title: Comparison of the outcome and morbidity for localized or locally advanced prostate cancer treated by high-dose-rate brachytherapy plus external beam radiotherapy (EBRT) versus EBRT alone.
abstract: OBJECTIVE
  To compare the survival, gastrointestinal (GI) and genitourinary (GU) toxicity for localized or locally advanced prostate cancer treated by high-dose-rate-brachytherapy (HDR-BT) plus external beam radiotherapy (EBRT) versus EBRT alone at a single institute in Taiwan.
  
  
  METHODS
  Eighty-eight patients with T1c-T3b prostate cancer consecutively treated by EBRT alone (33 patients) or HDR-BT+EBRT (55 patients) were studied. The median dose of EBRT was 70.2 Gy in the EBRT group and 50.4 Gy in the HDR-BT group. HDR-BT was performed 2-3 weeks before EBRT, with 12.6 Gy in three fractions over 24 h.
  
  
  RESULTS
  Five patients (15.2%) in the EBRT group and seven (12.7%) in the HDR-BT group developed a biochemical relapse. The 5-year actuarial biochemical relapse-free survival rates were 65.0% in the EBRT group and 66.7% in the HDR-BT group (P = 0.76). The 5-year actuarial likelihood of late > or =Grade 2 and > or =Grade 3 GI toxicity in the EBRT versus HDR-BT group was 62.8 versus 7.7% (P < 0.001) and 19.6 versus 0% (P = 0.001), respectively. In a multivariate analysis, the only predictor for late GI toxicity was the mode of RT. The 5-year actuarial likelihood of late > or =Grade 2 and > or =Grade 3 GU toxicity in the EBRT versus HDR-BT group was 14.8 versus 15.9% (P = 0.86) and 3.6 versus 8.5% (P = 0.40), respectively.
  
  
  CONCLUSIONS
  The addition of HDR-BT before EBRT with a reduced dose from the EBRT produces a comparable survival outcome and GU toxicity but a significantly less GI toxicity for prostate cancer patients.
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta-Pei Road, Niao Sung Hsian, Kaohsiung Hsien, Taiwan.
authors.forename: Fu-Min
authors.initials: FM
authors.lastname: Fang
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Wang
authors.forename: Chong-Jong
authors.initials: CJ
authors.lastname: Wang
authors.forename: Hsuan-Ying
authors.initials: HY
authors.lastname: Huang
authors.forename: Po-Hui
authors.initials: PH
authors.lastname: Chiang
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D052801:Male Urogenital Diseases / Q000209:etiology; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies
chemical_list: D007496:Iridium Radioisotopes