title: 3D conformal HDR brachytherapy and external beam irradiation combined with temporary androgen deprivation in the treatment of localized prostate cancer.
abstract: OBJECTIVE
  To evaluate treatment outcome of 3D conformal high dose rate (HDR) brachytherapy and external beam irradiation (EBRT) combined with temporary androgen deprivation for patients with localized prostate cancer.
  
  
  METHODS
  Between January 1997 and September 1999 we treated 102 patients with stage T1-3 N0 M0 prostate cancer. Stage T1-2 was found in 71, T3 in 31 patients. Median pretreatment PSA level was 15.3 ng/ml. After ultrasound-guided transrectal implantation of four afterloading needles, CT based 3D brachytherapy planning was performed. All patients received four HDR implants using a reference dose per implant of 5 or 7Gy. Time between each implant was 14 days. After brachytherapy EBRT followed up to 39.6 or 45.0 Gy. All patients received temporary androgen deprivation, starting 2-19 months before brachytherapy, ending 3 months after EBRT.
  
  
  RESULTS
  Median follow-up was 2.6 years (range 2.0-4.1 years). Actuarial biochemical control rate was 87% at 2 years and 82% at 3 years. In 14 patients we noted biochemical failure, in five patients clinical failure. Overall survival was 90%, disease specific survival 98.0% at 3 years. Acute grade 3 toxicity occurred in 4%, late grade 3 toxicity in 5%. One patient developed a prostatourethral-rectal fistula as late grade 4 toxicity. The conformal quality of 300 HDR implants was analyzed using dose volume histograms.
  
  
  CONCLUSIONS
  3D conformal HDR brachytherapy and EBRT combined with temporary androgen deprivation is an effective treatment modality for prostate cancer with minimal associated toxicity and encouraging biochemical control rates after a median follow-up of 2.6 years.
authors.affiliation: Department of Radiation Oncology, Strahlenklinik, Klinikum Offenbach, Offenbach am Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Martin
authors.forename: Sandra
authors.initials: S
authors.lastname: Röddiger
authors.forename: Ralf
authors.initials: R
authors.lastname: Kurek
authors.forename: Thomas
authors.initials: T
authors.lastname: Dannenberg
authors.forename: Oliver
authors.initials: O
authors.lastname: Eckart
authors.forename: Christos
authors.initials: C
authors.lastname: Kolotas
authors.forename: Reinhard
authors.initials: R
authors.lastname: Heyd
authors.forename: Bernd
authors.initials: B
authors.lastname: Rogge
authors.forename: Dimos
authors.initials: D
authors.lastname: Baltas
authors.forename: Ulf
authors.initials: U
authors.lastname: Tunn
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone