High-dose-rate brachytherapy as monotherapy for localized prostate cancer: a retrospective analysis with special focus on tolerance and chronic toxicity.
OBJECTIVE
To examine retrospectively fractionated high-dose-rate brachytherapy as monotherapy for localized prostate cancer with special focus on tolerance and toxicity, especially chronic toxicity.


METHODS
Between May 1995 and October 2001, 43 patients with localized prostate cancer were treated with high-dose-rate brachytherapy without external beam irradiation at Osaka University Hospital. The stage was T1, T2, T3, and T4 in 8, 14, 18, and 3 patients, respectively. The adenocarcinoma was well, moderately, or poorly differentiated in 12, 16, and 15 patients, respectively. The median initial prostate-specific antigen level was 19.3 ng/mL (range 3.8-233.0). Thirty-eight patients also received hormonal therapy. Metallic needles were implanted transperineally under real-time ultrasound guidance, followed by a dose optimization program. Patients were irradiated twice daily at intervals of >6 h. A total dose of 54 Gy in nine fractions within 5 days (48 Gy in eight fractions within 5 days for the first 7 cases) was administered in one implant session. The median follow-up was 24 months (range 1-76).


RESULTS
Radiation Therapy Oncology Group acute toxicity of Grade 4, 2, and 1 occurred in 1 (2%), 12 (28%), and 8 (19%) patients, respectively. Five patients had late toxicity: one with rectal ulcer (Grade 2) and four with rectal bleeding (Grade 1). The volume receiving 100% of the prescribed dose showed significant correlations with the incidence of acute and chronic toxicities (p = 0.005 and p = 0.014, respectively). The 3-year actuarial overall survival, local control, and biochemical no evidence of disease rate was 94%, 100%, and 55%, respectively. The crude biochemical control rate for low, intermediate, and high-risk patients was 100% (5 of 5), 80% (8 of 10), and 61% (17 of 28), respectively.


CONCLUSIONS
High-dose-rate brachytherapy as monotherapy was found to be feasible and well tolerated. It showed a low chronic toxicity rate without any event of Radiation Therapy Oncology Group of Grade 3 or greater.
Yoshioka
Yasuo
Y
Department of Multidisciplinary Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan. yoshioka@radonc.med.osaka-u.ac.jp
Nose
Takayuki
T
Yoshida
Ken
K
Oh
Ryoong Jin
RJ
Yamada
Yuji
Y
Tanaka
Eiichi
E
Yamazaki
Hideya
H
Inoue
Takehiro
T
Inoue
Toshihiko
T
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006417:Hematuria / Q000209:etiology; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011836:Radiation Tolerance; D011874:Radiometry; D011879:Radiotherapy Dosage; D012002:Rectal Diseases / Q000209:etiology; D012007:Rectum / Q000293:injuries / Q000528:radiation effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology; D014521:Urethra / Q000293:injuries / Q000528:radiation effects
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone