title: High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results.
abstract: OBJECTIVE
  To report the clinical outcome of high-dose-rate (HDR) interstitial (IRT) brachytherapy (BRT) as sole treatment (monotherapy) for clinically localized prostate cancer.
  
  
  METHODS
  Between January 2002 and December 2009, 718 consecutive patients with clinically localized prostate cancer were treated with transrectal ultrasound (TRUS)-guided HDR monotherapy. Three treatment protocols were applied; 141 patients received 38.0 Gy using one implant in 4 fractions of 9.5 Gy with computed tomography-based treatment planning; 351 patients received 38.0 Gy in 4 fractions of 9.5 Gy, using 2 implants (2 weeks apart) and intraoperative TRUS real-time treatment planning; and 226 patients received 34.5 Gy, using 3 single-fraction implants of 11.5 Gy (3 weeks apart) and intraoperative TRUS real-time treatment planning. Biochemical failure was defined according to the Phoenix consensus, and toxicity was evaluated using Common Toxicity Criteria for Adverse Events version 3.
  
  
  RESULTS
  The median follow-up time was 52.8 months. The 36-, 60-, and 96-month biochemical control and metastasis-free survival rates for the entire cohort were 97%, 94%, and 90% and 99%, 98%, and 97%, respectively. Toxicity was scored per event, with 5.4% acute grade 3 genitourinary and 0.2% acute grade 3 gastrointestinal toxicity. Late grade 3 genitourinary and gastrointestinal toxicities were 3.5% and 1.6%, respectively. Two patients developed grade 4 incontinence. No other instance of grade 4 or greater acute or late toxicity was reported.
  
  
  CONCLUSIONS
  Our results confirm IRT-HDR-BRT is safe and effective as monotherapy for clinically localized prostate cancer.
authors.affiliation: Department of Radiation Oncology, Klinikum Offenbach, Offenbach, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tselis
authors.forename: Dimos
authors.initials: D
authors.lastname: Baltas
authors.forename: Thomas
authors.initials: T
authors.lastname: Buhleier
authors.forename: Thomas
authors.initials: T
authors.lastname: Martin
authors.forename: Natasa
authors.initials: N
authors.lastname: Milickovic
authors.forename: Sokratis
authors.initials: S
authors.lastname: Papaioannou
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Ulf W
authors.initials: UW
authors.lastname: Tunn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods; D014555:Urination Disorders / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen