title: High-dose-rate brachytherapy plus external beam radiotherapy for T1 to T3 prostate cancer: an experience in Taiwan.
abstract: OBJECTIVE
  To report outcomes for localized prostate cancer patients treated with the combination of high-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT).
  
  
  METHODS
  Eighty-five Stage T1c to T3b prostate cancer patients treated with HDR brachytherapy plus EBRT were included. An HDR dose of 16.5 Gy in 3 fractions over 24 hours was given 2 weeks before EBRT. An EBRT dose of 50.4 Gy was administered to the prostate and seminal vesicles. Younger patients (aged less than 75 years) with greater than 15% risk of nodal metastasis received whole-pelvis RT (45 Gy in 25 fractions) as part of EBRT.
  
  
  RESULTS
  Fifty percent of patients belonged to the high-risk (T3a or Gleason score 8-10 or prostate-specific antigen greater than 20 ng/mL) or very-high-risk (T3b) groups. After a median follow-up of 49 months (range, 24 to 70 months), 4-year biochemical control survival (less than nadir + 2) was 86% (100%, 91%, and 81% for patients in the low, intermediate, and high-risk groups, respectively. Three of four T3b patients experienced early biochemical failure. Four patients (5%) had grade 3 implant-related urinary retention. Chronic gastrointestinal toxicities were limited, but four grade 3 chronic genitourinary toxicities (5%) were noted in relation to urethral stricture and severe hematuria. Whole-pelvis EBRT was a major contributing factor to acute but not to chronic gastrointestinal toxicities. Among 60 patients with pretreatment sexual potency, 17 (26%) retained capability after 4 years. Six patients (10%) lost potency merely as a result of salvage hormone therapy.
  
  
  CONCLUSIONS
  High-dose-rate brachytherapy plus EBRT can achieve satisfactory biochemical control with acceptable complications for T1c to T3a prostate cancer patients.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yen-Chao
authors.initials: YC
authors.lastname: Chen
authors.forename: Cheng-Keng
authors.initials: CK
authors.lastname: Chuang
authors.forename: Ming-Li
authors.initials: ML
authors.lastname: Hsieh
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chen
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.forename: Chie-Yi
authors.initials: CY
authors.lastname: Yeh
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013624:Taiwan