title: Implementation of high-dose-rate brachytherapy and androgen deprivation in patients with prostate cancer.
abstract: OBJECTIVE
  To evaluate outcome (overall survival [OS], the actuarial 5-year cancer-specific survival [CSS], disease-free survival [DFS], biochemical failure-free survival [BFS]), complications and morbidity in patients treated with high-dose-rate brachytherapy (HDR-BT) boost and hormonal treatment with curative aims.
  
  
  METHODS
  Between 2004 and 2009, 275 prospectively followed pN0/N0M0 patients were included: 19 patients (7%) with T2, Gleason score 7 and prostate-specific antigen (PSA) <10 and 256 patients (93%) with T3 or Gleason score 8-10 or PSA >20 received multimodal treatment with conformal four-field radiotherapy (prostate/vesiculae 2 Gy × 25) combined with HDR-BT (iridium 192; prostate 10 Gy × 2) with long-term androgen deprivation therapy (ADT).
  
  
  RESULTS
  After a median observation time of 44.2 months (range, 10.4-90.5 months) 12 patients had relapsed clinically and/or biochemically and 10 patients were dead, of which 2 patients died from prostate cancer. Five-year estimates of BFS, CSS, DFS, and OS rates were 98.5%, 99.3%, 95.6%, and 96.3%, respectively. None of the patients with either Gleason score <8 or with intermediate risk profile had relapsed. The number of HDR-BT treatments was not related to outcome. Despite of age (median, 65.7 years; range, 45.7-77 years) and considerable pretreatment comorbidity in 39 of 275 patients, Genitourinary treatment-related morbidity was moderate with long-lasting Radiation Therapy Oncology Group Grade 2 voiding problems in 26 patients (9.5%) and occasionally mucous discharge in 20 patients (7%), none with Grade >2 for gastrointestinal at follow-up. Complications during implantations were related to pubic arch interference (4 patients) and lithotomy time, causing 2 patients to develop compartment syndrome.
  
  
  CONCLUSIONS
  Despite still preliminary observations, our 5-year outcome estimates favor the implementation of high-dose-rate brachytherapy in high-risk patients combined with conformal external radiotherapy and long-term ADT. High-quality implants can be achieved by a trained specialized team at a high-turnover center using transrectal ultrasound-based treatment plans with acceptable morbidity and complication rates.
authors.affiliation: Cancer Clinic, Oslo University Hospital, The Norwegian Radiumhospital, Department of Radiotherapy and Oncology, Oslo, Norway. wolfgang.lilleby@ous-hf.no
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lilleby
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tafjord
authors.forename: Nils K
authors.initials: NK
authors.lastname: Raabe
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003161:Compartment Syndromes / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016609:Neoplasms, Second Primary; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology
chemical_list: D000726:Androgen Antagonists; D007496:Iridium Radioisotopes; D017430:Prostate-Specific Antigen