title: High-dose-rate monotherapy: safe and effective brachytherapy for patients with localized prostate cancer.
abstract: OBJECTIVE
  High-dose-rate (HDR) brachytherapy used as the only treatment (monotherapy) for early prostate cancer is consistent with current concepts in prostate radiobiology, and the dose is reliably delivered in a prospectively defined anatomic distribution that meets all the requirements for safe and effective therapy. We report the disease control and toxicity of HDR monotherapy from California Endocurietherapy (CET) and William Beaumont Hospital (WBH) in low- and intermediate-risk prostate cancer patients.
  
  
  METHODS
  There were 298 patients with localized prostate cancer treated with HDR monotherapy between 1996 and 2005. Two biologically equivalent hypofractionation protocols were used. At CET the dose was 42 Gy in six fractions (two implantations 1 week apart) delivered to a computed tomography-defined planning treatment volume. At WBH the dose was 38 Gy in four fractions (one implantation) based on intraoperative transrectal ultrasound real-time treatment planning. The bladder, urethral, and rectal dose constraints were similar. Toxicity was scored with the National Cancer Institute Common Toxicity Criteria for Adverse Events version 3.
  
  
  RESULTS
  The median follow-up time was 5.2 years. The median age of the patients was 63 years, and the median value of the pretreatment prostate-specific antigen was 6.0 ng/mL. The 8-year results were 99% local control, 97% biochemical control (nadir +2), 99% distant metastasis-free survival, 99% cause-specific survival, and 95% overall survival. Toxicity was scored per event, meaning that an individual patient with more than one symptom was represented repeatedly in the morbidity data table. Genitourinary toxicity consisted of 10% transient Grade 2 urinary frequency or urgency and 3% Grade 3 episode of urinary retention. Gastrointestinal toxicity was <1%.
  
  
  CONCLUSIONS
  High disease control rates and low morbidity demonstrate that HDR monotherapy is safe and effective for patients with localized prostate cancer.
authors.affiliation: California Endocurietherapy at UCLA, Department of Radiation Oncology, David Geffen School of Medicine of the University of California at Los Angeles, Los Angeles, CA 90095, USA. jdemanes@mednet.ucla.edu
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Martinez
authors.forename: Michel
authors.initials: M
authors.lastname: Ghilezan
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Hill
authors.forename: Lionel
authors.initials: L
authors.lastname: Schour
authors.forename: David
authors.initials: D
authors.lastname: Brandt
authors.forename: Gary
authors.initials: G
authors.lastname: Gustafson
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002173:Cancer Care Facilities; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012007:Rectum / Q000528:radiation effects; D012062:Relative Biological Effectiveness; D018084:Ultrasonography, Interventional; D014521:Urethra / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen