title: Combined transperineal implant and external beam radiation for the treatment of prostate cancer: a large patient cohort in the community setting.
abstract: OBJECTIVE
  Treatment of prostate cancer using higher doses of external beam radiation (EBRT) has been shown to improve results, but there are toxicity concerns with further dose escalation. A treatment option to safely increase total dose to the prostate includes combination therapy using EBRT and low-dose-rate transperineal brachytherapy seed implant. Our purpose was to report the results of combined modality therapy from a single institution in the community setting.
  
  
  METHODS
  Retrospective review from single institution in the community setting. All patients were treated with a combination of EBRT followed by low-dose-rate brachytherapy seed placement.
  
  
  RESULTS
  A total of 824 patients were analyzed with a median followup of 5.5 years, all censored patients had a minimum followup of 2 years. A total of 588 patients received hormone therapy before or concurrent with the radiation. Three hundred twenty-nine patients had low-risk disease, 300 patients had intermediate-risk disease, and 195 patients had high-risk disease. Five-year overall survivals were 86.1%, 85.0%, and 82.5% for low-, intermediate-, and high-risk patients. Five-year actuarial biochemical relapse-free survivals (bRFSs) were 85.4%, 83.2%, and 79.6% for low-, intermediate-, and high-risk patients. High-risk patients who received hormonal therapy had an improved bRFS vs. patients not receiving hormones.
  
  
  CONCLUSIONS
  Combination treatment using brachytherapy and EBRT is well tolerated, with acceptable overall survival and bRFS rates and should be considered a standard treatment option for patients. Hormones should be considered for high-risk patients.
authors: Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors: Gregory J
authors: GJ
authors: Kubicek
authors: Marco
authors: M
authors: Naguib
authors: Sandy
authors: S
authors: Redfield
authors: Nola
authors: N
authors: Grayback
authors: Sam I
authors: SI
authors: Brown
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome