Long-term outcome of high dose rate brachytherapy in radiotherapy of localised prostate cancer.
OBJECTIVE
High dose rate brachytherapy (HDR-BT) in prostate cancer (PC) is receiving increasing interest. The steep dose gradient gives a possibility to escalate the dose to the prostate. If the alpha/beta ratio is low for PC, hypofractionation will be of advantage. A retrospective analysis of outcome in patients (pts) consecutively treated with combined HDR-BT and conformal external beam radiotherapy (ERT) was performed.


METHODS
Data from 214 pts treated consecutively from 1988 to 2000 were analysed. The median age was 64 years (50-77). Median follow up was 4 years (12-165 months). Pre-irradiatory endocrine therapy was given to 150 pts (70%). The pts were divided into low-, intermediate- and high (80/87/47 pts) risk groups according to the occurrence of none, one, or more risk factors defined by T-classification, PSA and histopathology. ERT was given with 2 Gy fractions to 50 Gy. HDR-BT consisted of two 10 Gy fractions.


RESULTS
Overall 5-year biochemical no evidence of disease (bNED) was 82%, and for the low-, intermediate-, and high-risk group bNED was 92, 88 and 61%, respectively. PSA-relapse was found in 17, local recurrence in 3 and distant metastases in 13 pts. Five pts died of PC. No recurrences were observed after 5 years. Severe late complications were few. Urethral stricture (13 pts) was the most frequent. No severe rectal complications were seen.


CONCLUSIONS
Dose escalation with HDR-BT is safe and effective in radiotherapy of localised PC.
Aström
Lennart
L
Department of Oncology, University of Gothenburg, Gothenburg, Sweden.
Pedersen
Dorte
D
Mercke
Claes
C
Holmäng
Sten
S
Johansson
Karl Axel
KA
D000368:Aged; D001918:Brachytherapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen