores >12 were ineligible. Patients underwent transrectal ultrasound-guided interstitial implant of the prostate followed by single-fraction HDR brachytherapy to a prescription dose of 19 Gy. RESULTS: Sixty-eight patients were enrolled with a median follow-up of 3.9 years. Median age was 62 years. Median gland volume at the time of treatment was 35 cm3, 92.6% of patients had T1 disease, 63.2% had a Gleason score of 6, and median pretreatment prostate-specific antigen was 5.0 ng/mL. Chronic grade 2 genitourinary toxicity was 14.7%. No grade 3 urinary toxicity occurred. A single patient experienced grade 2+ rectal toxicity (grade 3 diarrhea) that was transient and resolved with medical management. The 5-year estimated disease-free survival was 77.2% with no significant difference between low- and intermediate-risk patients. A single patient developed distant metastases during the follow-up period. Biopsy-proven local failure at 5 years was 18.8%, occurring at a median interval of 4.0 years posttreatment. No deaths occurred during follow-up. CONCLUSIONS: With extended follow-up, toxicity rates after single-fraction 19-Gy HDR brachytherapy remain low. Higher-than-expected rates of biochemical and local failure, however, raise concerns regarding the adequacy of this dose. Additional investigation to define the optimal single-fraction HDR brachytherapy dose is warranted, and single-fraction treatment currently should not be offered outside the context of a clinical trial.
Authors: Neal Andruska; Benjamin W Fischer-Valuck; Ruben Carmona; Temitope Agabalogun; Randall J Brenneman; Hiram A Gay; Jeff M Michalski; Brian C Baumann Journal: J Natl Compr Canc Netw Date: 2022-02-22 Impact factor: 12.693
Authors: Neal Andruska; Jeff M Michalski; Ruben Carmona; Temitope Agabalogun; Randall J Brenneman; Hiram A Gay; Benjamin W Fischer-Valuck; Brian C Baumann Journal: Brachytherapy Date: 2022-02-03 Impact factor: 2.441
Authors: Esther Mayrata; Jose Maria Espinosa; David Büchser; Francisco Casquero; Fernan Suárez; Alba González; Pablo Minguez; Jose Fernando Pérez; Iñigo San Miguel; Jon Cacicedo; Alfonso Gómez-Iturriaga Journal: J Contemp Brachytherapy Date: 2021-02-18
Authors: Finbar Slevin; Samantha Hodgson; Sree Lakshmi Rodda; Peter Bownes; David Bottomley; Ese Adiotomre; Bashar Al-Qaisieh; Emma Dugdale; Oliver Hulson; Joshua Mason; Jonathan Smith; Ann M Henry Journal: Clin Transl Radiat Oncol Date: 2020-03-27
Authors: Justin M Barnes; Prashant Gabani; Max Sanders; Anupama Chundury; Michael Altman; Jose Garcia-Ramirez; Harold Li; Jacqueline E Zoberi; Brian C Baumann; Hiram A Gay Journal: J Contemp Brachytherapy Date: 2019-10-30
Authors: Hannah M Dahn; Patricia A K Oliver; Stefan Allen; Amanda Cherpak; Alasdair Syme; Nikhilesh Patil; David Bowes Journal: Adv Radiat Oncol Date: 2019-05-21