title: HDR brachytherapy combined with external beam radiation for localised prostate cancer: early experience from the Sydney Cancer Centre.
abstract: BACKGROUND
  To report the toxicity and early efficacy of high-dose rate brachytherapy (HDR) as a boost to external beam radiation (EBRT) in the treatment of localised prostate cancer.
  
  
  METHODS
  Between December 2002 and November 2007, 101 consecutive patients with intermediate or high risk prostate cancer were treated with EBRT plus an HDR boost. The HDR boost was initially delivered in three fractions of 6.5 Gy each via one implant; this was subsequently modified to a two-fraction technique with separate implants 2 weeks apart (8.5 Gy each). Most patients also received at least 3 months of androgen ablation.
  
  
  RESULTS
  Our cohort included 65 intermediate risk and 36 high-risk patients. Sixty-seven patients received the three-fraction regime; 34 the two-fraction schedule. Median follow-up was 56 months, at which time 82% of patients were free from failure. The 4-year disease-free survival for intermediate and high-risk groups was 95% and 66%, respectively (overall 85%). Significant acute toxicities included clot retention (eight patients), one traumatic urethral injury, one case of retention requiring suprapubic catheter placement, one case of new onset atrial fibrillation and three cases of pulmonary emboli. At 4 years, the rate of late grade 2 genitourinary toxicity was 8%; two patients experienced grade 3 toxicity. No late grade 3 gastrointestinal toxicity was observed. Potency was preserved in 72% of those patients reporting normal pre-treatment sexual function.
  
  
  CONCLUSIONS
  Our cohort experienced toxicity similar to previously published HDR boost series with very promising early efficacy results.
authors.affiliation: Department of Radiation Oncology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. deborahwhalley@yahoo.com
authors.forename: Deborah
authors.initials: D
authors.lastname: Whalley
authors.forename: Nitya
authors.initials: N
authors.lastname: Patanjali
authors.forename: Michael
authors.initials: M
authors.lastname: Jackson
authors.forename: Aimee
authors.initials: A
authors.lastname: Lovett
authors.forename: Mark
authors.initials: M
authors.lastname: Chatfield
authors.forename: George
authors.initials: G
authors.lastname: Hruby
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen