title: Conformal high dose rate brachytherapy improves biochemical control and cause specific survival in patients with prostate cancer and poor prognostic factors.
abstract: OBJECTIVE
  To improve outcome for patients with prostate cancer with poor prognostic factors higher than conventional radiation doses are required. To achieve this outcome a brachytherapy boost was given. We report the results of the first high dose rate dose-escalation brachytherapy trial.
  
  
  METHODS
  Between 1991 and 2000, 207 patients were prospectively enrolled in a dose escalation trial including pelvic radiotherapy and conformal high dose rate prostate brachytherapy boost. The dose was increased from 5.5 to 11.5 Gy. per implant. Patient eligibility for the study included pretreatment prostate specific antigen 10 or greater, Gleason 7 or greater or clinical stage T2b or higher. No patient received hormonal therapy. The American Society for Therapeutic Radiology and Oncology consensus panel definition of biochemical failure was applied.
  
  
  RESULTS
  Median patient age was 69 years. Mean followup was 4.7 years (range 0.6 to 10.4). The 5-year actuarial biochemical control rate was 74%. The 5-year biochemical control was 85% for 1 poor prognostic factor, 75% for 2 and 50% for all 3 (p = 0.001). On Cox regression multivariate analysis lower brachytherapy dose, and higher Gleason and nadir value were associated with biochemical failure. The 5-year actuarial overall survival was 92%, cause specific survival 98% and disease-free survival 68%. The 5-year actuarial rates of complications were 8% and 0% for grades 3 and 4 genitourinary, and 0.5% and 0.5% for grades 3 and 4 gastrointestinal, respectively. The 5-year actuarial impotence rate was 51%.
  
  
  CONCLUSIONS
  For patients with poor prognostic factors external beam radiation therapy with conformal high dose rate brachytherapy boost improved biochemical control, resulting in a high cause specific survival rate with low toxicity. Another important advantage is that the patient is not radioactive after the high dose rate implant.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Martinez
authors.forename: Jose
authors.initials: J
authors.lastname: Gonzalez
authors.forename: William
authors.initials: W
authors.lastname: Spencer
authors.forename: Gary
authors.initials: G
authors.lastname: Gustafson
authors.forename: Larry
authors.initials: L
authors.lastname: Kestin
authors.forename: David
authors.initials: D
authors.lastname: Kearney
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018572:Disease-Free Survival; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D015996:Survival Rate
chemical_list: D007496:Iridium Radioisotopes; D017430:Prostate-Specific Antigen