<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>Temporary prostate brachytherapy, in combination with external beam radiotherapy (EBRT), is an established and evolving treatment technique for non-metastatic, intermediate and high-risk prostate cancer. This study aimed to evaluate the outcomes of patients with localized intermediate and high-risk prostate cancer treated with combined EBRT and high-dose-rate brachytherapy boost (HDR-BT) at a single centre.</p>
</sec>
<sec><h3>Patients &amp; Methods</h3>
<p>A retrospective review of patients who underwent EBRT and HDR-BT treatment between January 2015 and December 2020. Patient and tumor characteristics, treatment outcomes (Kaplan-Meier analysis), and toxicities were analysed.</p>
</sec>
<sec><h3>Results</h3>
<p>127 patients with intermediate (28.3%) or high-risk (71.7%) prostate cancer were included. Median follow-up was 42 months. Five-year bDFS, CSS and OS rate was 77.5%, 98.1% and 93.0%, respectively, with no significant difference between risk groups. The most frequent toxicity was acute grade 1 urinary obstruction (7.9%). One patient experienced acute and late grade 3 urinary obstruction. No grade ≥4 were observed.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>Combined EBRT and HDR-BT demonstrated favourable disease control rates and manageable toxicities in patients with localized intermediate and high-risk prostate cancer. The 5-year bDFS rate was consistent with previous studies, supporting the effectiveness of this treatment approach. The low incidence of toxicities highlights the conformality and biological efficiency of HDR-BT boost. This treatment strategy provides an effective, safe and convenient option for this group of patients. To the best of our knowledge, this is the first report of the use of helical tomotherapy based intensity-modulated radiation therapy in combination with prostate HDR-BT (81.1% of cases).</p>
</sec>
</abstract>

Background
Temporary prostate brachytherapy, in combination with external beam radiotherapy (EBRT), is an established and evolving treatment technique for non-metastatic, intermediate and high-risk prostate cancer. This study aimed to evaluate the outcomes of patients with localized intermediate and high-risk prostate cancer treated with combined EBRT and high-dose-rate brachytherapy boost (HDR-BT) at a single centre.

Patients & Methods
A retrospective review of patients who underwent EBRT and HDR-BT treatment between January 2015 and December 2020. Patient and tumor characteristics, treatment outcomes (Kaplan-Meier analysis), and toxicities were analysed.

Results
127 patients with intermediate (28.3%) or high-risk (71.7%) prostate cancer were included. Median follow-up was 42 months. Five-year bDFS, CSS and OS rate was 77.5%, 98.1% and 93.0%, respectively, with no significant difference between risk groups. The most frequent toxicity was acute grade 1 urinary obstruction (7.9%). One patient experienced acute and late grade 3 urinary obstruction. No grade ≥4 were observed.

Conclusions
Combined EBRT and HDR-BT demonstrated favourable disease control rates and manageable toxicities in patients with localized intermediate and high-risk prostate cancer. The 5-year bDFS rate was consistent with previous studies, supporting the effectiveness of this treatment approach. The low incidence of toxicities highlights the conformality and biological efficiency of HDR-BT boost. This treatment strategy provides an effective, safe and convenient option for this group of patients. To the best of our knowledge, this is the first report of the use of helical tomotherapy based intensity-modulated radiation therapy in combination with prostate HDR-BT (81.1% of cases).

Outcomes of patients with localized prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy boost: A single-center retrospective study

Radiotherapy Department, Portuguese Institute of Oncology of Coimbra

Portugal Faculty of Medicine - Coimbra University

Forum of Clinical Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background
Temporary prostate brachytherapy, in combination with external beam radiotherapy (EBRT), is an established and evolving treatment technique for...

Characteristic	Value
External radiotherapy technique
3DCRT	24 (18.9)
H-IMRT	103 (81.1)
External radiotherapy dose (cGy)
4500	84 (66.1)
3750	43 (33.9)
WPRT
Yes	74 (58.3)
No	53 (41.7)
Number of HDR-BT applications
One	24 (18.9)
Two	103 (81.1)

Adverse events	Grade
Adverse events	1	2	3	4	5
Acute
Dysuria	8 (6.3)	0	0	0	0
Haematuria	0	5 (3.9)	0	0	0
Urinary urgency/frequency	4 (3.1)	0	0	0	0
Urinary tract obstruction	10 (7.9)	1 (0.8)	1 (0.8)	0	0
Rectal bleeding	6 (4.7)	0	0	0	0
Anal pain	0	0	0	0	0
Late
Dysuria	2 (1.6)	0	0	0	0
Hematuria	4 (3.1)	4 (3.1)	0	0	0
Urinary urgency/frequency	6 (4.7)	0	0	0	0
Urinary tract obstruction	4 (3.1)	3 (2)	2 (1.6)	0	0
Rectal bleeding	4 (3.1)	0	0	0	0
Anal pain	0	0	0	0	0

Characteristic	Value
Total number of patients	127
Age (years)
Median	67
Range	53–78
Pretreatment PSA
Range (ng/mL)	2.90–81.21
PSA <10 ng/mL	47 (37.0)
10 ≤ PSA < 20 ng/mL	39 (30.7)
PSA ≥20 ng/mL	41 (32.3)
Tumor stage
T1c	22 (17.3)
T2a	13 (10.2)
T2b	10 (7.9)
T2c	57 (44.9)
T3a	21 (16.5)
T3b	2 (1.6)
T4	2 (1.6)
Gleason score
≤6	11 (8.7)
7	90 (70.9)
8–10	26 (20.5)
D’Amico risk group
Intermediate	36 (28.3)
High	91 (71.7)

Outcomes of patients with localized prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy boost: A single-center retrospective study

Article Category: Research Article

Publicado en línea: 07 jun 2024

Páginas: -

Recibido: 23 ago 2023

Aceptado: 20 dic 2023

DOI: https://doi.org/10.2478/fco-2023-0020

Palabras clave
brachytherapy, high dose rate, intensity modulated radiotherapy, prostate cancer, radiotherapy

© 2023 David Rothwell et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Treatment characteristics.

Treatment-related toxicities.

Characteristics of patients and tumors.

Outcomes of patients with localized prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy boost: A single-center retrospective study

Article Category: Research Article

Publicado en línea: 07 jun 2024

Páginas: -

Recibido: 23 ago 2023

Aceptado: 20 dic 2023

DOI: https://doi.org/10.2478/fco-2023-0020

Palabras clavebrachytherapy, high dose rate, intensity modulated radiotherapy, prostate cancer, radiotherapy

© 2023 David Rothwell et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Treatment characteristics.

Treatment-related toxicities.

Characteristics of patients and tumors.

Palabras clave
brachytherapy, high dose rate, intensity modulated radiotherapy, prostate cancer, radiotherapy