title: High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence.
abstract: OBJECTIVE
  To evaluate genitourinary (GU) and gastrointestinal (GI) morbidity and biochemical control of disease in patients with localized prostate adenocarcinoma treated with escalating doses per fraction of high-dose rate brachytherapy alone.
  
  
  METHODS
  A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median follow-up times were 60, 54, 36, and 6 months, respectively.
  
  
  RESULTS
  Incidence of early Grade ≥ 3 GU morbidity was 3% to 7%, and Grade 4 was 0% to 4%. During the first 12 weeks, the highest mean International Prostate Symptom Score (IPSS) value was 14, and between 6 months and 5 years it was 8. Grade 3 or 4 early GI morbidity was not observed. The 3-year actuarial rate of Grade 3 GU was 3% to 16%, and was 3% to 7% for strictures requiring surgery (4-year rate). An incidence of 1% Grade 3 GI events was seen at 3 years. Late Grade 4 GU or GI events were not observed. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (log-rank p = 0.02).
  
  
  CONCLUSIONS
  There was no significant difference in urinary and rectal morbidity between schedules. Biochemical control of disease in patients with intermediate and high risk of relapse was good.
authors.affiliation: Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoskin
authors.forename: Ana
authors.initials: A
authors.lastname: Rojas
authors.forename: Gerry
authors.initials: G
authors.lastname: Lowe
authors.forename: Linda
authors.initials: L
authors.lastname: Bryant
authors.forename: Peter
authors.initials: P
authors.lastname: Ostler
authors.forename: Rob
authors.initials: R
authors.lastname: Hughes
authors.forename: Jessica
authors.initials: J
authors.lastname: Milner
authors.forename: Helen
authors.initials: H
authors.lastname: Cladd
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D058958:Organs at Risk / Q000528:radiation effects; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D012007:Rectum / Q000528:radiation effects; D014521:Urethra / Q000528:radiation effects
chemical_list: D007496:Iridium Radioisotopes; D017430:Prostate-Specific Antigen