High dose rate brachytherapy boost for prostate cancer: a systematic review.
Studies of dose-escalated external beam radiation therapy (EBRT) and low dose rate brachytherapy (LDR-BT) have shown excellent rates of tumor control and cancer specific survival. Moreover, LDR-BT combined with EBRT (i.e. "LDR-BT boost") is hypothesized to improve local control. While phase II trials with LDR-BT boost have produced mature data of outcomes and toxicities, high dose rate (HDR)-BT has been growing in popularity as an alternative boost therapy. Boost from HDR-BT has theoretical advantages over LDR-BT, including improved cancer cell death and better dose distribution from customization of catheter dwell times, locations, and inverse dose optimization. Freedom from biochemical failure rates at five years for low-, intermediate-, high-risk, and locally advanced patients have generally been 85-100%, 80-98%, 59-96%, and 34-85%, respectively. Late Radiation Therapy Oncology Group grade 3-4 toxicities have also been encouraging with <6% of patients experiencing any toxicity. Limitations of current HDR-BT boost studies include reports of only single-institution experiences, and unrefined reports of toxicity or patient quality of life. Comparative effectiveness research will help guide clinicians in selecting the most appropriate treatment option for individual patients based on risk-stratification, expected outcomes, toxicities, quality of life, and cost.
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: nicholaszaorsky@gmail.com.
Nicholas G
NG
Zaorsky
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: Laura.Doyle@jeffersonhospital.org.
Laura A
LA
Doyle
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: Kosj.Yamoah@jeffersonhospital.org.
Kosj
K
Yamoah
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA; Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, 1015 Chestnut Street, Suite M100, Philadelphia, PA 19107, USA. Electronic address: Jocelyn.Andrel@jefferson.edu.
Jocelyn A
JA
Andrel
Department of Urology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1102, Philadelphia, PA 19107, USA. Electronic address: Edouard.Trabulsi@jefferson.edu.
Edouard J
EJ
Trabulsi
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: Mark.Hurwitz@jeffersonhospital.org.
Mark D
MD
Hurwitz
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: Adam.Dicker@jefferson.edu.
Adam P
AP
Dicker
Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Bodine Center for Cancer Treatment, 111 S. 11th Street, Philadelphia, PA 19107, USA. Electronic address: Robert.Den@jeffersonhospital.org.
Robert B
RB
Den
D001918:Brachytherapy / Q000009:adverse effects*; D018450:Disease Progression; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012307:Risk Factors
Brachytherapy; Comparative effectiveness research; Prostate cancer; Quality of life; Radiotherapy; Technology; Toxicity