title: Biochemical outcome after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy: 12 years of experience.
abstract: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Biochemical control from series in which radical prostatectomy is performed for patients with unfavorable prostate cancer and/or low dose external beam radiation therapy are given remains suboptimal. The treatment regimen of HDR brachytherapy and external beam radiotherapy is a safe and very effective treatment for patients with high risk localized prostate cancer with excellent biochemical control and low toxicity.
  
  
  OBJECTIVE
  • To investigate the long-term oncological outcome, during the PSA era, of patients with prostate cancer who were treated using high-dose-rate (HDR) brachy therapy (BT) combined with external beam radiation therapy (EBRT).
  
  
  METHODS
  • From June 1998 to April 2007, 313 patients with localized prostate cancer were treated with 46 Gy of EBRT to the pelvis with a HDR-BT boost. • The mean (median) follow-up was 71 (68) months. • Toxicity was reported according to the Common Toxicity Criteria for Adverse Event, V.4.
  
  
  RESULTS
  • The 10-year actuarial biochemical control was 100% for patients with no high-risk criteria, 88% for patients with two intermediate-risk criteria, 91% with one high-risk criterion and 79% for patients with two to three high-risk criteria (P= 0.004). • The 10-year cancer-specific survival was 97% (standard deviation ± 1%). • The multivariate Cox regression analyses identified, Gleason score and T stage as independent prognostic factors for biochemical failure. • Gleason score was the only factor to significantly affect distant metastases. • Grade ≥ 3 late toxicity was not detected.
  
  
  CONCLUSIONS
  • The 10-year results confirm the feasibility and effectiveness of EBRT with conformal HDR-BT boost for patients with localised prostate cancer.
authors: Department of Radiation Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain. pprada@telecable.es
authors: Pedro J
authors: PJ
authors: Prada
authors: Herminio
authors: H
authors: González
authors: José
authors: J
authors: Fernández
authors: Isabel
authors: I
authors: Jiménez
authors: Aránzazu
authors: A
authors: Iglesias
authors: Inmaculada
authors: I
authors: Romo
mesh_terms: D017668:Age of Onset; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen