Single-fraction high-dose-rate brachytherapy and hypofractionated external beam radiotherapy for men with intermediate-risk prostate cancer: analysis of short- and medium-term toxicity and quality of life.
OBJECTIVE
To determine the short- and medium-term effects of a single high-dose-rate brachytherapy fraction of 15 Gy and hypofractionated external beam radiation therapy for prostate cancer.


METHODS
Eligible patients had localized prostate cancer with a Gleason score of 7 and a prostate-specific antigen (PSA) concentration of <20 ng/ml or a Gleason score of 6 with a PSA concentration of 10 to 20 ng/ml. Patients received high-dose-rate brachytherapy as a single 15-Gy dose, followed by external beam radiation therapy at 37.5 Gy in 15 fractions, and were followed prospectively for toxicity (using Common Terminology Criteria for Adverse Events version 3.0), urinary symptoms (using the International Prostate Symptom Score [IPSS]), erectile function (with the International Index of Erectile Function [IIEF]), and health-related quality of life (with the Expanded Prostate Cancer Index Composite [EPIC]). Clinical examinations and PSA measurements were performed at every visit, and prostate biopsies were repeated at 2 years. The trial accrued 125 patients, with a median follow-up of 1.14 years.


RESULTS
Acute grade 2 and 3 genitourinary toxicity occurred in 62% and 1.6% of patients, respectively, and acute grade 2 gastrointestinal toxicity occurred in 6.5% of patients. No grade 3 late toxicity has occurred: 47% of patients had grade 2 genitourinary and 10% of patients had grade 2 gastrointestinal toxicity. Median IPSSs rose from 5 at baseline to 12 at 1 month and returned to 7 at 3 months. Of the total number of patients who were initially potent (IIEF, >21), 8% of patients developed mild to moderate dysfunction, and 27% of patients developed severe erectile dysfunction. Baseline EPIC bowel, urinary, and sexual bother scores decreased by 9, 7, and 19 points, respectively, at 1 year. No patient has experienced biochemical failure, and 16 of the first 17 biopsy results showed no malignancy.


CONCLUSIONS
Treatment is well tolerated in the short and medium term, with low toxicity and encouraging early indicators of disease control.
Morton
Gerard C
GC
Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Canada. gerard.morton@sunnybrook.ca
Loblaw
D Andrew
DA
Sankreacha
Raxa
R
Deabreu
Andrea
A
Zhang
Liying
L
Mamedov
Alexandre
A
Cheung
Patrick
P
Keller
Brian
B
Danjoux
Cyril
C
Szumacher
Ewa
E
Thomas
Gillian
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D019583:Dose Fractionation, Radiation; D007172:Erectile Dysfunction / Q000209:etiology; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D012044:Regression Analysis; D014555:Urination Disorders / Q000209:etiology
D017430:Prostate-Specific Antigen